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Neurology (Expert Forum)
pain spots chest shoulders and upper arms
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pain spots chest shoulders and upper arms
by kat3d, Jan 11, 2007 12:00AM
I have suffered from pain in my arms (especially) for the last 7 years. I've been tested i.e. x-rays, eeg's twice, bloodwork, mri's (head, neck and shoulders). There have been a lot of diagnoses thrown out there. Wherever there is a pain there is a mirror pain on the opposite side. I've tried physical therapy, massage therapy, steroid shots, and various and sundry nerve pain medications (Neurontin for the longest period of time around 3 years). I am presently on Cymbalta. So.. the doctor's by a process of elimination (not ms, not Lyme, not Lupus, not nerve damage, not repetitive motion, not rheumatoid arthritis) have decided I have fibromyalgia. I on the other hand have some reservations because I don't seem to have classic symptoms. I started originally with a case of shingles. Then I injured my shoulder lifting something very heavy (same shoulder as the shingles rash). The burning pain started in that same upper arm after physical therapy and massage therapy. It may have been there originally and the massage therapy exaserbated it. Then the pain was in the other upper arm and escalated to other parts of my body. However I don't have this same pain in my lower extremities. And my pain spots are not in the standard areas of the fibromyalgia chart. I've been sent to Rheumatoligists, Nuerologists, Physical therapists and today I just choose to stick with a primary care doctor. Because my insurance coverage is not so great I have dug myself in a hole financially with the excessive costs of doctors and meds.
Do you have any thoughts to offer? help
Do you have any thoughts to offer? help
Doctor's Answer
by CCF-Neuro-M.D.-SH, Jan 30, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The case you describe sounds very complex and there is a lot of data that I do not have. That being said I will try and address some possible causes of your arm pain. Shingles is a reactivation of the virus (Herpes Zoster) that causes chickenpox (that many of us get as a child). Many of us never experience the reactivation of the herpes zoster, but most all of us have this virus 'sleeping' in our nerves. As people age, or when they become sick the virus is more likely to 'wake up'. The virus then causes pain, numbness and itching in a strip along the skin (in the area of the nerve the virus was sleeping in). This is often followed by blisters (which may bleed). When the blisters go away the pain may persist for months or even years. This pain is burning pain at the skin level, but may also cause shock like pains down the arms, depending on how the nerve was involved. There are several medications for this type of pain including neurontin, lyrica and to a lesser degree medications such as elavil, cymbalta, effexor, etc. have been used. I suspect the pain you have is due to post hepetic neuralgia, but some other things to consider include amyotrophy, vitamin deficiency, multiple myeloma and heavy metal toxicity. I would recommend an EMG (I did not see this in your list of tests) of the upper extremities and screening blood work to include b12 level, b6 level, serum and urine elctrophoresis, and heavy metal screen. As far a fibromylagia is concerned this is a poorly defined pain syndrome, that is thought to involve the many areas to the skin and touching causes pain in many 'pressure points'. One theory is that fibromylagia is related to specific sleep problems and getting a sleep study may be helpful.
The case you describe sounds very complex and there is a lot of data that I do not have. That being said I will try and address some possible causes of your arm pain. Shingles is a reactivation of the virus (Herpes Zoster) that causes chickenpox (that many of us get as a child). Many of us never experience the reactivation of the herpes zoster, but most all of us have this virus 'sleeping' in our nerves. As people age, or when they become sick the virus is more likely to 'wake up'. The virus then causes pain, numbness and itching in a strip along the skin (in the area of the nerve the virus was sleeping in). This is often followed by blisters (which may bleed). When the blisters go away the pain may persist for months or even years. This pain is burning pain at the skin level, but may also cause shock like pains down the arms, depending on how the nerve was involved. There are several medications for this type of pain including neurontin, lyrica and to a lesser degree medications such as elavil, cymbalta, effexor, etc. have been used. I suspect the pain you have is due to post hepetic neuralgia, but some other things to consider include amyotrophy, vitamin deficiency, multiple myeloma and heavy metal toxicity. I would recommend an EMG (I did not see this in your list of tests) of the upper extremities and screening blood work to include b12 level, b6 level, serum and urine elctrophoresis, and heavy metal screen. As far a fibromylagia is concerned this is a poorly defined pain syndrome, that is thought to involve the many areas to the skin and touching causes pain in many 'pressure points'. One theory is that fibromylagia is related to specific sleep problems and getting a sleep study may be helpful.
I AM 59 YEARS OLD. MY MAJOR PAIN IS IN MY ARMS, LOWER BACK AND SHOULDERS. I DO OFFICE WORK WHICH INVOLVES A LOT OF COMPUTER INPUT, PREPARING AND FILING CLIENT FILES, TALKING ON THE PHONE WITH THE STATE COURTS, MAKING COPIES, A FAIR AMOUNT OF WALKING BETWEEN MY DEPARTMENT AND OTHER AREAS IN THE COMPANY.
INSTEAD OF MUSCLE PAIN I SEEM TO HAVE PAIN SPOTS IN THE CENTER OF MY CHEST ONE ON EACH SIDE CLOSE TO THE CENTER, I HAVE TENDER SORE SPOTS UNDER AND ON THE SIDES OF MY UPPER ARMS, ALSO IN MY SHOULDERS AND LOWER BACK. NOT A WHOLE LOT OF THIS TYPE OF PAIN IN MY LEGS. I DO HAVE SOME ARTHRITIS PAIN IN MY KNEES. MY PAIN IS WORSE FIRST THING IN THE MORNING AND AT NIGHT. I START MY DAY STRETCHING MY LEGS AND FEET AND ANKLES BEFORE I GET OUT OF BED I ALSO DO SOME MILD MOVEMENT WITH THE ARMS. AFRAID IF I STRETCH THE ARMS I WILL START MY DAY WITH SORE ACHING ARMS. MY NECK IS TIGHT AND I DO HAVE SOME DEGENERATIVE ARTHRITIS IN THE C5 AND C6. HOWEVER, IT IS NOT ENOUGH ACCORDING THE THE