When to Worry About Your Pain: 4 Rules

By Julie Silver, MDAssistant Professor, Harvard Medical School, Physical Medicine and RehabilitationDr. Silver is the author of You Can Heal Yourself and an award-winning book from the American Cancer Society titled What Helped Get Me Through: Cancer Survivors Share Wisdom and Hope.

Posted on | By Julie Silver, MD

Learning to treat pain effectively takes years. As a medical doctor who specializes in Physical Medicine and Rehabilitation (PM&R), I have extensive training in treating pain. Doctors who specialize in PM&R are formally called physiatrists and are sometimes informally referred to as pain doctors.

One of the first things we learn is when to worry about pain. Since we are taught to treat so many different kinds of pain, we need to know when to sound an alarm about a patient’s condition and how to act to treat them most effectively. If you’ve been experiencing pain, it’s important that you learn to think like a pain doctor. While these “rules” about when to worry certainly do not cover every person and every situation, they are important to know to get to the source of your problem.

How to Think Like a Pain Doctor

1. Two-Week Rule
Any pain that lasts for more than two weeks should be checked out. A lot of people think that new pain means that they have cancer. In fact, most new pain is due to bones, joints, nerves and other musculoskeletal structures. Many doctors use the two-week rule because a lot of musculoskeletal pain will resolve within a two-week period. Also, a two-week delay in diagnosis is very unlikely to change someone’s prognosis if the pain is due to cancer. Though the two-week rule applies to most pain, there are times when doctors ignore this rule and become immediately concerned (See Rules 2, 3 and 4).

2. Acute-Trauma Rule
Doctors should immediately check all pain associated with acute trauma, such as a car accident or fall off a ladder. Usually, people aren't overly worried that cancer is causing their pain if they have trauma that results in immediate or even slightly delayed pain. However, all pain associated with trauma necessitates an evaluation; this includes a physical examination and possible imaging tests such as x-rays or MRIs.

Article written by Julie Silver, MD
Assistant Professor, Harvard Medical School, Physical Medicine and Rehabilitation. Dr. Silver is the author of You Can Heal...