What should you know about pain syncope?

A sudden drop in blood pressure and heart rate can briefly reduce blood flow to the brain. Warning symptoms may include nausea, sweating, warmth, pale skin, dizziness, blurred vision, or ringing in the ears. The trigger may be an injury, procedure, abdominal pain, or another intensely unpleasant sensation. Fainting itself can cause a fall, so the injury from the collapse may need assessment. A clinician may also consider contributors such as dehydration, anaemia, low blood sugar, or an irregular heart rhythm.

Help the person lie flat and raise their legs if there is no suspected injury. Loosen tight clothing, keep the area clear, and check that they are breathing normally. Do not give food or drink until they are fully alert. After recovery, sit up slowly and rest; avoid driving, heights, or bathing alone until the cause has been discussed with a clinician. Record the pain trigger, warning symptoms, duration of unresponsiveness, and any injury.

Seek emergency help if the person does not quickly regain awareness, has trouble breathing, chest pain, a severe headache, seizure-like movements, a serious injury, or faints during exercise. Arrange medical assessment for a first faint, repeated episodes, fainting without warning, or a possible heart problem. Prompt review is also sensible when vomiting, poor fluid intake, heavy bleeding, or symptoms suggesting anaemia, dehydration, hypoglycaemia, or atrial fibrillation are present.

Ask whether the episode fits pain syncope, whether an examination or heart tracing is needed, and how to manage the painful trigger. Mention medicines, fluid intake, bleeding, palpitations, family history of sudden death, and any fall or head injury.