No one can tell me what this pain is!

[KathyS]

I hope you can give me some insight to what I might be dealing with.  I am a 46-year-old female, moderately overweight but in excellent health, I take no medications, don't smoke, and drink only 1-2 cocktails or glasses of wine a week.  Almost one year ago, I began having pain in my chest, at the very center right between my breasts, which sometimes radiates to my back. Although most of the time the pain is a crushing, pressure sensation, sometimes it starts with what feels like a "pop".  I started out with the typical tests (EKG, chest xray, etc.) and after my second ER visit, a sonogram showed gallstones.  I had a lap chole in July with no complications at all, however it did nothing for the pain. In fact I experienced the exact same pain before I even left the hospital the day after surgery. Following that, I had a complete cardiac workup, including a heart catheterization ("just to be sure" my doctor said).  Since then, I have had an upper GI (no hiatal hernia or spasms), chest CT, MRI of back, MRCP to check for blocked bile duct or stray stone, upper endoscopy (no evidence of acid damage and no obstructions), an esophageal motility test and a 24-hour pH test.  I have tried various acid meds (Protonix, Nexium) with no luck, and I even spent about two months on Percocet but hated that drugged feeling.  None of these tests or procedures has shown up to give an indication of what's causing the pain.  I have had so many procedures, some of them two or three times, and I'm very frustrated that no one can pinpoint the source of the pain.  I haven't had a colonoscopy yet, that's the next step according to my gastroenterologist.  

During the past 6-8 weeks, the site of the pain has changed a bit.  Sometime I now feel extreme pressure even with the top of my right breast which radiates to my right shoulder, right arm, and into my right shoulder blade.  I still have chest pain in the middle of my chest at times, too.  There seems to be no rhyme or reason why it alternates between these two sites.  I have pain to some degree every day, sometimes it's more annoying than truly painful, and some days I'm doubled over and heading for the ER.  I have kept a food and activity diary and it seems completely unrelated to anything I've eaten or done.  It's not stress related, either.  I even changed jobs last summer because one doc suggested it was stress related, but it didn't change at all.  Also, in the past couple of weeks I have had extreme lower pain which feels like kidney area.  I can't even stand to touch my own back on either side of the base of my spine.  That doesn't happen every day but when it does, it's excruciating.  (As I said, this is a very recent development and may not be related to the chest pain at all.)  I am on my sixth doctor in the past ten months and this one already seems as stumped as the rest.  Any thoughts or suggestions?  Anyone?!?  Thanks.  I appreciate any and all input!  I'm at my wit's end and tired of hurting.  

[Kevin Pho, MD]

Hello - thanks for asking your question.

You are describing chronic chest pain.  Cardiac cath negative. Upper GI, MRCP, MRI of the back, upper endoscopy, esophageal motility test, 24-hr pH test all negative.  6 doctors are not able to find the cause of the chest pain.  

This is obviously a comprehensive workup.  If 6 doctors are not able to find the cause and all the tests are negative, it is not likely I will be able to add to the evaluation considering I am not able to examine you.  But here are some thoughts.

Rheumatological diseases can present with chest pain and a negative workup.   Examples include rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and fibromyalgia.  A referral to a rheumatologist would be reasonable to evaluate for these diseases.

Nerve pain may also be considered, especially since you are describing a radiating nature to the pain.  You may want to be evaluated by a neurologist.  It can then be determined if electrodiagnostic testing (i.e. EMG) would be helpful in your case.

If every single test is negative and the neurology and rheumatological evaluation continues to be non-revealing, then you may want to be evaluated by a physiatrist (rehabilitation physician).  They can further elucidate any musculoskeletal causes for the pain and evaluate for rehabilitation potential.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[s.mcm]

I wonder if any chance it could be problems with the bile duct? When they do blood tests in the ER are your liver enzymes high? I am going for an ERCP test on Tues to see what is causing my similiar pain.
good luck

[Kygirl]

Same description of pain that I experienced when I had gall bladder disease.  Was so diseased they could not operate until I was stable (2weeks in hospital).  This was in the 80's after my son was born.  I weighed 98 pounds at best.  Woke up with the pain in my chest and radiated to back, between the shoulder blades. Never had pains until that night.  Pain was better if I was in a wierd position----Head Down and on my knees with butt in air! It did take them a while to determine that was it....times have changed though and medical help has gotten better.  Good luck

[Jzam]

Please post your prognosis when available, my husband complains of similar pain and discomfort and your comments have shed some new light to what up until now has been "nothing" according to his doctor.  Many Thanks!

[KathyS]

Thanks for the post.  I have another appointment with my gastroenterologist this next Monday, and I'll post more then.  However, when his nurse called to set up the appointment, she indicated that he wanted to talk to me about pain management.  This is just so damn frustrating.  It's hard to believe that this pain would just appear out of the blue, no injuries or illnesses preceded it, and yet not one doctor can determine what it is.  The doc may still want to do a colonoscopy, I haven't had one yet and that's what he said would be next, but like I said I'll find out on Monday.  I'm sorry your husband is dealing with the same symptoms.  I hope he can find out something.  If so, post here and we'll compare notes!  Good luck!

[5fan]

I would be curious to see what your amylase/lipase and trypsin levels are.  I posted above in response to Huck_Finn if you want to read, but I had very, very similar pain to what you are having - found out I was having an acute pancreatitis attack when I thought it was my gallbladder.  My gallbladder was involved and was removed after the pancreatitis was controlled, but the pain didn't want to go away.  TEN months later I have been diagnosed with IBS, Gastroparesis and CHORNIC PANCREATITIS (the pain in the middle of my chest, through to my back and up under my right shoulder blade)!!!!!

Best of luck!!

[5fan]

I would be curious to see what your amylase/lipase and trypsin levels are.  I posted above in response to Huck_Finn if you want to read, but I had very, very similar pain to what you are having - found out I was having an acute pancreatitis attack when I thought it was my gallbladder.  My gallbladder was involved and was removed after the pancreatitis was controlled, but the pain didn't want to go away.  TEN months later I have been diagnosed with IBS, Gastroparesis and CHORNIC PANCREATITIS (the pain in the middle of my chest, through to my back and up under my right shoulder blade)!!!!!

Best of luck!!

[krisg]

definetly think about the bile duct being involved.  I had my gallblader out 5 years ago for stones and after the surgery I had excruciating attacks of pain afterwards.  I finally was diagnosed with biliary colic due to high grade of stenosis in my bile duct.(narrowing)  I had an ERCP done twice.  The first one done was negative for Sphincter of Oddi dysfunction. The dr. said everything looked fine. The medical report stated otherwise, as I found out when I requested my files. Then after another 2 years of pain and er room visits I started to piece together my medical reports.  Every time I was in the ER, my liver enzymes were elevated.  Finally found a good surgeon and had another ERCP done.  He had to do a pre-cut sphincterotomy just to access my bile duct and then do a generous cut of the bile duct to help it drain.  So sometimes it takes many tests and repeat of tests to find out whats going on.  It took me almost 5 years to at least know what is happening now.