Chronic Pain: How to Identify Causes and Seek Treatment

When experiencing multiple areas of soreness and tingling, which symptom should be prioritized and how can the underlying cause be determined?

Dear Dr.
Liao,
Regarding Symptom 1, during my military service, I experienced a back strain while lifting heavy objects.
For a while, I would wake up in the middle of the night due to pain, making it difficult to sleep.
I sought treatment at a military hospital and received medication, which alleviated the symptoms significantly.
After my discharge, my current job requires me to sit at a desk for over 7 hours a day.
After six months of this, I began to experience back pain again, accompanied by discomfort in my lower back.
I have consulted both orthopedic and rehabilitation specialists, and X-rays confirmed that there are no issues with my bones.
The doctors believe that prolonged sitting and poor posture have led to muscle stiffness.
I underwent three months of rehabilitation and took muscle relaxants, but there has been no improvement.
For Symptom 2, two months later, after getting up from my seat, I experienced mild stabbing pain in my right hip.
Two days later, the pain intensified to the point where I could barely walk.
I urgently went to a large hospital for an injection to relieve the pain.
At that time, the doctor diagnosed me with acute sciatica and arranged for a nerve conduction study in the neurology department, which returned normal results.
I have been taking anti-inflammatory and pain relief medications, and now, two months later, I still experience stabbing pain when coughing or performing certain movements, but not while walking, and my legs do not feel numb.
For the above two symptoms, what types of examinations (CT scan, MRI?) can be done to determine the underlying cause? I would like to address these issues as soon as possible, as they have been troubling me for quite some time and are affecting my work and daily life.
I sincerely request your assistance in providing the correct direction and necessary examinations.
Thank you very much, and I wish you good health and all the best.

Nick, 20~29 year old female. Ask Date: 2015/12/18

Dr. Liao Yaopan reply Family Medicine

Hello, based on your inquiry, it is recommended to consult a neurosurgeon for further evaluation.
Thank you for your message, and we appreciate your concern.
Changhua Hospital.

Reply Date: 2015/12/18

More Info

Chronic pain, particularly in the back and hips, can significantly impact daily life, as you've described in your symptoms. Understanding the underlying causes and seeking appropriate treatment is crucial for managing this condition effectively.

From your description, it seems that your pain has a multifactorial origin. The initial injury during your military service, where you lifted heavy objects, likely set the stage for ongoing issues. This type of injury can lead to muscle strain, ligament sprain, or even disc problems, which may not always be visible on X-rays. The subsequent development of pain after prolonged sitting suggests that your posture and the ergonomics of your workspace may be contributing factors. Poor posture can lead to muscle imbalances and increased strain on the lumbar spine, exacerbating discomfort.

The acute episode of right hip pain you experienced, diagnosed as acute sciatica, indicates that there may be nerve involvement. Sciatica is often caused by compression or irritation of the sciatic nerve, which can occur due to herniated discs, spinal stenosis, or other structural issues in the lumbar spine. The fact that your nerve conduction studies were normal is a positive sign, suggesting that there may not be significant nerve damage, but it does not rule out the possibility of nerve irritation or inflammation.

Given the complexity of your symptoms, further imaging studies could provide valuable insights. Here are some recommendations:
1. MRI (Magnetic Resonance Imaging): An MRI of the lumbar spine is highly recommended. It provides detailed images of soft tissues, including discs, nerves, and muscles, which can help identify any herniated discs, nerve root compression, or other abnormalities that may not be visible on X-rays.

2. CT Scan (Computed Tomography): If MRI is contraindicated or unavailable, a CT scan can also provide detailed images of the spine and may help identify structural issues.

3. Physical Therapy Evaluation: Since you've already undergone physical therapy without significant improvement, consider a re-evaluation. A physical therapist can assess your posture, movement patterns, and muscle strength to develop a tailored rehabilitation program. They may also incorporate modalities such as ultrasound, electrical stimulation, or manual therapy to alleviate pain.

4. Pain Management Consultation: If your pain persists, consulting a pain management specialist may be beneficial. They can offer interventions such as epidural steroid injections or nerve blocks, which can provide temporary relief and help you engage more effectively in physical therapy.

5. Lifestyle Modifications: In addition to medical interventions, consider making ergonomic adjustments to your workspace. Ensure that your chair supports your lower back, and your computer screen is at eye level to reduce strain. Incorporating regular breaks to stand, stretch, and move around can also help alleviate discomfort.

6. Mind-Body Techniques: Chronic pain often has a psychological component. Techniques such as cognitive-behavioral therapy (CBT), mindfulness, or yoga can help manage pain perception and improve coping strategies.

In summary, your symptoms warrant further investigation through MRI or CT imaging to identify any underlying structural issues. A multidisciplinary approach, including physical therapy, pain management, and lifestyle modifications, will be essential in addressing your chronic pain effectively. It's important to communicate openly with your healthcare providers about your symptoms and concerns to ensure you receive the most appropriate care. Wishing you a swift recovery and improved quality of life.

Similar Q&A

Chronic Pain: Seeking Help for Unexplained Neurological Issues

Hello doctor, I have been experiencing pain in my limbs and lower back for over ten years. However, in the past year or two, the pain has intensified, occurring almost every two to three days, and I have been relying on painkillers to get through my daily life. Interestingly, I h...

Dr. Huang Yingzhe reply Neurology
Given your age, I would recommend starting with a consultation in immunology and rheumatology, and then considering neurology or psychosomatic medicine. It can indeed be challenging to make a diagnosis at times, and medication may be used initially to reduce pain.

Overcoming Chronic Pain and Anxiety: A Path to Normal Life

Hello doctor, I have been suffering from various ailments for 5 years and have not worked for 3 years. It started with numbness in my left leg due to prolonged sitting, which later progressed to pain in my left knee. The entire leg felt numb, as if blood was not circulating, and ...

Dr. Lin Zhebin reply Family Medicine
Hello: Here are some personal suggestions regarding the issues you raised: 1. Anxiety disorder + hypochondriasis + autonomic nervous system dysregulation with palpitations + left-sided headache and numbness: - It is recommended to continue taking psychiatric medications to alle...

Understanding Chronic Pain: Neurological Insights and Solutions

Hello Director Yeh, I have been suffering from chronic pain and numbness in my left upper back. Even during short activities like washing dishes, I feel unable to support my body, which leads to headaches. Additionally, I experience pulling pain in my left foot's fourth toe...

Dr. Ye Boshou reply Neurology
Hello: 1. The pain in the back may be due to tendonitis or neuropathy. 2. The knee has been examined and found to be normal; if pain persists, physical therapy may be needed. 3. It is recommended to see a physical therapist.

Understanding and Treating Chronic Bone Pain After Injury

I previously had an injury to my neck, where the twisting caused compression of the bones, and I often experience soreness and pain. Is there a way to treat this effectively?

Dr. Chen Xingyuan reply Orthopedics
Dear Miss Amy, There are many reasons for neck pain, such as injuries, inflammation of muscles or tendons, and diseases of the bones or nerves. Therefore, identifying the underlying cause is very important. In fact, most neck pain is caused by poor posture or improper use, leadi...