13 most painful medical conditions
What is the most painful thing in the world? The worst type of pain is whatever pain you personally endure. While ranking the most painful medical conditions is subjective, experts and patients alike can agree: Certain medical conditions are especially excruciating.
When health care providers ask patients to rate their pain on a scale from 1 to 10, these conditions — whether acute or chronic — often break the charts with a resounding “11.” Not all pain can always be cured, but proper diagnosis and treatment can help manage the condition and scale back the pain meter.
From kidney stone pain to trigeminal neuralgia pain, these 13 medical conditions are the most painful, according to experts. Find out how these conditions are treated and how you can manage the pain.
1. Kidney stones
If you’ve ever suffered from a kidney stone, you know why it ranks high on the pain scale.
Picture trying to shove a pebble through a straw: Kidney stones are hard stones or crystals that form in the kidneys and typically cause severe pain or spasms while trying to move down the urinary tract from the kidney to the bladder through the thin attached tube, called the ureter. Trying to pass a kidney stone stuck in the urinary tract can bring people to their knees and straight to the emergency room.
Kidney stone symptoms
Usually made of calcium, these hard pellets block the flow of urine, making the kidney swell and causing waves of excruciating pain at the mid-back, abdomen or sides and for men, pain at the end of their penis. Nausea, vomiting, fever and blood in the urine are common.
Kidney stone treatment
Diagnosing a kidney stone typically requires imaging tests and/or a urinalysis. Once the condition is confirmed, kidney stone treatments may include IV fluid and medication that relaxes the muscles in your ureter to help the stone — and the severe pain — to pass. Stubborn small kidney stones may require shock wave therapy, called lithotripsy, to break them up. Larger or recurring stones may call for more complex methods like surgery to remove the stone.
2. Childbirth
For some women, intense pain in the lower back is an unforgettable aspect of childbirth. Often called back labor, pain peaks during contractions and lingers in between, making it more difficult for women to push. It’s sometimes caused by the baby’s head position, with the back of the head pressing into the mother’s tailbone, but that’s not always the case.
Non-medication methods to ease the mother’s pain include moving away from a back-lying position, walking and applying counter pressure with a tennis ball or warm compresses to the back. Breathing techniques and relaxation exercises are also sometimes effective forms of natural pain relief.
If these aren’t enough, relief options include pain medication or an epidural nerve block using local anesthesia to numb the area.
3. Trauma
Pain due to physical trauma — such as a gunshot wound, car accident injury or a painful medical procedure — can leave someone feeling like they’ve experienced the worst pain in the world. The intensity of pain may be influenced by factors including someone’s pain thresholds, their resilience or the nature of the traumatic event.
Trauma symptoms
Trauma can cause sudden and severe pain, provoking a variety of bodily signs.
Signs of acute pain include:
— Rising blood pressure.
— Racing pulse.
— Sharp, stabbing pain.
— Throbbing.
— Tingling.
— Weakness.
— Numbness.
— Changes in physique, movements and posture.
While these signs all tell the story of intense pain, clinicians must rely on patients to gauge exactly how much pain they’re in to determine the best pain management strategies.
Trauma treatment
Treating trauma requires an individualized approach. Physical trauma typically requires immediate medical attention to stabilize the individual, assess the harm and intervene accordingly. Dealing with trauma can have lasting psychological effects, so getting support from mental health professionals or support groups can be an important component of emotional healing.
4. Shingles
Shingles, also known as herpes zoster, is a viral infection caused by the same virus that causes chickenpox. If you’ve had chickenpox, the virus can remain dormant in nerve cells for years and reactivate later in life, causing shingles.
Shingles symptoms
Besides rashes, blisters and scabbing, shingles patients suffer intense pain. This occurs in parts of the body along a nerve pattern, called the dermatome, where the virus resides — often across the trunk. Unfortunately, some patients go on to develop a chronic condition called postherpetic neuralgia, with symptoms including deep or burning pain, extreme sensitivity to touch and numbness in the affected area, which can last for years if not addressed promptly.
Shingles treatment
Early treatment for shingles can help prevent the transition from acute to chronic pain, says Dr. Asokumar Buvanendran, an anesthesiologist specializing in pain medicine at Rush University Medical Center in Chicago.
