cronic pain

im 35 year male. im suffering from severe unexplaineable pain near xiphisternum( see the diagram) since 3.yrs i have got done all the tests such as CTscan of abdomen and pelves, MRI sternum, CT coronary angiography,Barium meal follow test,HIDA scan, TMT, ECOHO, Endoscopy, Colonoscopy, PTH (hormone), calcium,serum,all blood reports are normal all reports are normal and a pain terapist as given me local infiltration black 3times between 6 manths gap and i have taken rectas sheet black i was  relieved from pain for 3 days and the pain came back again and  botox was given but i have not get any relief and taken psyacatist treatment but no use. please see to the that whether i have got any problem in my nerves or muscle in that area please infrom us about any tests and treatment   related to this problem    

[J T Junig, MD PhD]

If I read your comments correctly, the only thing that helped was a procedure to block the rectus sheath (connective tissue around the rectus abdominus muscles)?  As an aside, this is a good example of how silly the medical system has become-- in the past, a doctor with diagnostic skill would know how to examine you, and have enough confidence to tell you if anything would work-- without needing to run tens of thousands of dollars-- maybe more-- of testing.  CT coronary angiography?  ECHO? Endoscopy? and MRI of the sternum!!??!!  I wonder what the heck they expected to see with any of those tests.

The proper approach is to do a sequence of exams or procedures to identify whether the pain is chest wall or internal.  If it is coming from the chest or abdominal wall, there is rarely much that can be done procedurally to eliminate the pain, in the absence of a mass or tumor.  

Since the rectus injection seemed to help, I would keep the focus there.  You likely have a nerve that is entrapped, or a neuroma-- a microscopic nerve tumor-- or maybe a small band of muscle that lacks sufficient oxygen supply.  Perhaps trigger injections of the rectus can be used to further identify the exact region of the pain.  You might be able to reduce the pain using a medication that reduces nerve excitability-- like lyrica or neurontin.  

But IF the rectus injection truly helped, don't go off on tests of other areas;  that tells you that the pain is isolated to your abdominal wall, in the rectus muscle or connective tissue around the muscle.  Don't go to specialists looking at other areas- like the heart or liver-- as the rectus injection supposedly ruled those areas out as sources of the pain.