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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
Question Title: Mid thoracic pain secondary to injuries w/complicationsForum: Neurology Forum
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I am a 34 yr old white female. I have two children and a very demanding job as a Benefits Analyst in a major HMO in Arkansas. I smoke approx 1 pack of cigarettes a day. I occassionally drink 1-2 glasses of wine in the evenings. I weigh approx. 121 lbs. In 1992, my car was struck from behind. I suffered double whiplash injury. I had suffered acute/ chronic thoracic and cervical pain for approx 1 and 1/2 yrs afterwards. I had frequent severe muscle tension headaches for quite a while after that. Off and on since then, I would have flare-ups that would require narcotic pain med and muscle relaxers (Vicodin, Flexaril, etc) to relieve the symptoms until they would back down to a reasonable level. I have also been prescribed Buspar off and on to control occassional High Stress situations. I have never been officially diagnosed with anxiety, however, I do get very uptight when the pain and other life events necessitate it. Also, I purchased a TENS unit in 02/93. This is very helpful when I have a flare-up of a particular place (T4,5,6) that feels like a knife is placed in that area approx. a 1/2 inch to an inch deep. In April, 1996, I dropped down a few inches in a car seat. I suffered immediate severe pain. I could barely move for several days. There were bands of pain that would encircle my ribs and bring tears. The Thoracic region MRI results were negative at that time. However, for the following two years, I was still in a great deal of pain. Over the course of approx. 2 yrs following the 1996 injury, I had many rounds of PT prior to seeking treatment from Little Rock Pain Clinic. I have also had PT treatment as part of my treatment plan. The last PT I have seen for the last year or so (as needed) is specialized in treatment of Myofascial Pain symptoms. Dr. Hart (LRPC) has been my lifeline for the last 2 years. He has managed to knock out most of my symptoms with Trigger Point injections, epidurals, facet injections (T5/T6) and two RF procedures performed on a nerve to the left of this area. Life after the first RF procedure was pretty good except for Myofascial symptoms that still left me taking narcotics (Oxycontin) and muscle relaxer(Baclofen). However, the nerve regenerated (or so we thought) in 02/98. I was immediately started on PT again and another RF was perfomed in 03/98 along with several Trigger Point injections and an epidural on my Cervical and Thoracic spinal area. After the effects of the lidocaine or marcaine?? wore off, I was left with only a very severe pain in the area referenced above (T5,6). Upon awakening in the a.m, it would feel fine for about 15-30 minutes. Then the pain sets in and it's difficult to walk. My TENS unit helps but doesn't always take out all of it. An MRI was done and revealed a small herniation in the T4 region. I consulted with a Neuro-surgeon for possible surgery. He basically stated that he felt that the surgery was far too risky for the area it was located in and also , in his opinion, the herniation was not large enough to explain the severity of the pain. Anyway, now I'm also seeing a GI due to Dr. Hart's suspicion that I had a hiatal hernia that may be complicating matters due to onsets of severe heartburn and SEVERE pain that comes on in this same Thoracic region when I eat a mid to large meal. It is so severe, that a lot of times, I have to just stop eating. This also explains my weight loss. I have had a problem with losing weight since 04/96 anyway (approx. 15 lbs). However, since 03/98, I have lost another 5-6 lbs. It is very difficult to get excited about eating at all anymore. There have been two Rxs for Medrol Dose packs. The first one (04/98). The latter one (06/98) had virtually no effect. I had an EGD done in 07/98 that did reveal a Small Sliding Hiatal Hernia w/ no inflammation. I have been taking Prilosec. (2 x day until a week ago or so, GI dr. asked that I back down to 1x day. It has helped the heartburn but I still have no relief of the backpain when I eat. (as explained earlier). The GI dr. did not have much to suggest as far as a connection between the two issues. I'm still using my TENS. I'm also using Duragesic patches (50 u/g hr). Still taking the Baclofen. I discontinued the Buspar due to sleeping problems. I also take Lortab (5 mg) for breakthrough pain. And, I take the Prilosec. I have searched all over the web looking for a connection between a hiatal hernia and Thoracic back pain and can find nothing. Would it be possible if I were to have this fixed, that it may lessen my back pain? Do you have any documentation on any such connection? I've scheduled another appt with the GI for f/u and to discuss Dr. Hart's suggestions. Any suggestions, comments, opinions, etc. would be appreciated.
Dear Dena, Thank you for your question. the fact that your pain is brougth on after having a med to large meal Should you wish to be evaluated at the Cleveland CLinic please Good luck,
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