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Pain is a protective mechanism that warns a person to remove the source of discomfort to avoid further injury. It is also the most common symptom that something is amiss in the body. Pain is often trivial and fleeting. However, any pain that is severe, recurs, or persists warrants medical investigation. No two people feel or react to pain in exactly the same manner, so tracking down the cause of pain often requires considerable medical detective work. Diffuse or generalized pain often is the hardest to pinpoint.

Causes of pain

Anemia
Pain, along with fatigue, pallor, shortness of breath, and other symptoms, is a common symptom of anemia. In some forms of anemia, such as sickle-cell disease, the pain may feel as if it is mostly in the joints and bones. In others, it is more diffuse.

Arthritis
Pain and inflammation accompany almost all forms of arthritis. In some types, such as rheumatoid arthritis, the pain may be generalized, and felt not only in the joints, but in other parts of the body as well. Reiter's syndrome, a type of arthritis that affects mostly men, can cause pain and other symptoms in the urinary tract, eyes, and skin. Infectious arthritis can cause pain in joints and elsewhere.

Back problems
Back pain may originate in the spinal column and the nerves that radiate from the spinal cord, or it may arise elsewhere, such as in the kidneys, and be referred to the back. More commonly, back pain is due to strain, misuse of the back, disk problems, or degenerative diseases such as osteoporosis or arthritis.

Cancer
In its early stages, many cancers are painless. But in others, pain may be one of the first symptoms. For example, a deep, aching pain in the bones may be due to multiple myeloma, Ewing's sarcoma, osteosarcoma, or some other type of bone cancer. Widespread

achiness, especially in the joints, may signify leukemia. Nagging abdominal pain may be caused by cancer of the stomach, intestines, liver, gallbladder, or pancreas. Painful swollen glands often accompany metastatic cancer — malignancies that have spread to other parts of the body — or primary cancers, such as leukemia, Hodgkin's disease, or lymphoma.

Circulatory disorders
Diminished blood flow can cause severe pain, due to a lack of oxygen reaching body tissue. The cause may be blood vessels clogged by atherosclerosis — the buildup of fatty deposits — or diseases of the vessels themselves, such as Buerger's disease or thrombophlebitis.

Emotional problems
Pain that has a psychological rather than an organic cause is referred to as psychogenic or psychosomatic pain. Although psychogenic pain probably is not as common as many people believe, to those who suffer from it, it can be as real and debilitating as any other type of pain. Anxiety often is accompanied by pain. Panic attacks also can produce chest pain, headache, and other pains.

Muscle disorders
Muscle pain may originate from damage to the muscles themselves, or it may be related to the nerves that control the muscles. The pain may also arise in the tendons, which attach muscles to bone. In some disorders, such as shin splints, the pain may be

localized; in others, such as muscular dystrophy, the pain may be widespread.

Nerve disorders
Nerves carry pain impulses to and from the brain. Any nerve damage or disease can cause pain, often characterized by prickling or "pins and needles" sensations.

Viral infections
Many viral infections begin with generalized achiness and muscle soreness. For example, a person with a bout of flu often complains of "hurting all over." Similarly, a child who is developing chickenpox will be fussy while complaining of pain. The presence of other symptoms, such as a fever, rash, or nausea, may provide useful clues as to the cause of the pain.