Pain/cold hand

I have been having a good deal of pain in the right side of my back about midway down real slose to my shoulder blade and now my right hand is about 4 times colder to the touch than my left one. I also have white spots on my brain that the Dr. does not seem to have an answer for.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Local back pain is usually a result of irritation of or damage to structures of the spine (e.g., periosteum, ligament, dura, and joints).  The pain is usually exacerbated by activities that cause these structures to have increased pressure load (e.g., prolonged sitting or walking up steps). Prolonged irritation of these joints can cause muscle spasm described as a diffuse, burning pain. X-rays of the back may show chronic degenerative changes of the bones. An MRI of the thoracic spine (the area that you may be describing), is usually not indicated if no neurological deficits, but since you seem to have some symptoms, it may be helpful to evaluate for other causes of back pain.

Treatment of these types of pains includes NSAIDs and physical therapy. If no improvement with these, a pain specialist may opt to do a procedure called facet joint block.

Regarding the MRI findings, there are multiple causes for white spots or plaques in the brain. Most often, these are due to what is called "chronic small vessel disease", literally meaning diseased small vessels that supply blood flow to the brain. This is not an uncommon process in the brain and increases with age. This is not a disease in and of itself but rather is a reflection of unhealthy blood vessels, damaged by years of plaque build-up. This is most often due to a combination of several factors including the following: high blood pressure, diabetes, smoking, and high cholesterol. If these factors are well controlled, the damage to the brain can be stabilized and further damage prevented.

Other causes of plaques in the brain can be migraine. People with migraine often have plaques on their MRI that are of unclear cause or significance.

I would suggest you follow up with your primary care physician for a routine evaluation. He/she may be able to direct you further in workup and management.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.