Antiviral medications that shorten the length and severity of illness are available to treat shingles. The earlier you start treatment, the better, as they’re more effective at treating the symptoms when you start taking them immediately after a rash appears.
Older adults are particularly vulnerable to getting shingles, likely due to a weakening immune system as you age. Luckily, you can take steps to protect yourself and prevent shingles. Healthy adults ages 50 and older should get two doses of Shingrix — the only shingles vaccine available in the U.S. — spaced two to six months apart, according to the Centers for Disease Control and Prevention.
5. Trigeminal neuralgia
Trigeminal neuralgia is a peripheral, excruciating pain in the face that can be triggered by a harmless activity, such as talking, chewing, wearing a mask or washing your face, explains Dr. Maggie Waung, a neurologist at the Trigeminal Neuralgia Clinic at UC San Francisco and an assistant professor of neurology within the UCSF Weill Institute for Neurosciences.
Because the involved nerves are compromised, “even a light wind blowing on your face can trigger this brief, often electric shock-like pain,” Waung adds.
As a result, patients may avoid basic hygiene, like brushing their teeth, in an effort to avoid stimulating a bout of facial pain with trigeminal neuralgia, as well as engage in behaviors — like being very still, minimizing chewing or even staying out of the wind to prevent it from blowing on the face — as self-preservation strategies.
Trigeminal neuralgia causes
Reasons for trigeminal neuralgia include:
— Compression of the trigeminal nerve by an artery in the brain, called neurovascular compression.
— Facial trauma.
— Nerve compression from a tumor.
— Multiple sclerosis, in which neurons lose some of their protective covering, called the myelin sheath, is another culprit.
Oftentimes, however, the cause is unknown or idiopathic.
Trigeminal neuralgia symptoms
The trigeminal nerve carries sensory information from the face via three branches — above the eyebrow, along the cheek and at chin level. Trigeminal neuralgia is an interruption in that nerve conduction, explains Heidi Maloni, retired associate clinical director of the Multiple Sclerosis Center of Excellence-East, part of the Department of Veterans Affairs. Pain is usually felt on just one side of the face, typically the lower part, but can affect both sides of the face in some cases.
Patients with multiple sclerosis have a 20-fold increased risk of developing trigeminal neuralgia. It affects up to 5% of patients with MS and often affects older people, according to a 2019 study.
Trigeminal neuralgia treatment
Certain treatments can ease or even cure trigeminal neuralgia pain, depending on the cause:
— Medication. Carbamazepine (Tegretol), which is also an anti-seizure medication, is the only treatment specifically approved for trigeminal neuralgia pain by the Food and Drug Administration. Carbamazepine acts on sodium channels in the cells to prevent pain-related nerves from firing. Other anti-seizure drugs, like oxcarbazepine (Trileptal), gabapentin and phenytoin (Dilantin), are also effective for some patients.
— Surgery. Microvascular decompression involves an invasive surgical procedure to gently separate the blood vessel from where it’s pressing on the trigeminal nerve in the brain.
— High-dose radiation. Gamma knife radiosurgery directs high-dose radiation to the trigeminal nerve root. This minimally invasive option helps numb the nerve so it’s not continually sending pain signals.
“We always start off with medications,” Waung says. “When people aren’t doing well on medications, we’ll consider surgical options.”
Before considering surgery, patients are first thoroughly evaluated to determine if they’re appropriate candidates, particularly for more invasive procedures.
6. Post-surgery pain and recovery
No surprise here: Recovering from surgery can be painful. But some procedures cause more postoperative pain than others.
Knee replacement surgery would rank near the top of the list because it requires cutting through bone, Buvanendran says, whereas the aftermath of hip replacement doesn’t seem to hurt as much. But with every breath, lung surgery brings postoperative pain to the involved muscles, he adds.
Postoperative pain is a major issue for hospital patients recovering from head and neck surgery in particular.
Virtual reality sessions may be a viable tool for reducing their pain, as well as their opioid use, an innovative study suggests. Participants included those who had undergone surgery in sensitive areas, like the oral cavity, throat and neck, with a few who required tissue reconstruction or tracheostomy — an opening created in the front of the neck to enable breathing-tube insertion, in the study published in June 2022 in JAMA Otolaryngology–Head & Neck Surgery.
