Abdominal Pain: Causes and Concerns in Internal Medicine - Internal Medicine

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Understanding abdominal pain and its potential causes can be quite complex, especially when symptoms are intermittent and diagnostic tests return normal results. Your situation, characterized by episodes of side and back pain, as well as sensations resembling gastric spasms, raises several considerations that merit exploration.

Firstly, it’s important to recognize that abdominal pain can stem from a variety of sources, including gastrointestinal, musculoskeletal, and even psychological factors. Given your history of sudden onset pain and the absence of any visible rash or other symptoms associated with shingles (herpes zoster), it seems less likely that your pain is directly related to a viral infection. However, the initial concern about shingles is valid, as it can present with pain before any rash appears, particularly in individuals who have had prior exposure to the virus.

The fact that your pain resolves quickly after receiving pain relief in the emergency department suggests that it may be more related to muscle strain or spasms rather than a serious underlying condition. Muscle pain can be exacerbated by activities such as golfing, especially if there are movements that involve twisting or sudden exertion. It’s also worth noting that muscle spasms can sometimes mimic visceral pain, leading to confusion about the source of discomfort.

In your case, the recurrent nature of the pain and its association with physical activity could indicate a musculoskeletal issue, such as a muscle strain or even a herniated disc, particularly if the pain radiates to the back. While imaging studies like X-rays or ultrasounds may not show soft tissue injuries, an MRI could provide more insight into potential disc issues or nerve impingement that might not be visible on other imaging modalities.

Additionally, psychological factors such as stress and anxiety can exacerbate physical symptoms, including pain. If you have a history of anxiety, it may be worthwhile to consider how stress might be influencing your physical health. Anxiety can lead to muscle tension, which may contribute to pain, particularly in the back and abdomen.

Given that you have experienced these episodes multiple times without a clear diagnosis, it may be beneficial to consult with a specialist, such as a gastroenterologist or an orthopedic physician, who can conduct a thorough evaluation and possibly recommend further imaging studies like an MRI if musculoskeletal issues are suspected. A multidisciplinary approach, including physical therapy, may also be helpful in managing your symptoms and preventing future episodes.

In summary, while your symptoms have not yet yielded a definitive diagnosis, the interplay between physical activity, potential muscle strain, and psychological factors could all be contributing to your abdominal and back pain. Continuing to monitor your symptoms, maintaining open communication with your healthcare providers, and considering a comprehensive evaluation may lead to a better understanding of your condition and effective management strategies.