Living With Chronic Pain

Intermittent Pain

Last week I defined chronic pain as any pain lasting longer than the reasonably expected healing time for the tissue involved. Most consider it to be after 3-6 months. But a variation of chronic pain is the type that’s intermittent, which is when pain-free times alternate with weeks or months of daily pain.

In some ways. I think intermittent pain is one of the more challenging type to have – one minute everything is going fine, then the next, seemingly out of the blue, there’s significant pain lasting minutes, hours or days. It then resolves for awhile so it gets ignored. Until the next bout. Many adults experience chronic intermittent pain in the back, hip, neck, head, or abdomen. We often chalk it up to stress or age. While most are probably benign anything that is repetitive or long lasting needs to be assessed to ensure it is not due to an underlying issue.

Here are a few examples of the types of pain often ignored or diminished until it gets to hard to ignore:

One family member had intermittent low back back since her twenties, assuming it was a result of how she slept or exercised. The pain worsened when she was pregnant but she attributed it to the weight from her belly. This time it persisted after delivery. Being young and healthy she never imagined it would be a problem until one day bending over to pick up her 2 year old, she felt an excruciating pain down her leg. She had ruptured a disc and ultimately required surgery. Now she takes precautions never thought about before- not lifting over 20 pounds, having her toddler crawl into her lap instead of picking him up, even lighter purses. Along with stretching and mobilizing safely she’s had rare episodes since.

Another patient had intermittent headaches. For years she thought they were due to stress. But when they became more frequent and interfered with her life she finally sought help. It turned out she had temporomandibular joint dysfunction. A condition that causes painful clicking, popping or jaw pain due to grinding that often translates to ear, head or neck complaints. Allowing it to persist can lead to cracked and shifting teeth. Getting a night guard to protect the jaw and teeth from further damage as well as a muscle relaxant to stop the spasms gave her tremendous relief.

Another had intermittent abdominal pain along with alternating diarrhea and constipation, again chalked up to stress and diet. After dealing with it for years, he decided to investigate. A combination of indigestion and irritable bowel was diagnosed after more serious issues were ruled out. Although stress, diet and weight can contribute to the process an infection -H Pylori- was also found to be present. Once treated and given better dietary options and stress reduction techniques, he’s vastly improved. In another case colitis or bowel inflammation was diagnosed, requiring a different treatment plan.

Recently I saw a young man who admitted he’d had aching in his hands, especially in the morning, for years. He was certain it had been due to playing instruments- the piccolo, guitar and piano- since it improved when he stopped. But in the past few months it had progressed- now his hands were also red, swollen and warm to the touch. Worried he’d lose his livelihood, so he finally sought help when it had impacted his ability to perform. After a thorough evaluation, it became clear he had rheumatoid arthritis. Fortunately he was seen before erosive, or bone loss, had occurred, permanently damaging the fingers.

An older lady came in concerned because her year long struggle with hip pain had started to cause back troubles. She was convinced it was “bursitis.” Closer evaluation showed it was due to ligament damage in her knee that had caused her gait to change, putting undo stress on the low back and hip. Neither of which were the culprit. Resolving the knee problem took the other pains away.

I’ve reiterated many times my bouts of neck and shoulder blade pain, surely due to being a single mom, long work days, and stress. Not once did I imagine it was due to serious underlying neck arthritis. And I’m in the profession. I should have know better! But that’s human nature- to diminish our concerns and assume it’s nothing.

If you’re having intermittent and persistent pain, get it checked out. The vast majority of the time, there won’t be any underlying disease. The point is to make sure you’re in that category. Even then, if it all boils down to stress, isn’t it time to deal with that? If you haven’t sought medical care already, when stress starts to manifest as physical concerns, isn’t it time to talk to someone? There could be many options available to help keep it at bay.

Dr. Courtney

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