Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Pleuritic Pain
Question: My husband has been in a lot of pain. We have gone to ER and nothing showed up from testing. Maybe pleurisy; they said. Sent him home. Still hurting. What can be done?
Brief Answer:
Perhaps a stronger painkiller
Detailed Answer:
Hello,
Since you haven't provided enough information I could not possibly give a complete answer, but I'll try to give you the best I can.
If he's been checked in the ER then I guess they've done the basic tests (X-ray, blood tests, oxygen saturation, electrocardiogram) and a clinical examination of course. If all of the above are negative then you shouldn't worry too much. Taking pills for the pain should suffice. I'll explain it later in greater detail.
You haven't mentioned the exact location of the pain. I gather he had back pain probably one-sided.
In cases like this the doctor has to assess several parameters (clinical and laboratory) to exclude serious diagnoses like acute coronary syndrome, pneumonia etc. Pleurisy denotes pain that worsens with breathing movements.
I'll mention some of them, so that you could identify similarities to your husband's case.
Sudden onset of pleuritic pain calls for immediate action to exclude pulmonary embolism (usually associated with calf pain, warmth and/or edema), pneumothorax (could be related to injury or for no reason at all), rib fracture (injury related in most cases).
Gradual onset of pleuritic pain usually presents in pericarditis (inflammation of the heart's lining), pneumonia (fever should be the key-symptom), various causes of pleural effusion (including cancer, drugs, autoimmune diseases etc).
The list of possible causes goes on and on. One potential cause of particular interest is herpes zoster virus which causes shingles. This can present with pain even days before the rash appears.
A careful doctor can exclude most of the diagnosis I mentioned with clinical examination and with the appropriate laboratory testing one can be almost certain (as much as science allows for) that nothing serious is going on.
Tests I usually order in similar cases include
- X-ray of the chest
- d-dimers assay
- electrocardiogram
- oxygen saturation (SpO2)
- basic biochemistry panel
If all are normal then analgesics can be safely given, if not contraindicated for some other reason, and follow-up is scheduled.
Paracetamol is sufficient for many cases of pain. When paracetamol is not enough a non-steroidal anti-inflammatory drug (NSAID) can be more efficient. Since your husband is 70 years old, he should probably consult his doctor before taking NSAIDs.
I hope I've given you some insight on his situation!
If you need further clarifications, I'll be glad to provide them for you. If you will, please add some more details.
Kind Regards!
Perhaps a stronger painkiller
Detailed Answer:
Hello,
Since you haven't provided enough information I could not possibly give a complete answer, but I'll try to give you the best I can.
If he's been checked in the ER then I guess they've done the basic tests (X-ray, blood tests, oxygen saturation, electrocardiogram) and a clinical examination of course. If all of the above are negative then you shouldn't worry too much. Taking pills for the pain should suffice. I'll explain it later in greater detail.
You haven't mentioned the exact location of the pain. I gather he had back pain probably one-sided.
In cases like this the doctor has to assess several parameters (clinical and laboratory) to exclude serious diagnoses like acute coronary syndrome, pneumonia etc. Pleurisy denotes pain that worsens with breathing movements.
I'll mention some of them, so that you could identify similarities to your husband's case.
Sudden onset of pleuritic pain calls for immediate action to exclude pulmonary embolism (usually associated with calf pain, warmth and/or edema), pneumothorax (could be related to injury or for no reason at all), rib fracture (injury related in most cases).
Gradual onset of pleuritic pain usually presents in pericarditis (inflammation of the heart's lining), pneumonia (fever should be the key-symptom), various causes of pleural effusion (including cancer, drugs, autoimmune diseases etc).
The list of possible causes goes on and on. One potential cause of particular interest is herpes zoster virus which causes shingles. This can present with pain even days before the rash appears.
A careful doctor can exclude most of the diagnosis I mentioned with clinical examination and with the appropriate laboratory testing one can be almost certain (as much as science allows for) that nothing serious is going on.
Tests I usually order in similar cases include
- X-ray of the chest
- d-dimers assay
- electrocardiogram
- oxygen saturation (SpO2)
- basic biochemistry panel
If all are normal then analgesics can be safely given, if not contraindicated for some other reason, and follow-up is scheduled.
