chronic back pain

I had surgery early 1999 to remove a pilonidal cyst.  Since that time I have had chronic back pain.  I have been to physical therapy, had blood work done, seen a chiroprator, had a nuclear bone scan, and MRI of my upper back.  None of which have given me any indication as to the source of the problem.  My pain is constant but effects different areas of my back.  I also have had sharp shooting pain through my back when I turn certain ways. My doctor now wants to do "pain management", but I want to find out what the problem is and get it fixed.  It now, once again, has become uncomfortable for me to sit in a normal position, but my surgeon says the cyst is not recurring.  My question is could the surgery or the cyst in any way be effecting some nerves and thus be the cause of my back problems?????

[CCF NEURO[P] M.D.-RPS]

Dear Chris:

I am really sorry that your having back pain.  Back pain is sometimes a really difficult diagnosis to find the etiology.  Usually, there are changes on MRI but we have a group of patient who received MRI for other reasons, other than pain, and have terrible looking MRI but no back pain.  Then there are patients with normal scans and exams who have back pain.  I wish I could tell you what was causing your back pain.  There is always the possibility that surgery did something, but if nothing has been found on testing, then I would be reluctant to attribute it to surgery.  Usually, if the cause is surgery there should be tell tale signs on the MRI, enhancement, hyperintensity on T2 or inflammation of the nerve root outlets.  I would try and work with a rehab specialist together with the pain management person.  

Sincerely,

CCF Neuro MD