Subject: Re: chronic back pain
Forum: The Neurology and Neurosurgery Forum
Topic Area:
Posted by CCF Neuro MD on July 13, 1997 at 14:52:00:
In Reply to: chronic back pain posted by Scott Small on July 05, 1997 at 12:41:49:

: I have been having back pain for about 5 years. There is a spot on my back between T4 and T8 that is sharp pain it then radiates around my ribs and then spasms around the rib area. I have had two rhizatomys that have been in the T4, T7 and T8 areas. I have been on several different medications and also been to Emory University however no one can diagnose the problem. I am now being sent to the mayo clinic for this problem. Have you ever heard of any symptoms like these?

What you describe sounds like thoracic or truncal radiculopathy. It is not very common, but we do see a few cases each year, although they may not be as severe and intractible as your case. The causes can be compressive or non-compressive. Compression of the thoracic nerve roots can be from a local tumor or cancer metastases to the spine or from spondylosis or degenerative arthritis of the thoracic spine (which is uncommon). Reading about the evaluations and treatments you have received at Emory, I think these compressive causes are unlikely in your case. The two important non-compressive causes are diabetes and prior herpes zoster (shingles). There are a few less common causes such as lyme disease. Besides pain, some patients may have an area of numbness of skin at the appropriate level, and may also have abdominal wall weakness with bulging. Treatment depends upon the cause, of course. Symptomatic treatment of the neuralgic pain includes medications such as carbamazepine and tricyclic agents, which you must have tried, and invarive measures such as epidural or intrathecal analgesia and surgery.
The department of neurology at Emory is an excellent one, and your case must be a really difficult one diagnostically and therapeutically that you need to go to the Mayo Clinic for further management. In case you wish to come to the Cleveland Clinic for yet another opinion, I recommend that you see any of the neuromuscular specialists here (Drs. Levin, Mitsumoto or Shields). Neurology appointments can be made by calling (800)223-2273 or (216)444-5559. The Cleveland Clinic also has a very active pain department.
I wish you the best of luck.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options of your specific medical condition.

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