Intermittent, shifting pain can indicate chronic pain in nursing assessment.

Pain that doesn’t sit still can be one of the trickier shifts a nurse faces. You’re listening for a pattern, trying to read between the lines of a patient’s story, and you want to land on the right explanation so you can respond with the right care. When a client describes intermittent pain that isn’t anchored to a single spot, the line of thinking usually lands on chronic pain. Here’s the why behind that, plus a practical guide for assessing and supporting someone living with this kind of experience.

Chronic pain: what does it really mean?

Let me explain it in plain terms. Chronic pain is pain that sticks around longer than we’d expect based on typical healing timelines. A common threshold clinicians refer to is six months. But the clock isn’t the whole story. The pain can wax and wane, and the locations may shift over time. A patient might wake up with a dull ache in one area, then several days later feel sharp discomfort somewhere else entirely. That unpredictability is a hallmark of chronic pain, not a single, well-defined injury.

This isn’t just “tired nerves” or a vague discomfort. Chronic pain often involves changes in the nervous system. The way the brain and spinal cord process signals can become more sensitized, so ordinary sensations feel more intense, or pain can be triggered by things that wouldn’t have bothered the person before. That’s why someone can have pain in different spots at different times—because the underlying nervous system has learned to respond differently to stimuli.

A quick contrast to keep things straight

• Acute pain: sharp, intense, and tied to a specific tissue injury or event. Think a sprain, a cut, or a burn. It’s supposed to go away as the body heals.

• Psychogenic pain: pain that is heavily influenced by psychological factors, though that doesn’t mean the pain isn’t real. The body and mind are connected in intricate ways here.

• Neuropathic pain: caused by nerve damage or abnormal nerve signaling. It often feels like burning, tingling, shooting, or electric shocks, and it tends to follow a nerve pattern or distribution.

Intermittent, moving pain fits chronic pain more often than the others, especially when the patient describes variability in intensity and location over weeks or months. That’s the clinical signal to look beyond a single injury and toward a longer, more complex picture.

What a nurse keeps in mind during assessment

Assessment isn’t just about asking the right questions; it’s about listening for patterns and digging a little deeper with a curious, nonjudgmental mindset. Here are practical steps that tend to make a real difference:

• Start with a clear pain narrative

• When did it start? Has it lasted more than six months?

• How often does it occur, and how long does each episode last?

• Where is the pain located, and does it move? Does it ever radiate or feel as if it’s in multiple areas?

• What does the pain feel like (quality): dull, sharp, throbbing, burning, tingling?

• What makes it better or worse? Do activities, rest, heat, or medications affect it?

• How does the pain impact daily life — sleep, mood, work, social activities?

• Use reliable pain scales with flexibility

• Numeric Rating Scale (0-10) for adults who can rate intensity.

• Descriptor scales or the Wong-Baker FACES scale when appropriate (children, older adults with communication challenges).

• Consider a pain diary or a simple log for patients who experience fluctuations, so you can spot patterns over days or weeks.

• Explore related symptoms and triggers

• Are there fatigue, mood changes, or sleep disturbances that accompany the pain? These clues often braid into chronic pain.

• Any signs of stress, anxiety, or depression? Psychosocial factors can amplify pain perception and vice versa.

• Look for functional impact: limited mobility, changes in activity tolerance, or reduced participation in usual roles.

• Examine the big picture, not just the site

• Review medical history for chronic conditions that often accompany persistent pain (arthritis, fibromyalgia, inflammatory diseases, neuropathic components, or post-surgical pain).

• Consider medications, including analgesics and non-pharmacologic therapies, and assess effectiveness, side effects, and adherence.

• Check for red flags that would shift priorities (unexplained weight loss, fever, sudden neurological changes, weakness, or new, severe symptoms).

• Make notes, not judgments

• Document clearly where the patient says the pain is now, where it has been in the past, and any patterns of migration.

