Chronic back pain

[inspiredmomof5]

Dr Junig,
I sent my whole message to the comment section of the Raynuads. Is there anyway you can pull it up from there. Please let me know. I really want your advice.
Thank you Kelly Ferguson

[J T Junig, MD PhD]

Your frustration and misery come through very clearly, as you talk about the toll the pain has had on your life.  I cannot be too specific-- in part because I do not have access to all of the information required to even try give a direct answer, and in part because that is not my role here.  But I will try to offer a couple suggestions;  some may be off-base, depending on the specifics of your condition.  Thank you for taking the time to explain what you have been going through.

It is unusual to develop disc problems in the thoracic spine-- i.e. at the level of the chest.  Because there is more an more body weight to support the lower you go on the spine, it is the lumbar discs that tend to cause problems for people.  The other problematic area is the cervical or neck region, usually due to trauma, congenital conditions, or arthritis.  With your pain being mainly at the mid-chest level, I doubt the bulging discs at C7 and T1 have much to do with it;  disc bulges at those levels would be more likely to give pain symptoms in the upper arms and shoulders, not at the bra line.  Be aware that in any MRI or CT scan, people with no pain at all frequently have 'disc bulges' and even herniations, that are totally asymptomatic.  Likewise, findings of bulges or herniations (or osteophytes, 'degenerative disc disease', spondylosis, spondylolisthesis... all scary sounding names) are often present without causing any pain at all.  Too many times people come to my office and when I ask about their pain, they start listing all of the MRI findings.  The imaging studies are sometimes helpful to localize a lesion, but they are far from being a definitive answer.

So from my standpoint, we don't have a 'cause' for your mid-chest pain, which seems to be the pain that you are most focused on.  Sometimes a neurosurgeon will 'brush off' a case that is complicated-- neurosurgeons (understandably) prefer straightforward operations, where the cause of the pain is clearly defined.  Telling you there is a 50/50 chance of helping (and I think he was being very, very optimistic) is sometimes a way of telling the patient 'I'm sorry-- I cannot help you'.  I suspect that was the case here.

I would want to first try to figure out what is causing that pain-- is coming from bone, muscle, nerve, or fascia?  You make this determination by history and physical to start-- if the pain is coming from muscle or fascia, for example, sometimes it can be 'palpated'-- i.e. a tender spot can be found.  If the pain is aggravated by deep breathing, that tells us that it is coming from an area that moves with respiration.  If it is unrelated to breathing, it must be coming from an area that is stationary during respiration, for example something inside the spinal column.  Often, pains that wrap around the body following the angle of a rib are coming from an intercostal nerve-- those nerves run along the underside of each rib, providing sensation to the skin and muscle above them.  

I have written this before, but unfortunately you are the person who will have to direct the search for answers, as doctors rarely provide that service anymore-- which is a real loss in my opinion.  The first goal is to find the cause, and again, I don't think you are there yet.  A good pain clinic will do procedures that help identify the location of the pain--  I recommend that you keep the search for cause at the top of the list, and resist the procedures that are high-paying 'shots in the dark', such as epidural steroid injections and trigger point injections.  Ask the doc, 'do you know where the pain is coming from?'  If he/she doesn't, try to encourage the doctor to first figure that out!  

I know this is getting confusing... but for example, you come to my pain clinic... I could 'guess' that the pain is coming from nerve compression in your spine, and do an epidural for $500 bucks or so.  If it doesn't help (and it probably wouldn't) we wouldn't know anything more than before the injection--  because even if the problem IS nerve compression, sometimes epidurals don't help.  So a better option would be for me to do a couple of intercostal nerve blocks at specific levels, perhaps under 'flouro' (mobile x-ray), to see if the blocks stop the pain temporarily.  This is NOT a permanent treatment;  it is a diagnostic procedure.  If the pain is stopped, that tells us that the problem is 'distal' to the block-- not in the spine or spinal cord, and not from the muscles or tissue proximal to the block i.e the big muscles along the spine.  If intercostal blocks do NOT work, then the opposite is true-- the pain is likely coming from somewhere proximal to the blocks.

