Living With Chronic Pain

Intermittent Pain

Chronic pain is debilitating. That constant irritant or outright agony that never goes away. But at least those of us who suffer with it know what to expect and often what makes it better or worse. Intermittent pain on the other hand is far more challenging.

This is when pain-free times alternate with days, weeks or months of daily pain. One minute everything is going fine, then WHAM out of the blue, a bolt of lightening hits the body. These are often associated with headaches, arthritis, TMJ disease, irritable bowel syndrome, colitis, and neuropathic pain. There are many of types of neuropathic pain – post surgical (lower back pain with intermittent leg pain), CRPS (chronic regional pain syndrome), and diabetic neuropathic pain in the feet causing a stinging needle-type pain up and down the legs intermittently.

Claudication is another cause for intermittent pain that usually occurs in the legs with walking that puts a literal cramp in any plan to keep active. There are two main types:

With vascular claudication, blood vessels narrow to the point where the amount of blood that flows through them is not enough to meet the demands of the lower extremities when moving. At rest it’s not an issue, but when stressed, the blood supply can no longer keep up with the muscles urgent needs. When walking or exercising the muscles in the legs require more blood flow so they can provide the increased oxygen needs to cells.

Several medical problems can cause claudication, but the most common is peripheral artery disease. Peripheral artery disease (PAD) is caused by atherosclerosis, which is a hardening of the arteries from an accumulation of cholesterol plaques that form on the inner lining of the arteries. This is especially common at branching points of the arteries in the legs. Atherosclerotic plaques cause “ dents” in vessels. These block the increased blood flow and oxygen required with activity causing the muscles of the legs to ache and burn. 

Neurogenic claudication occurs when nerves get impinged as they exit the spinal cord, as commonly occurs after surgery or with lumbar stenosis. This is a narrowing in either the opening that houses the spinal canal, or the neural foramina – the openings where the nerves exit the spinal cord and traverse to the extremities. With neurogenic claudication sensitive nerve tissue that normally passes through these spaces unimpeded becomes compressed by the nearby bone, degenerative changes, disc ruptures or other issues. Now instead of the impact being on blood flow, essential nerve impulses required to get the lower extremities moving are compromised. The more the activity the less the muscles can respond and the worse the pain. If pushed too far they can’t respond at all.

One year my daughter and I visited Disneyland with a friend and her two boys. Not wanting to slow them down or stop their fun, I pushed myself to the limits. After hours of walking the park minutes resting on rides no longer gave me sufficient time to recover. I was done. Every step was painful. I knew it was time to quit.

But they all wanted to enjoy just one more thrill on Space Mountain.

I remember thinking, why not, one more then I’ll have a nice long car trip home. But my body didn’t agree. I couldn’t beg, threaten or demand any more. Half way up the tight, winding hallway, deep into the mountain I couldn’t go on. The nerves were shot, the muscles dead and the pain excruciating.

I sat down in the middle of hundreds of waiting patrons, incapable of moving any further. Now that’s embarrassing. As was the attitude that clearly implied I was faking it,

“You were fine one minute ago, what happened ?”

As if I enjoyed the humiliation of keeping people waiting 45 minutes while the park got a wheelchair through and wheeled me out to the parking lot!

Talking to my neurosurgeon afterwards he reminded me of my anatomy after dozens of surgeries and the physiological consequences they cause. I’m a physician, I should have known better and realized the truth. But when it comes to my own health and limitations, just as all other pain patients tend to do, I internalized the problem. Immediately believing I just needed to be stronger and deal with it. Never knowing when the pain will strike, or how intensely, often encourages withdrawal, depression and inactivity. Intermittent pain can be debilitating, exhausting, overwhelming and challenging to manage. More so if it’s on top of chronic pain as well. Once I realized what was happening, that it wasn’t something I could overcome, but rather signs my body was desperately sending to tell me to stop, I could finally honor my needs before catastrophe struck.

Knowledge is empowering. Don’t let intermittent pain keep you from living your life to the fullest. Talk to your healthcare provider today to learn the underlying cause, how to deal with it and any treatment options they may be available. Knowing the cause made all the difference in mine.


Sources:

-wjgnet.com/2218-5836/full/v5/i2/134.htm

-jamanetwork.com/article.aspx?doi=10.1001/jama.2009.1946

-sciencedirect.com/science/article/pii/S1743919117305836?via%3Dihub

-mayoclinic.org/diseases-conditions/claudication/symptoms-causes/syc-20370952

-ncbi.nlm.nih.gov/books/NBK430872/

-healthskills.wordpress.com/2009/01/21/intermittent-pain/

-ncbi.nlm.nih.gov/pmc/articles/PMC4630161/

-medicinenet.com/claudication/article.htm#what_are_the_symptoms_of_claudication

-medicinenet.com/claudication/article.htm#who_gets_claudication

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