• Record functional limitations and the patient’s own goals for relief. For many with chronic pain, improving function and quality of life is as important as reducing pain intensity.

Transitioning from assessment to care planning

Understanding that the pain is chronic immediately nudges the care plan toward a comprehensive, multidisciplinary approach. The goal isn’t simply to “knock out the pain,” but to reduce its impact and improve the patient’s ability to live their life.

• Multimodal management makes sense

• Pharmacologic strategies can include non-opioid medications, adjuvant therapies, and careful, patient-specific use of analgesics when appropriate. The emphasis is on balancing relief with safety, minimizing side effects, and avoiding overreliance on one method.

• Nonpharmacologic options matter just as much. Gentle activity, physical therapy, heat or cold therapy, relaxation techniques, mindfulness, cognitive-behavioral strategies, and pacing can all help.

• Self-management and education

• Teach patients about the nature of chronic pain, how stress and sleep influence symptoms, and the importance of a steady, predictable routine when possible.

• Help them build a pain management plan they can live with, including what to do if pain worsens or if new symptoms appear.

• Reassessment is ongoing

• Chronic pain isn’t static. Regular reevaluation helps you adjust therapies, set new goals, and catch any shifts in the condition or contributing factors.

Why this distinction matters in care

Labeling intermittent, moving pain as chronic isn’t about labeling someone as ‘difficult’ or creating a box they must fit. It’s about recognizing a pattern that calls for a broader, more nuanced response. Patients often feel relieved when a clinician sees beyond a single symptom and acknowledges the whole picture—the way sleep, mood, stress, and daily function all weave into pain.

Digressing a moment for real-world texture

You’ve probably met patients whose pain has a mind of its own: it drifts, it surges, and it’s tough to predict. It can be exasperating to witness. But this is where a nurse’s steady presence shines. Validating the patient’s experience, asking thoughtful questions, and offering practical steps create trust. When a patient believes you understand the fluctuating nature of their discomfort, they’re more likely to share important details and engage in a plan that improves their day-to-day life.

A few practical tips you can bring to the bedside

• Keep a simple, patient-friendly pain diary: date, location, intensity, quality, and what helped or worsened it. A quick note each day can reveal patterns that aren’t obvious in a single visit.

• Use flexible language in documentation: “intermittent pain with shifting location, duration variable, impact on function present.”

• Encourage small, attainable goals: a better night’s sleep, longer walks, or fewer steps before stopping. Small wins add up and reinforce a sense of control.

• Coordinate with a team: PT/OT, social work, and behavioral health are allies in chronic pain management. The patient feels supported when care is cohesive.

Common pitfalls—and how to avoid them

• Don’t assume all intermittent pain is psychosomatic. Real, measurable symptoms deserve empathetic investigation and careful management.

• Don’t fixate on a single diagnostic label. Chronic pain is often a tapestry of factors—medical, psychological, and social—that intertwine.

• Don’t overlook the patient’s goals. Pain relief matters, but so does the ability to do what’s important to them—work, family activities, hobbies.

Bringing it back to the core idea

So, when a client reports pain that comes and goes and isn’t pinned to one spot, the best lens to use is chronic pain. It captures the durability, the variability, and the nervous-system emphasis that sets this experience apart from a simple injury or a purely psychological symptom. This understanding helps you guide the patient with compassion and practical, evidence-based strategies that address both sensation and life context.

If you’re building your clinical toolkit, keep this distinction in mind as a starting point for a thoughtful assessment and a collaborative care plan. You’ll be better prepared to respond when the pain isn’t a single, neat story but a longer, living narrative that your patient is writing with you.

Closing thought: people aren’t just their symptoms

Pain is personal. It touches sleep, mood, finances, and relationships. The better you are at recognizing the pattern, validating the experience, and coordinating a plan, the more you can help someone regain footing in daily life. That’s the art and science of nursing in one—listening well, thinking clearly, and acting with a plan that respects both the science of pain and the humanity of the person who bears it.