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Could my thoracic/chest pain of over a year, be of a neurological origi...
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Could my thoracic/chest pain of over a year, be of a neurological origin?

Could my thoracic/chest pain of over a year, be of a neurological origin?  

Symptoms: Chest/thoracic pain of over a year. Pain involves central sternum and wraps around my rib cage to the back between my shoulders. It has seemingly spread to my lower rib cage as well over the last few months. It is not induced by anything nor can it be recreated. Exercise possibly enhances the already existing pain. It is a deep ache that cannot be touched or recreated by touching or pushing. At the peak of my pain, I find myself exhausted with general malaise; although the exhaustion could be a coincidence.

The pain is near constant with seldom moments of relief. Ibuprophen nor Acetamenophen provide relief. My only relief comes from red wine? Strange, I know. Maybe relief from the wine is a coincidence…but hey, I'll take it!

It does effect my life at times by making me too uncomfortable to enjoy activities like running.
I am a 30yrs old, Female, 132lbs, and active. I have no other health issues.

I have had extensive tests and workups to rule out the following issues:
*Cadiac disorders/diseases (stress, echo halter etc)
*GERD/Stomach issues (endocopy)
*Pulmonary disorders/diseases  (bronchoscopy, Chest CAT and X-Ray)
*Gallbladder issues (ultra sound and chemistry panel)
*Anxiety (tried meds)

The only thing we have not considered or talked about is neurological. Could I have nerve, muscle or spinal issues that are causing this pain?       (I do not have numbness or tingling anywhere, and my pain is restricted to my chest wall)
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A family member of mine has symptoms that are somewhat similar. Hers are slightly lower down -- from the bra strap in the back to the lower ribs around the front. Like you, touching it doesn't hurt it right away, although it might hurt later. She describes as feeling like one of her ribs was replaced by a dagger, although my take is that's more burning than sharp. She calls it Rib Pain, not back pain.  

Anyway, she had a lot of tests and the problem turned out to be a herniated disc between T5-T6. It had previously been found on MR and disregarded, but epidural spine injections provided (some) relief and confirmed the diagnosis. An MR might help.

Check out Dermatome Man -- a common diagram that maps vertebra to dermatomes (if your spine gets pinched, your brain will be tricked into thinking the pain is in your sternum/ribs).

Thoracic discs rarely get herniated without significant trauma. Have you experienced trauma? My family member had not -- like you she was in her 30's, thin, quite healthy.

I think this scenario is rare, but thought I would pass it along.

More definitely: Do you see a pain management specialist? I would seek out an interventional pain management doctor. Regular doctors (even ortho's and such) have no idea how to deal with long term pain. It really requires a comprehensive approach. We went to one for a pain management plan and wound up with a diagnosis. Here's the kind of place you want, in AZ http://arizonapain.com/

Lastly: Pain and depression are linked. One aggravates the other. I would suggest that when you seek out Pain Dr. you ask about a psych evaluation. When you say  "at the peak of my pain I feel exhaustion/malaise" that sounds suspiciously like either the pain is driving depression or the depression is aggravating the pain. I am in no way suggesting the problem isn't with a physical issue, I'm just saying that pain messes with your brain, and fighting this from a depression angle could really help with the *pain relief." My doctor said that when someone is dealing with this kind of pain, "depression is assumed."

Oh and finally... try icing the area above and beyond where your bra strap would be. If that brings you any relief it might add to the suspicion. I wouldn't rule out this hypothesis based on Ice NOT working, but if ice on your spine works then it might reinforce the hypothesis.

I am sorry you are in so much pain.
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A family member of mine has symptoms that are somewhat similar. Hers are slightly lower down -- from the bra strap in the back to the lower ribs around the front. Like you, touching it doesn't hurt it right away, although it might hurt later. She describes as feeling like one of her ribs was replaced by a dagger, although my take is that's more burning than sharp. She calls it Rib Pain, not back pain.  

Anyway, she had a lot of tests and the problem turned out to be a herniated disc between T5-T6. It had previously been found on MR and disregarded, but epidural spine injections provided (some) relief and confirmed the diagnosis. An MR might help.