About three days after surgery, patients were randomly assigned either to use a headset for a 3D, immersive VR experience or to a control group whose members each used a hand-held, smartphone device. Gaming sessions involved 15 minutes of playing Angry Birds. Patients in the VR group had significantly lower pain scores and required less opioid use than patients who didn’t experience the immersive VR intervention.
Some pre-surgery tips can help improve your recovery, such as maintaining a healthy weight and quitting smoking.
7. Back pain or injury
Whether acute episodes or chronic, back pain can be debilitating for many. According to the 2019 National Health Interview Survey from the National Center for Health Statistics, about 44% of adults ages 30 to 44 and 46% of adults ages 65 and over experienced back pain in the past three months. Women (41%) on average were more likely to experience back pain than men (37%).
Overall, 264 million days of work are lost to back pain every year nationally, according to a 2018 report from the United States Bone and Joint Initiative. Some suffering from back pain experience a constant, dull ache, whereas others may have sudden, recurrent sharp pains.
As a source of agonizing back pain, an acute disc herniation — possibly caused by heavy lifting — is all too common.
Your disc protrudes, bulges and pushes on the nerve, causing severe pain to go down your legs, Buvanendran explains.
Back pain treatment
There are various ways to treat back pain, depending on the origin of pain, whether it’s acute or chronic, and other personal factors of the individual. Some back pain relief treatment options may include:
— Pharmacologic interventions, such as pain medication, anti-inflammatories or muscle relaxants.
— Physical therapy or massage therapy.
— Heat application.
— Rest and avoid heavy lifting.
— Surgery, when necessary.
It’s important to talk to your doctor to discuss your pain and treatment options, particularly if you’re experiencing persistent, chronic back pain. Typically, your doctor may perform tests to rule out serious medical conditions, such as a tumor or infection, before starting with more conservative treatment options or surgery, if necessary.
8. Major joint osteoarthritis
When osteoarthritis invades your hips, knees or shoulders, every movement causes joint pain. Major joint osteoarthritis is a degenerative joint disease that primarily affects the cartilage in your joints.
Major joint osteoarthritis symptoms
The breakdown and loss of cartilage, the connective tissue that protects and cushions your bones and joints, can lead to severe pain, stiffness and reduced flexibility in the affected joints. As cartilage between these joints wears out, padding between them is lost. The resulting bone rubbing on bone sounds bad and feels worse.
Other symptoms you may experience include:
— Swelling.
— Inflammation.
— Grating or crackling sensation with movement.
— Changes to your bone or joint structure.
— Difficulty performing day-to-day activities.
When osteoarthritis pain makes it difficult for people to even move, it puts them at risk for other serious medical conditions, like heart disease. Pain and immobility can also contribute to mental health issues, such as anxiety and depression.
Major joint osteoarthritis treatment
Treatment options vary based on the individual, and may include a combination of pain management strategies and medical interventions, including:
— Over-the-counter or prescription pain medications.
— Physical therapy exercises.
— Assistive support devices like canes or braces.
— Corticosteroid shots.
— Lifestyle interventions, like maintaining a healthy body weight to reduce stress on joints.
— Surgical options, in severe cases.
9. Headaches
Headaches are painful in general, but cluster headaches, spinal headaches and migraines are considered among the most excruciating.
Cluster headaches
Typically, people with cluster headaches are painfully awakened in the middle of the night with stabbing, searing or burning pain on one side of the head, or facial pain around the eye or at the temple. The cause of cluster headaches is uncertain, but they may be related to the release of inflammatory chemicals, like histamine, that are produced by the body.
Cluster periods, in which people often have daily or more frequent headaches, typically last from several weeks to several months. Some people have seasonal cluster episodes, such as every fall or spring.
Avoiding individual triggers — such as alcohol use, cigarette smoking, bright lights and high altitudes — helps prevent cluster headaches for some people. Doctors may prescribe daily medicines to relax blood vessels (verapamil), reduce inflammation (steroids like prednisone) or to promote the balance of specific brain chemicals (lithium carbonate). High-dose oxygen therapy may stop a cluster headache attack in progress.
Spinal headaches
Though rare, the majority of spinal headaches result from a tear or puncture made during a spinal tap procedure. These are not accidental punctures — it’s actually part of the spinal tap procedure. However, leaking of fluid from around the spinal cord can cause a severe spinal headache, Buvanendran explains.
