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intercoastal neuralgia
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intercoastal neuralgia


  Approximately a year and a half ago I started having pain in my upper back in the right shoulder area that radiates to the chest wall. The pain only occurs while sitting at the computer at work or while riding in a car. The longer I have to sit the pain becomes worse. The pain is a burning sensation. I have had a bone scan, mri, ct-scan and nothing has shown up. My neurologist has tried Nsaid's , muscle relaxers, high dose neurontin and tegretol and nothing has helped. I have also had one nerve block to the 4th rib area and this didn't help either. I would like to know if my symptoms could be intercoastal neuralgia and any other treatment options I might try because my quality of life has really diminished. Thanks for any info in advance.  
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Dear Greg:
It is difficult for me to figure out the localization and possible cause of your right shoulder and chest wall pain without having the opportunity of seeing you in person and carefully going over all the tests you have had. One of the tests that you do not mention is an EMG examination. This test can be potentially useful even for thoracic root lesions, but more importantly, it would be a fairly sensitive way of looking for a cervical root lesion (C5-C8) which can cause chest pain quite like yours. Also, I do not know if cervical spine MRI has been done. From a treatment standpoint you seem to have used some of the more commonly used medicines to the hilt without benefit. After a clear diagnosis is established, a pain management consultation may be beneficial.
In case coming to Cleveland for a second opinion is feasible, I can recommend Dr. Levin, Mitsumoto, or Shields who are experts in the field of neuromuscular disorders at the Cleveland Clinic.




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