Check out Dermatome Man -- a common diagram that maps vertebra to dermatomes (if your spine gets pinched, your brain will be tricked into thinking the pain is in your sternum/ribs).

Thoracic discs rarely get herniated without significant trauma. Have you experienced trauma? My family member had not -- like you she was in her 30's, thin, quite healthy.

I think this scenario is rare, but thought I would pass it along.

More definitely: Do you see a pain management specialist? I would seek out an interventional pain management doctor. Regular doctors (even ortho's and such) have no idea how to deal with long term pain. It really requires a comprehensive approach. We went to one for a pain management plan and wound up with a diagnosis. Here's the kind of place you want, in AZ http://arizonapain.com/

Lastly: Pain and depression are linked. One aggravates the other. I would suggest that when you seek out Pain Dr. you ask about a psych evaluation. When you say  "at the peak of my pain I feel exhaustion/malaise" that sounds suspiciously like either the pain is driving depression or the depression is aggravating the pain. I am in no way suggesting the problem isn't with a physical issue, I'm just saying that pain messes with your brain, and fighting this from a depression angle could really help with the *pain relief." My doctor said that when someone is dealing with this kind of pain, "depression is assumed."

Oh and finally... try icing the area above and beyond where your bra strap would be. If that brings you any relief it might add to the suspicion. I wouldn't rule out this hypothesis based on Ice NOT working, but if ice on your spine works then it might reinforce the hypothesis.

I am sorry you are in so much pain.
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curiousygiorgio,

Thank you for taking the time to write such a descriptive and detailed answer. I can tell by your response that you are a compassionate person. I appreciate that.

Ironically no, I have not had any trauma. But, I do like to run, so maybe it’s a running injury? The possibility of a slipped/herniated disk is there.

I have recently read a discription of a MS symptom called, “MS Hug” which accuratly decribes the type of pain I am feeling; The way it girdles around my rib cage and shoulder blades. Some have even mentioned that this girdling pain/spasms gives them the sensation to cough. Which I do have; a sensation to cough with no medical reason why. It spiked my interest into seeking more advice. I have never discussed the possibility of anything spinal or nerological with my doctor yet.

I have not had any MRIs done – but I am thinking this would be a great next step. At least it would be one more thing to check off.  And, if this ends up clean. I think I will check out the AZ Pain clinic link you sent. It’s an option I never thought of. Thanks for looking up the link.

I truly appreciate your concern about my emotional health. I have never thought of myself as depressed. I remain active, healthy, and spiritual.  But, then again, I am on the inside looking out. I think I will pay more attention to see if depression could be lingering there unnoticed. When my pain is peaked, I do generally feel unwell with malaise. I have always assumed I felt unwell because of the pain, and not the other way around. It’s an interesting thought.

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With respect to running: Unlike the lumbar spine, in the thoracic spine everything is very tightly packed together -- a minor bulge can have a much more significant impact than the same size bulge in the lumbar spine. Activities that cause compression (like running) "can" cause this, although obviously it's not an everyday running injury. Oddly, you are the ideal age for a disc injury -- we in our 30's still have supple discs, in 10-15 years they will be hard and less prone to herniation.

Besides a disc bulge, which would be apparent on MR (but not conclusive in and of itself), pain like you are describing could also result from facet joint inflammation in the thoracic spine. Genetics plays a role -- some people are just more prone to spine problems.

Either way, if it were related to the thoracic spine, a simple epidural steroid injection and perhaps a facet joint block would likely improve things very much. *Interventional* pain management doctors make their money doing these injections, and unlike the neurologist they are more likely to have the time and compassion to hear you out.

I don't know anything about MS Hug. I hope you do not have MS.

With respect to depression: Depression is such a maligned word, and misunderstood. I never looked like the wind-up doll or the crying man on the TV commercials, so I assumed I had never spent a depressed day in my life.

This is a great article about depression and pain.

      http://www.health.harvard.edu/newsweek/Depression_and_pain.htm

Take care,

George
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