Chest to Toothache: Most Frequent ER Pains Explained

1. chest pain – The King of Red Flags

chest pain is the MVP of emergency visits—not just because it’s common, but because it scares everyone, including us. From a benign musculoskeletal tweak to a full-blown myocardial infarction, the differential is as wide as a Grand Canyon.

chest pain doesn't play fair:

• Could be cardiac (ACS, pericarditis)
• Could be pulmonary (PE, pneumothorax, pneumonia)
• Could be GI (GERD, esophageal spasm, even a hamburger regret)
• Could be anxiety (but make sure the ECG is clean first)

Every ED doctor has that reflex: “Is it the heart?” Even when the patient swears it’s just gas after shawarma. D-dimer, troponins, serial ECGs, and sometimes CT-angio—we go full detective mode. No shortcuts here.

2. Abdominal Pain – The Vague, The Violent, and The Misleading

Abdominal pain is chaos in a clinical wrapper. It doesn’t tell you much unless you’re Sherlock Holmes with an ultrasound probe. The pain could be anywhere, and the real problem could be somewhere else entirely.

Common causes:

• Appendicitis (classics still show up!)
• Cholecystitis (post-fatty meal drama)
• Pancreatitis (thank you, alcohol and gallstones)
• Renal colic (you hear the scream before you read the triage)
• Bowel obstruction (vomit and distension parade)
• Diverticulitis (especially in older patients)
• Gastroenteritis (self-limiting, but the pain can be intense)

In women, add gynecological chaos: ectopic pregnancy, ovarian torsion, or ruptured cysts—all mimicking each other. Meanwhile, older patients show up with a silent abdomen and an aortic aneurysm ready to rupture.

3. Headache – When to Worry and When to Smile

Headaches are one of the most annoying complaints, not because they’re dangerous most of the time, but because once in a while, they hide a ticking bomb.

Things that worry us:

• Sudden "worst headache of life" → Subarachnoid hemorrhage
• Papilledema or vision changes → Raised intracranial pressure
• Fever + neck stiffness → Meningitis
• Temporal pain in elderly → Temporal arteritis
• Immunocompromised? Think cryptococcus or abscess

But then there’s migraine, tension-type headache, cluster headache, medication overuse headache… all these add flavor to our clinical judgment soup.

The CT scanner and lumbar puncture become our weapons of choice when the red flags start waving.

4. back pain – A Common Complaint with Rare Nightmares

back pain can be anything—from poor posture and lifting wrong, to an epidural abscess or spinal metastasis.

Most common causes:

• Mechanical or muscular
• herniated disc or Sciatica
• Spinal stenosis

What raises alarms:

• Fever + IV drug use = Epidural abscess
• Urinary retention + saddle anesthesia = Cauda equina
• Night pain + weight loss = Malignancy
• Trauma = Fracture, especially in the elderly

You learn to spot the difference between “I twisted my back” and “my spinal cord is about to give out” really fast in emergency medicine.

5. Joint Pain – Mono, Poly, or Red-Hot Mystery?

Joint pain has a dramatic range—sometimes subtle, sometimes screaming red-hot.

One joint? Think:

• Gout (especially that classic red, swollen toe)
• Septic arthritis (urgent tap needed)
• Trauma (ligament, dislocation, fracture)

Multiple joints? Think:

• Viral arthritis
• Rheumatoid or lupus flare
• Reactive arthritis

What really keeps ED docs on alert is a red, hot, tender joint in a febrile patient—until proven otherwise, it's septic arthritis until your synovial tap says otherwise.

6. Pelvic Pain – A Diagnostic Minefield, Especially in Females

Pelvic pain in women of reproductive age should trigger immediate questions: Could she be pregnant? If yes, we’re all thinking ectopic until proven otherwise.