Accompanying symptoms of a spinal headache can include nausea, dizziness, severe light sensitivity and neck stiffness.
Doctors sometimes treat spinal headaches with blood patches from the patient’s own blood to plug the leakage site. With an epidural blood patch, the doctor typically withdraws blood from the patient — like from your arm or hand — and injects it back into the spinal tap site in a small quantity.
Migraines
Migraines can knock people out for days. Individuals experiencing a migraine suffer from an array of symptoms — not just pain in the head.
Symptoms of a migraine include:
— Throbbing or pulsing pain on one side of the head.
— Increased sensitivity to light.
— Nausea.
— Vomiting.
Even once migraine symptoms resolve, people often feel exhausted or weak for a day or a few days following a migraine.
For this and other pain conditions, a balanced approach using a variety of therapies, which will depend on the condition and patient, is best. Prescription medications for migraine can help both prevent migraines, as well as reduce their pain. Other migraine treatments may include over-the-counter migraine medications, acupuncture, complementary and alternative medicine and cognitive behavioral therapy. With each individual, the goal is to reduce pain and suffering and improve their quality of life.
10. Complex regional pain syndrome
After an arm or leg injury — usually from fractures, surgery, sprains or immobilization — some people experience ongoing, excruciating pain from trauma to their peripheral nerves, a very rare condition and serious complication, called complex regional pain syndrome. In other cases of CRPS, the cause is never determined.
Complex regional pain syndrome symptoms
In addition to prolonged pain and inflammation, if you have CRPS, you may have other symptoms that include changes in skin color, body temperature and/or swelling below the site of injury.
A CRPS diagnosis can be complicated. Oftentimes, neurologists or orthopedists must weigh in. Nerve conduction studies, ultrasound, MRI or advanced bone scans using dye may reveal underlying bone nerve damage or bone abnormalities.
Complex regional pain syndrome treatment
While there’s no cure for CRPS, a combination of treatment options including medication, psychological support and physical rehabilitation are used to help manage symptoms.
11. Sickle cell disease
Sickle cell disease is a lifelong illness that is estimated to affect more than 100,000 people in the U.S. and 20 million people globally. Although it’s classified as a rare disorder, sickle cell disease is well-known for the pain it causes.
Sickle cell disease symptoms
The inherited condition affects red blood cell formation. In a sickle cell crisis, normally flexible and disc-shaped blood cells become stiff and crescent-shaped. Blood can’t flow smoothly, which reduces the delivery of needed oxygen to the body’s cells, causing painful episodes. As such, pain management is an ongoing challenge for people with sickle cell disease.
Symptoms of sickle cell disease include:
— Anemia.
— Acute pain.
— Acute chest syndrome.
— Day-to-day discomfort.
— Swollen hands and feet.
Sickle cell disease treatment
Clinical management of a pain crises typically includes giving IV fluids and administering pain-reducing medication. In the most severe cases, patients are hospitalized to manage the sickle cell pain.
12. Endometriosis
Endometriosis occurs when tissue similar to that normally lining a woman’s uterus grows outside her uterus. Ovaries, fallopian tubes and tissue lining the pelvis are most often involved. As with normal uterine tissue, this abnormal pelvic tissue is affected by hormones released with each menstrual cycle.
Endometriosis symptoms
Cysts, irritation, scar tissue and adhesions — abnormal bands that can make pelvic organs stick to one another — may result. Though some people with endometriosis may experience no symptoms, others experience:
— Pain during menstruation.
— Pain or discomfort during or after sex.
— Pain when urinating or defecating.
— Chronic pelvic pain, ranging from dull and achy to sharp and stabbing.
— Heavy bleeding during or between a period.
— Difficulty getting pregnant.
— Bloating, nausea, fatigue.
— Endometriosis pain can be incredibly debilitating for some.
Endometriosis treatment
Getting an accurate diagnosis of endometriosis from an OB-GYN can be challenging. Symptoms of endometriosis often mimic other conditions, and there really aren’t any accurate screening tools or tests to identify those with the chronic disease, other than surgery. Performing a minimally invasive surgical procedure, called a laparoscopy, can be used to definitively diagnose someone with endometriosis.