Intercostal blocks can be done by any anesthesiologist at a pain clinic, sometimes under x-ray, sometimes without (skinny patients are much easier for this block).  There are some risks, but generally not life-threatening risks, provided the doctor is experienced with them.  Pick a doctor by looking for 'Board Certification' at the minimum.

One last thing-- you mention some very troubling things about what has happened to your health-- not leaving the house, weight gain, suicidal thoughts...  first, if you are having thoughts of harming yourself, get help right away.  Call 911 if necessary.  There are people who can help.  If you aren't feeling THAT low, understand that there is a huge connection between the mind, the brain, and chronic pain.  The pain cannot go away in the presence of severe untreated depression.  So yes, see a psychologist or psychiatrist and find support.  If a psychiatrist feels that medication is appropriate, remember that antidepressants take weeks to work-- AT A MINIMUM.  Take the medication daily, even if you have temporary side effects-- as most people do.

Then there are the basics, which must be done as well in order for you to move forward.  Take walks with or without the kids, at least daily if at all possible.  Get fresh air.  Eat well, Try to get on a regular sleep schedule-- do NOT stay in bed during the day.  Get dressed and groomed appropriately each morning, even when you don't feel like it.

I hope that 2009 is the year that you find some answers to what has been doing this to you.  I sincerely wish you the best.
JJ

[J T Junig, MD PhD]

Sure-- Here is your question.  I will try to get to it tomorrow morning, as I am beat right now!!

I have chronic pain throughout my body. (How to make a long story short, wow). I have suffered from chronic back pain for the past 15+ yrs. I am 45 and a mom to 5 kids.
My mother had a huge problem with her back (multiple surgeries). I had a fusion in my neck in 2002 @ C4 & 5. Felt better for two yrs. In 2004 I had our 5th child. During pregnancy my mid back started to bother me. As I would nurse her my mid back would scream out with sharp pain (like a hot poker stabbing me all the way through from my chest to my spine. I dealt with it the best I could (I tried PT and chiropractic and it made it worse). In 2007 I had a female outpatient surgery (not a big deal). On the 3rd day of recovery, I awoke to my entire left side going numb. My OB said go to the ER immediately. I did. After doing an EKG and CT Scan (stroke.heart attack)came back normal, they chalked it up to an anxiety attack. Gave me some pills and sent me on my way. As the days went on the pain was becoming unbearable. I finally went to my fam. doc. He was stumped too. He ordered 2 MRIs (thoracic and cervical). They results came back that I have 2 disc buldges at C7 & T1. For the next 2 yrs. we did conservative treatment. I still suffer everyday with intense pain in the spine around my neck and esp. around my bra line. My doc said I have FMS. When anything lies on my chest, while I am lying down, it brings on that hot poker pain. If I am vacuuming, ironing, talking on the phone, my arms and fingers (all 5) go completely numb/tingeling/burning. The also turn cold.I haven't been able to hold my child since she could walk, unless I was sitting in a chair. When I am resting my spine feels like it is being chiseled away at it, like something is eating away at it.
It is like the slow drop off water constantly hiting the same spot over and over (for yrs. now). I am very warn out. I suffer great depression, thought about suicide 2 times, just because I couldn't/can't bear the pain anymore. Will it ever go away? I went to my neurosurgeon who informed me that surgery at the level is very risky and the outcome is not very good. (50-50%). not good odds. My fam doc has done all he can do. He has referred me to a spine specialist and a psycologist. I do not have insurance so that always poses a problem. Do you have any ideas what is wrong with me and is there anyway we could fix it?? I am tired and very weary. I haven't left my home in weeks. The doc has me on Lyrica which I believed packed the weight on me (50 pounds in 8 mos.)I want off of that so I am slowly weaning off. I also take soma and Tramadol, which certainly helps to take the edge off. I feel so hopeless in this whole endeavor and I have children to raise. They need their Mommy back.
I feel like I live in an 85 yr old body, instead of 45.It even shows up in my face.
Any thoughts or anwsers would be so greatly appreciated it. Thank you for your time and what you do to help people. Kelly Ferguson