What Is Vascular Pain?

When the heart pumps out blood, it does so into blood vessels which carry blood all around the body. Vascular pain can be caused by different diseases affecting these vessels, which collectively are called the circulatory system.

Vascular pain can manifest as different symptoms, such as cramping, tightness or aching sensations, and should be investigated by a healthcare professional who can advise on treatment. The legs are the most likely places where pain will arise when thinking about vascular pain, although there can be pain in the feet, arms or hands depending on the underlying condition. There are also other rarer causes that don’t present with leg pain.

This article will not discuss heart-related causes.

What causes vascular pain?

Vascular diseases are varied and include:

• Peripheral arterial disease (PAD, also known as peripheral vascular disease)
• Vasculitis
• Raynaud’s phenomenon
• Blood clots (including DVT – deep vein thrombosis)
• Varicose veins

They may be caused by the following, depending on the disease

• Atherosclerosis (when the arteries become clogged and hardened)
• Diabetes
• Being overweight
• High cholesterol
• Smoking
• Infection

Symptoms

Pain can be experienced in many ways. With claudication, you can have muscle pain typically occurring in your legs when you are active but resolves when resting. PAD can cause muscle weakness, causing problems with walking and performing daily activities. There are other symptoms associated with certain diseases. These could be cold hands or feet, numbness, swelling, or tingling, among others. 

Atherosclerosis and vascular pain

Atherosclerosis is the primary cause of PAD and is a complex process leading to the buildup of fatty plaque in the arteries, making it harder for blood to flow through them. As well as PAD, atherosclerosis can increase your risk of a heart attack and stroke.

Because blood carries essential things needed for cells to function, reduced blood flow can cause pain and tissue death. When this happens in the leg, it may be called “claudication” and is apparent during exercise as the muscles in the leg don’t get the required oxygen from the blood. Resting for a few minutes can cause the pain to go away, but it can recur when being physically active again.

Risk factors for atherosclerosis include high cholesterol (especially “bad” LDL cholesterol), raised triglycerides (fats), high blood pressure, smoking, diabetes, an unhealthy diet and being overweight/obese.  Staying active is another way to lower your risk of developing it.

Blood clots

A deep vein thrombosis (DVT) is a blood clot usually affecting the leg that can be extremely serious.  Unlike atherosclerosis, this affects the veins which are the blood vessels carrying blood back towards the heart. Along with throbbing or cramping pain, you may notice swelling and redness in the affected area.

Triggers for developing a DVT are prolonged immobility, certain medications, recent major surgery or trauma, among others. Ultrasound can be used to diagnose it (as well as other imaging), and anticoagulation may be given to dissolve the clot.

A DVT can lead to a complication known as a pulmonary embolism (PE), which is when a part of a blood clot breaks off and blocks a blood vessel in the lung. This is a very serious condition, and you may experience:

• Breathlessness
• Chest pain or discomfort, sometimes worse when taking a breath/coughing
• A faster-than-normal heart rate (pulse)
• Light-headedness

It is vital that you contact emergency services if you have these symptoms.

Vasculitis

There are different types of vasculitis, and they involve the inflammation of blood vessels. With this inflammation, it can weaken and narrow the vessels to the extent that they become blocked. Most are rare conditions affecting one or more organs. The following list contains a few examples and is not exhaustive, and a brief summary of the type of pain involved is given for the conditions:

Behcet’s disease

Painful mouth ulcers, genital ulcers and eye inflammation are typical of the disease. Additionally, the joints are affected in roughly half of sufferers, leading to pain and stiffness.¹

Giant cell arteritis (temporal arteritis)

Affecting people mainly over 50, it causes frequent and severe headaches, tenderness around the scalp/temples, and jaw pain.

Henoch-schönlein purpura

This disease is most common in children between the ages of 2 and 11 years and involves the skin in all cases. Tummy pains can be severe and lead to blood in stool, and joints can become inflamed, leading to pain and swelling.

PAD

Being a relatively common condition, many will have experienced the typical symptom of pain developing in one or both calves when walking or exercising which is relieved when resting. Called intermittent claudication, it occurs because when you’re using your legs, you need extra blood and oxygen for the calf muscles.  Since the artery is narrowed, this demand isn’t met, and pain arises.