In combination with general pain relief methods, hormone therapies, surgery and pelvic floor physical therapy may help with endometriosis pain relief.
13. Bone cancer or bone metastasis
Bone pain from cancer can come directly from primary bone cancer itself or from bone metastasis, which is cancer that has spread to the bone from the original disease site in the body. Breast, prostate, lung and kidney tumors are among the most likely to spread to the bone.
Treatment for cancer bone pain involves a variety of methods to address pain at the source. Orthopedic surgery for weakened bones, radiation therapy to destroy cancer cells and medications, such as anti-inflammatories and steroids, can reduce pain.
Supportive measures to help relieve suffering may include acupuncture or acupressure, physical therapy, relaxation techniques, massage and counseling.
The emotional impact of pain
Much like how a migraine can leave someone exhausted and weak for days, many conditions in which someone is prone to experiencing long-lasting or unpredictable pain can have major emotional consequences.
“People fear pain, so they will do anything to try to avoid it,” Maloni says. “They might not talk. They might not eat. It can be critical. … Fear can cause people to catastrophize and self-isolate.”
As a result, this self-isolation can translate to an emotional effect, Maloni adds.
Unfortunately, unpredictable pain conditions can limit the ability to function and can keep some people from working.
“The most frustrating thing about it is there’s not often a sense of control,” Waung says.
Mindfulness and pain control
Being stoic about any pain condition isn’t easy or always ideal.
Maloni suggests mindfulness as a tool to help self-manage pain, along with — not instead of — seeking and getting treatment.
“Trying to get control of your reaction to the pain is very helpful. Tools like mindfulness exercises help to minimize the experience of pain and to help with the fear and anxiety associated with excruciating pain,” she says.
A systematic review of 60 studies encompassing nearly 6,500 participants evaluated mind-body therapies — such as meditation, hypnosis, relaxation, guided imagery and cognitive behavioral therapy — for intense pain conditions for which people were being treated with opioids. Mind-body therapies were associated with improved pain and reduced opioid use, according to the findings published in November 2019 in JAMA Internal Medicine.
Seeking effective pain management
Pain should be manageable, so don’t give up on finding relief. In some cases of hard-to-treat pain, a pain management specialist might be able to offer therapies beyond what’s available from your primary care provider.
“Pain management can explore both pharmacologic, surgical and nonpharmacologic interventions,” Maloni says. “Cognitive behavioral therapies, specifically acceptance and commitment therapy, combine mindfulness strategies with behavioral-change strategies.”
Acceptance and commitment therapy, also referred to as ACT, is a therapeutic approach sometimes used by pain management professionals that emphasizes acceptance of difficult feelings or circumstances rather than fighting or avoiding negative thoughts. The psychotherapy technique is a form of mindfulness-based cognitive therapy that aims to help patients develop new ways of thinking and respond to challenges accordingly.
Though patients may feel despondent when living in pain on a daily basis, it’s important to communicate with your doctor and seek a definitive diagnosis and effective pain treatment.
Additionally, in this day in age, more advanced technology and ongoing research continues to open up new possibilities.
“Severe acute pain can lead to development of chronic pain,” Buvanendran says.
How do you prevent that acute to chronic pain transition? The answer may be on the horizon. Buvanendran with Rush University Medical Center is part of a National Institutes of Health-funded nationwide research initiative called the Acute to Chronic Pain Signatures project, or A2CPS, that aims to better understand the connection between acute and chronic pain. Findings could help guide chronic pain prevention strategies in the future.
13 most painful medical conditions
These acute or chronic conditions can cause severe pain and rank high on a pain scale:
— Kidney stones.
— Childbirth.
— Trauma.
— Shingles.
— Trigeminal neuralgia.
— Post-surgery pain and recovery.
— Back pain or injury.
— Major joint osteoarthritis.
— Headaches.
— Complex regional pain syndrome.
— Sickle cell disease.
— Endometriosis.
— Bone cancer or bone metastasis.
More from U.S. News
12 Ways to Help a Loved One Grieve
What Not to Say to People With Chronic Pain — and What to Say Instead
How Alcohol Can Accelerate the Aging Process and Damage Your Health
Ranking the Most Painful Medical Conditions originally appeared on usnews.com
Update 02/08/24: This story was previously published at an earlier date and has been updated with new information.
