Intermittent Left Side Pain: Causes and Specialist Recommendations

Lower back pain

Hello doctor, I have been experiencing intermittent sharp pain on the left side of my ribcage extending towards the area near my spine, specifically to the left of the vertebrae.
The pain comes in sudden bursts and is not associated with tenderness or specific positions.
Sometimes it occurs every few minutes, and other times it happens two to three times within a minute.
Each episode lasts about one to two days and then completely resolves, occurring approximately once every six months, which makes me often forget about it.
The first episode seems to have occurred two to three years ago, but it always happens in the same location.
I have previously consulted a nephrologist and urologist, who found a very small urinary stone on the left side, but the doctor said that it would not cause pain and did not consider it the primary issue.
They suggested I improve my posture.
However, I feel that the pain is not muscular; it feels more like an internal cramping sensation.
I am worried it could be related to my pancreas after doing some online research.
Additionally, this recent episode and the one last October coincided with my menstrual period.
I am unsure which specialty to consult—should I see a hepatologist, gastroenterologist, pain specialist, or a rehabilitation specialist? Or would you recommend any specific tests? Thank you.

Zhuang, 20~29 year old female. Ask Date: 2021/07/26

Dr. Xiao Yongxun reply Family Medicine

Dear Miss Chuang,
1.
Acute pancreatitis is most common in middle-aged individuals, with the most frequent causes being gallstones and alcohol abuse.
In milder cases, it can lead to inflammation, edema, and fat necrosis of the pancreas and surrounding tissues.
In more severe cases, it can cause bleeding and necrosis of the pancreas itself, as well as fat necrosis in other areas of the abdominal cavity or even subcutaneous tissues.
Therefore, the primary clinical manifestation of acute pancreatitis is acute abdominal pain, although systemic symptoms or abnormalities may also occur.
Serum levels of amylase and lipase are significantly elevated.
In the case of chronic pancreatitis, the pancreas undergoes progressive tissue destruction and a gradual decrease in parenchyma due to repeated episodes of inflammation, which are replaced by fibrous tissue.
Similar to acute pancreatitis, it also commonly occurs in middle-aged individuals, particularly those with a history of alcohol abuse.
Atrophy and fibrosis of the pancreatic acinar tissue are often observed.
Calcification, dilation of the pancreatic duct, and the formation of pseudocysts are also quite common.
The main clinical symptom of chronic pancreatitis is recurrent abdominal pain; when pancreatic tissue is severely damaged, it may present with pancreatic insufficiency or diabetes.
2.
As for malignant tumors originating from the pancreatic duct epithelium, most are pancreatic adenocarcinomas, which predominantly affect older adults and are associated with smoking and high-fat diets.
Patients who have undergone partial gastrectomy are also at increased risk.
Pancreatic cancer typically occurs in the head of the pancreas.
Tumors located in the head of the pancreas can cause jaundice, making them more noticeable.
In contrast, tumors in the body and tail of the pancreas may not present symptoms until they are quite large, making early detection difficult.
Pancreatic cancer is challenging to diagnose early, resulting in a very poor prognosis.
3.
Based on your statements, timeline, and age, while it cannot be completely ruled out immediately, the likelihood of diagnosing pancreatitis or pancreatic cancer at this time is indeed low.
4.
Additionally, if the symptoms occur only during menstruation, endometriosis should be considered; however, clinically, there are very few cases similar to what you described, so it may not be prudent to suspect this diagnosis right away.
5.
Personally, I believe your symptoms may still be related to a musculoskeletal issue.
I recommend that you first discuss this with your primary care physician before making any decisions, or you may directly visit an orthopedic outpatient clinic at a regional hospital or higher.
Best regards.

Reply Date: 2021/07/26

More Info

Intermittent left side pain, particularly when it occurs in the area around the ribs and extends towards the spine, can be concerning and may have various underlying causes. Given your description of the pain as sharp and intermittent, with no associated tenderness upon palpation, it is essential to consider several potential factors that could contribute to your symptoms.

Firstly, the timing of your pain coinciding with your menstrual cycle suggests that hormonal changes could be influencing your discomfort. Conditions such as endometriosis or ovarian cysts can sometimes cause referred pain to the lower back or sides, particularly during menstruation. Endometriosis, for instance, occurs when tissue similar to the lining of the uterus grows outside of it, which can lead to significant pain during menstruation and may cause intermittent sharp pains in the pelvic region.

Additionally, the fact that you have a history of a small urinary stone, although deemed not the primary cause of your pain, should not be entirely dismissed. While small stones often do not cause symptoms, they can occasionally lead to intermittent pain if they move or cause irritation in the urinary tract. It may be worthwhile to follow up with a urologist to ensure that there are no other underlying issues related to your urinary system.

Musculoskeletal issues could also be a factor. The description of your pain as "not muscle pain" is interesting, but it is still possible that it could be related to muscle spasms or nerve irritation in the thoracic spine area. Conditions such as intercostal neuralgia, which involves irritation of the nerves running between the ribs, could lead to sharp, intermittent pain that is not necessarily associated with movement or pressure. A physical examination by a specialist in pain management or rehabilitation could help determine if this is the case.

Given the intermittent nature of your pain and its specific location, it may also be beneficial to consider gastrointestinal issues. Conditions such as gastritis, peptic ulcers, or even issues with the pancreas can sometimes present as left-sided pain. While you mentioned concerns about pancreatic issues, it is essential to note that pancreatic pain typically presents with other symptoms, such as nausea, vomiting, or changes in appetite. However, if you have any concerns about your digestive health, consulting a gastroenterologist could provide further insights.

In terms of specialist recommendations, it would be prudent to start with a visit to a gynecologist to rule out any reproductive system-related issues, especially considering the correlation with your menstrual cycle. If gynecological causes are ruled out, a consultation with a pain specialist or a physical medicine and rehabilitation physician could be beneficial. They can assess for any musculoskeletal or neurological issues that may be contributing to your pain.

In summary, while your left side pain could stem from various causes, including hormonal changes, musculoskeletal issues, or gastrointestinal concerns, it is essential to approach this systematically. Start with a gynecological evaluation, and if necessary, expand to other specialties based on findings. Keeping a detailed record of your symptoms, including their frequency, duration, and any associated factors, can also be helpful for your healthcare provider in diagnosing the issue accurately.

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