A reader Micah asks:

Is it considered chronic pain when the pain is cyclic? I have a friend who has a neurological disease that only flares up every 6 months or so. Even though he’s not in pain, he often thinks about it returning.

Yes, I’d consider that chronic pain, even thought it’s intermittent.  It sounds like pain is one of the symptoms that comes with a flare-up of his neurological problem.  Sometimes pain is a symptom of another disease (for example, multiple sclerosis and headaches are 2 neurological problems that can cause intermittent pain).  Sometimes pain is the disease itself (when there’s a disease of a part of the body that’s responsible for pain).

In your friend’s case, it may be that pain is one of the most scary or difficult-to-deal-with symptoms of his other disease.  All of the things we discuss on these pages may be of help at those times when he has pain.  And I’d even suggest learning some of the coping skills before the pain starts.

If your friend worries about the pain returning, another idea that comes to mind is that the pain may be causing anxiety symptoms.  One of the characteristics of anxiety is worrying too much about… everything in “Generalized Anxiety,” the anxiety itself in “Panic Disorder,” an object or situation in “Phobias” (like spiders or flying), social situations in “Social Anxiety,” etc.  In fact, one of the symptoms of Panic Disorder is being fearful about another panic episode, even if you haven’t had one in a long time.  And certainly pain can cause someone to worry about its returning.

Severe pain could also cause Post Traumatic Stress Disorder - PTSD, which is another anxiety disorder.  The experience of severe pain is a trauma, just like being in a bad car accident or seeing a shocking event is one.  Symptoms can include not just worrying about the pain coming back, but having nightmares about the situation, doing anything to avoid the situation, and an increase in anxiety in general.

Good luck to your friend.