Symptoms -- Location, Location, Location
Last reviewed by Faculty of Harvard Medical School on January 13, 2011
By Robert H. Shmerling, M.D.
When buying or selling a home, they say the three most important things are: Location, location and location.
When it comes to any type of symptoms you're having, doctors might say much the same thing: Location is the big player when it comes to sorting out the cause of your symptoms.
Consider the person in pain or with other symptoms calling his doctor. It's likely his doctor's first question will be, "Where does it hurt?" The answer quickly narrows down the long list of possible causes. Here are some examples:
Your doctor may repeatedly ask you, "Where was the pain when you first noticed it?" "Did it move anywhere?" "Was it still in the original location when it moved elsewhere?"
Here are a few examples of how the movement of symptoms can provide clues that can help your doctor sort out their causes:
Sometimes where the symptom appears isn't the original location of its cause. When the symptom is pain, it's called "referred pain." Doctors know the patterns of referred pain (or should!) and so the true cause of potentially misleading symptoms can often be quickly sorted out.
Some common examples include:
Many cases of referred pain occur because the nerves sending the pain signals to the brain are also providing sensation to other nearby structures. When the brain receives the signal, it's confused about the origin of the pain. The same explanation may account for nausea, belching or sweatiness that is often a symptom of a heart attack. For phantom limb pain, one theory is that the brain "re-wires" input from the missing limb. These new connections allow the brain to experience sensations from the missing part.
Whatever the symptoms are pain, numbness, shortness of breath or something else it's impossible to experience the symptom without communication from the body part to the brain. Patients sometimes ask me, "Could my pain be "all in my head?" I say, "Of course," because that's how it must be for everyone, for every condition.
But that doesn't help explain the source of the pain. Stress, anxiety, fear and other psychological states can contribute to many symptoms (including pain). But those symptoms are just as "real" as symptoms caused by something you can see, such as a serious injury. For this reason, I discourage debates about whether a symptom is "real or just in a person's mind" and prefer to focus instead on sorting out the cause and treatment.
Symptom location is important to your doctor. But it's just one of many pieces to the puzzle. Combined with other features (such as intensity, variability, quality, and context), your doctor can often sift through dozens of possible causes and arrive at the most likely. By giving your doctor an accurate account of your symptoms' location, you're helping him or her figure out what's going on.
So, the next time your doctor talks to you about the location of your symptoms, you'll know better what your doctor is saying.
Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.