Patients with generalized aches and pains are often seen in clinical practice, but a diagnosis can be difficult to make because of the wide variety of possible diseases that could be responsible.
The most common cause of aches and pains- other than overexertion- is a viral infection.
In cases where the aches and pains do not go away though, a more in depth analysis is required. Something as common as an underactive thyroid gland can cause generalized aches and pains along with fatigue. The diagnosis can be made clinically and confirmed by checking the thyroid stimulating hormone level.
Polymyalgia rheumatica is a disorder that affects people past the age of 50 years. Patients with this condition have widespread pain and stiffness in the neck, shoulders, hips, and buys. The pain is aggravated by inactivity.
Symptoms including low-grade fevers, and weight loss may be common. On physical examination, patients will have difficulty moving their shoulders and hips because of severe pain. Sometimes, patients will have pollution of the small joints of the hands, wrists, and the feet. Laboratory tests will show an elevated erythrocyte sedimentation rate.
Giant cell arteritis is a severe inflammatory disease that affects arteries. This condition often is found in patients who have polymyalgia rheumatica. The danger here is that patients with giant cell arteritis, because of inflammation of the arteries leading to the eye, may become blind. If this condition is suspected, a temporal artery biopsy is necessary in order to make the diagnosis.
A person presenting with swelling and pain involving the small joints of the hands, wrists, and feet will likely have another condition-rheumatoid arthritis. Rheumatoid arthritis is one of the most common forms of inflammatory arthritis. Patients will complain of significant morning stiffness thinking several hours. They will also have stiffness during the day. Chronic fatigue is a problem. On examination, they will have swilling of the hands, wrists, ankles, and feet. Laboratory tests such as the rheumatoid factor and anti-CCP along with the erythrocyte sedimentation rate may help confirm the diagnostic impression.
Osteoarthritis, a form of wear and tear arthritis, may also present with generalized aches and pains. However, on examination, the patient will be found to have involvement primarily of weight-bearing areas such as the neck, low back, hips, and knees. While localized infection is present, generalized infection is absent.
Likewise, crystal induced arthritis- gout and pseudogout- can cause generalized aches and pains. However, the aches and pains are generally located in the joints.
Inflammatory muscle disease may also be associated with generalized aches and pains. Elevated levels of muscle enzymes in the blood can be seen. The diagnosis can be confirmed by studies such as electromyography, magnetic resonance imaging, and muscle biopsy.
Paget's disease of bone is an unusual condition that also can cause generalized aches and pains. The blood bone alkaline phosphatase level is elevated.
Cancer that has spread to bone also can cause aches and pains. In fact, I have seen two patients in the last week who presented with metastatic cancer and who complained of generalized pain as their primary symptom.
Obviously, the treatment for a patient who hurts all over will depend upon securing a precise diagnosis. For people who have chronic generalized pain, one disease condition that needs to be considered is fibromyalgia. This is a disease that affects about 2% of the population and may start at almost any age.
Patients may have had their symptoms for many months to many years. Patients with fibromyalgia complain of “pain all over” and, by definition, have pain on both sides of the body both below the waist as well as above.
The pain may be described as deep and achy. Stiffness in the morning is common. Patients may also complain of chronic fatigue and feeling as if they have not gotten a good night sleep.
They may also complain of symptoms such as irritable bowel, irritable bladder, headaches, numbness and tingling, subjective swapping of the hands and feet, and be very sensitive to sensory stimuli such as light, odors, and sounds.
A diagnosis of fibromyalgia can only be made after other diseases that can cause aches and pains are excluded.
Less common causes of generalized aches and pains are systemic lupus erythematosus, strep-related illness, and Lyme disease. These have to be factored into the list of possibilities.