Common causes:

• Ovarian torsion (surgical urgency)
• Ruptured ovarian cyst (can mimic appendicitis)
• Ectopic pregnancy (don't miss this—ever)
• Pelvic inflammatory disease (the “I feel something died inside” kind of pain)
• Dysmenorrhea or endometriosis (severe pain but often chronic)

And the men? Don’t forget testicular torsion—young male with sudden pain and high-riding testicle? Drop everything. Urology, STAT.

7. Ear Pain – Not Always Otitis

Surprisingly common and surprisingly misleading.

Most common causes:

• Otitis media/externa (especially in kids and swimmers)
• Referred pain (dental abscesses, temporomandibular joint issues, even throat tumors)
• Barotrauma (airplane ears or deep-sea diving enthusiasts)

The key is a good otoscope exam—but how often do kids let you peek in peacefully?

8. Throat Pain – A Quick Peek Could Save a Life

Throat pain sounds harmless—until you meet Ludwig’s angina or epiglottitis.

Most common causes:

• Viral or bacterial pharyngitis
• Tonsillitis (with or without peritonsillar abscess)
• Epiglottitis (stridor? Trouble breathing? Don’t stick a tongue depressor!)
• Retropharyngeal abscess (rare, but dangerous)
• Foreign body (fish bones in toddlers, coins in the elderly)

Red flags? Difficulty swallowing, drooling, stridor, trismus. Any of these means get ENT involved fast.

9. Tooth Pain – The Dental ER’s Nightmare

Dental pain sends many to the ED at night. Why? Because dental clinics are closed, and tooth pain doesn’t wait.

Common culprits:

• Dental caries
• Periapical abscess
• Cracked tooth
• Impacted wisdom tooth

Sometimes it’s not the tooth—it’s a sinus infection, or worse, osteomyelitis of the jaw. The pain may radiate to the ear or temple, making diagnosis tricky.

10. Limb Pain – Where Trauma Meets Vascular Meets Weird

Limb pain can stem from trauma, infection, ischemia, or just bad posture. But a cold, pulseless, pale limb? That’s not just pain—that’s a vascular emergency.

Look out for:

• Fractures or dislocations
• DVT (especially in unilateral swollen limbs)
• Compartment syndrome (severe pain out of proportion to exam)
• Cellulitis (hot, red, tender limb)
• Arterial occlusion (surgical emergency)

And don’t forget—IV drug users often hide their abscesses in limbs. Be alert for signs of infection even if the patient downplays their history.

11. Neck Pain – Minor or Meningeal?

Neck pain gets less attention in the ED unless it's dramatic. But it can hide sinister causes.

Consider:

• Meningitis (check for stiffness)
• Carotid dissection (young patient + stroke signs)
• Muscular strain or whiplash
• Cervical spine fracture (after trauma)
• Retropharyngeal abscess (in children, or drooling adults)

If the patient has neck pain and neuro deficits—imaging is non-negotiable.

12. Pain in the “Unexplained” Category – Functional or Missed Diagnosis?

These are the patients who "don’t look sick," labs are normal, imaging is unremarkable—but the pain is real.

Could be:

• Functional GI disorders
• Chronic pain syndromes
• Fibromyalgia
• Psychosomatic presentations
• Malingering (rare, but can be suspected in certain contexts)

Here’s where empathy meets experience. These are tricky to manage, not because they’re faking—but because diagnosis is often elusive, and the ED isn’t designed for deep-dives.

Pain Patterns in Special Populations: Don’t Miss These

• Elderly: Atypical presentations are the rule. MI without chest pain, sepsis without fever, fractures without trauma.
• Children: Pain expression is often behavioral. Fever + crying = maybe otitis… or maybe UTI or even intussusception.
• Pregnant women: Appendicitis may shift, back pain could mean labor, and abdominal pain always raises suspicion for placental issues or ectopic.

The Art of Reading Pain in the ED

Pain is subjective. Some rate a stubbed toe a 10/10. Others walk in with a ruptured spleen and call it “a bit uncomfortable.”

In the emergency department:

• Pain is both symptom and signal.
• It's a story, often incomplete.
• It needs context, physical exam, labs, imaging, and experience.