Re: Face & Back Pain

Posted By HFHSM.D.-rf on June 08, 1998 at 08:31:09:

In Reply to: Face & Back Pain posted by Em on June 06, 1998 at 22:25:38:






I am a 40-yr old woman who developed reactive arthritis during
the Gulf War.  My condition has steadily worsened (sometimes
I think the drugs have been worse than the disease).  Since
1995 I have been on high doses of methotrexate (six rounds of
IV), also prednisone (sometimes IV), and diclophenac and
doxycycline since 1991.  And additional drugs, such as imuran,
cyclosporin A, etc. etc. etc.  Since Dec 97, I have had EXTREME
facial pain and pain in my back under my right shoulder blade.
The face doctor said the pain was not TMJ, but referred pain
from my back.  The back pain has responded to accupuncture, but
always returns.  From time to time (as you might imagine) I've
had elevated liver enzymes; my most recent count was elevated,
but I don't know which ones.  My friend's mother recently
died of liver cancer.  Her "symptoms": severe facial pain and
back pain.  They could not figure out the problem.  Her enzyme
levels were normal until--BOOM--they went ballistic, apparently
when the cancer finally reached critical mass.  By then it was
too late.  My Q: how likely is it my symptoms are pointing to
a liver problem?  My doctors keep sending me to PT, Accupuncture,
etc., which doesn't seem to me to be a course focused on finding
the CAUSE for my pain.  Thanks for your help.

Dear Em,
I was distressed to read your letter.  The Gulf War syndrome has altered many lives.  Unfortunately, physicians have had great difficulties understanding what went wrong and how to make it better.  With regard to your specific question, facial pain, even referred pain, would be an unusual presentation for hepatic cancer.  It would be very helpful to know the specific liver test abnormalities.  I would suggest the following tests to try and identify the cause of your pains (Many may have already been done): CT scan of the liver and pancreas, X-ray of shoulder and arm (humerus and scapula), thoracic and cervical spine, ultrasound of gallbladder,  kidney evalaution.  I agree with the accupunctute to control the pain.  
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
HFHSM.D.-rf
*keywords: shoulder pain, liver cancer
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