Paracetamol is sufficient for many cases of pain. When paracetamol is not enough a non-steroidal anti-inflammatory drug (NSAID) can be more efficient. Since your husband is 70 years old, he should probably consult his doctor before taking NSAIDs.
I hope I've given you some insight on his situation!
If you need further clarifications, I'll be glad to provide them for you. If you will, please add some more details.
Kind Regards!
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
I forgot to mention: stage 4 kidney disease. Probably not a factor in his immediate problem, but definitely worth telling.He still has a gall bladder. Any chance it could be that, or not? It seems to run in his family -son, sister, niece, mother, -?
Brief Answer:
That was a crucial bit of information
Detailed Answer:
Hello,
His kidney problem is probably not the cause of his pain although it could lead to both pleuritis and pericarditis because when it does it usually presents with painless pleural or pericardial effusion. If can't be excluded as a potential cause though!
Since he was examined in the ER I suppose they checked for that.
This problem prohibits the use of NSAIDs. NSAIDs are detrimental to the kidney and individuals with chronic renal failure should not use them.
An alternative option includes the most potent analgesics which may contain codein or other opioid substances. These kind of drugs should be better avoided if the pain is not severe.
Gall bladder pain that lasts for so long could only be caused by cholecystitis. This presents with pain on the right upper quadrant of the abdomen (just under the ribs), which may radiate to the back (just below the right scapula) and can - sometimes - prevent deep breaths because of the pain. This is very difficult to be ignored in an ER and I could almost safely - even if I haven't myself examined your husband - exclude it.
If you'd like, please inform me about the tests he's done (and the results of course) so that I'll be able to be more specific.
I hope he gets better soon!
Kind Regards!
That was a crucial bit of information
Detailed Answer:
Hello,
His kidney problem is probably not the cause of his pain although it could lead to both pleuritis and pericarditis because when it does it usually presents with painless pleural or pericardial effusion. If can't be excluded as a potential cause though!
Since he was examined in the ER I suppose they checked for that.
This problem prohibits the use of NSAIDs. NSAIDs are detrimental to the kidney and individuals with chronic renal failure should not use them.
An alternative option includes the most potent analgesics which may contain codein or other opioid substances. These kind of drugs should be better avoided if the pain is not severe.
Gall bladder pain that lasts for so long could only be caused by cholecystitis. This presents with pain on the right upper quadrant of the abdomen (just under the ribs), which may radiate to the back (just below the right scapula) and can - sometimes - prevent deep breaths because of the pain. This is very difficult to be ignored in an ER and I could almost safely - even if I haven't myself examined your husband - exclude it.
If you'd like, please inform me about the tests he's done (and the results of course) so that I'll be able to be more specific.
I hope he gets better soon!
Kind Regards!
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Brief Answer:
What kind of growth? What about the other tests?
Detailed Answer:
Hello,
I still do not have a complete picture about his tests. If you'd inform me about the results, I'll be able to help you more. A growth in the thyroid could be benign or malignant. When accompanied by painless and swollen lymph nodes the probability of malignancy is even higher. The radiologist should have a better picture whether this growth looks malignant or not.
Malignancies are a relatively common cause of high calcium increases particularly when the primary tumor has metastasized.
His back pain could also be attributed to that.
But I still need those results!!! Without them I'm just guessing!
Despite the fact that this is a guess coming out of knowledge and experience, it's still a guess!
Results of radiological tests, blood tests (I mean the exact values) etc are very important to formulate a differential diagnosis.
I wish you the best for your husband!
Kind Regards!
What kind of growth? What about the other tests?
Detailed Answer:
Hello,
I still do not have a complete picture about his tests. If you'd inform me about the results, I'll be able to help you more. A growth in the thyroid could be benign or malignant. When accompanied by painless and swollen lymph nodes the probability of malignancy is even higher. The radiologist should have a better picture whether this growth looks malignant or not.
Malignancies are a relatively common cause of high calcium increases particularly when the primary tumor has metastasized.
His back pain could also be attributed to that.
But I still need those results!!! Without them I'm just guessing!
Despite the fact that this is a guess coming out of knowledge and experience, it's still a guess!
Results of radiological tests, blood tests (I mean the exact values) etc are very important to formulate a differential diagnosis.
I wish you the best for your husband!
Kind Regards!
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