If the artery blockage is higher up, you may develop pain in the thigh or buttocks.

In more severe cases, the pain could arise even when resting, typically starting in the toes and feet. Sores can also occur, as well as:

• Hair loss on the legs
• Poor pulses in the feet
• Coldness of the lower leg and foot
• A shiny skin on the leg

Diagnosing PAD

By measuring the blood pressure in the ankle and comparing it to your arm reading, a healthcare worker can take what is called an ankle brachial pressure index (ABPI). If there is much of a difference, then it could mean PAD, although it isn’t possible to say which blood vessels are affected. Sometimes, the ABPI can be normal, however.

Treating PAD

Living a healthy lifestyle by stopping smoking, eating a healthy diet, losing weight if overweight and exercising is the most important thing you can do to treat PAD.

Sometimes aspirin or a drug called clopidogrel is given. This isn’t to treat the symptoms but rather to prevent damaging clots from forming in blood vessels. Cilostazol can be added if the condition is limiting your lifestyle, as this can provide symptom relief.²

Statins can be prescribed if your cholesterol levels are high, and your healthcare practitioner should monitor your blood pressure and, if you are diabetic, then how well you are managing the condition.

If things don’t improve, you may be referred to a vascular specialist. They may carry out a procedure called revascularisation coupled with exercise therapy. Surgical intervention is rare in those with PAD however.²

Living with vascular pain

The first step is to talk about the pain and to try and find the diagnosis.  Once you are informed of this, support groups specific to the disease you have are available over the internet or even in person.

Things you can do to help manage your condition are more specific to what you have.  Checking your feet and toes often is recommended for those with PAD, for example, as the blood supply to them may be compromised.

Complications of vascular pain

These depend on the condition. We discussed some of these (e.g. PE from a DVT), but for rarer conditions that affect other organs, it’s best to have an idea of the complications you may face.

It is a good idea to ask questions about your diagnosis and your risks for specific conditions.

FAQ

• What is vascular pain?

It is pain or discomfort caused by problems with the blood vessels.  The causes are varied, but essentially, the pain is from the reduction of blood flow to a particular area.

•  How is vascular pain diagnosed?

A healthcare professional will take a detailed history, examine you and may order tests and investigations. These can include blood tests, imaging and biopsies.

•  How can I treat it?

This depends on what the underlying cause is, but living a healthy lifestyle as possible is advised, whatever the circumstances. Pain relief could be used for vasculitis, although you should discuss with a pharmacist about over-the-counter drugs as they may need to be avoided when taking prescription medication.³

With certain conditions, prompt medical attention is required.  This includes the above, and with a DVT/PE and GCA, it can be an emergency.

• What is the outlook?

As the causes of vascular pain are different, you would have to find out the prognosis of your specific condition.

Generally, PAD it is associated with other cardiovascular disease, and so general cardiovascular prevention is encouraged.²

 Early intervention can stop the progression of diseases, therefore limiting the pain.

•  Is vascular pain a chronic condition, or can it be cured?

This varies on the underlying cause.  While some conditions leading to vascular pain can be managed effectively with treatment and/or lifestyle changes, others may require ongoing care to control symptoms and prevent recurrence.

• Is vascular pain more common in certain groups?

 Some causes of vascular pain affect the young more commonly, while others are found mainly in older groups of people.  Factors such as genetics, lifestyle choices, and underlying health conditions can also contribute to the risk of developing vascular pain from the different diseases. 

There is a higher risk for some ethnicities for some of the conditions, as well as differences between the sexes.

Summary

Vascular pain arises from diseases affecting the circulatory system. It can manifest as cramping, tightness or aching, typically in the legs but also in the arms and hands. 

Causes include peripheral arterial disease, vasculitis, Raynaud's, blood clots, and varicose veins. These may be triggered by atherosclerosis, diabetes, smoking, infection, etc. 

Symptoms depend on the specific disease but may include claudication, swelling, numbness, and tingling. Key causes are outlined - atherosclerosis, blood clots, and vasculitis. 

Diagnosis involves medical history, exams, tests and imaging. Treatment depends on the cause but may include lifestyle changes, medications, surgery or exercise therapy. 

Prognosis and complications vary by disease. Vascular pain risks differ between age groups, sexes and ethnicities. 

Seeking prompt medical care is advised.