Chronic chest pain - no explanation

[tyraaz]

My husband is 37 years old, 38 in August.  He has chronic chest pain - ribs and sternum.  Has had it since June of 2000.  Started on the left, now through the whole chest.  Hurts to breathe, always in pain, lays down most of the day, very limited activity.  On several pain meds and muscle relaxants.  Doctors originally said costochondritis but costo goes away and NSAIDS never helped him.  We've seen almost every type of specialist out there (rheumotologist, lung, cardio, pain management, accupuncture, yoga, chiropractor, physical therapy, used tens unit, neuromuscular, neurologist, psychologist, psychiatrist).  Had MRI's, CT's, bone scans, numerous blood tests.  Prior to this he was in decent health - had kidney stones off and on (still does). At 13 he had scoliosis but did martial arts and that straightened his back (he's a black belt but hasn't fully practiced in years (stopped a couple of years before the pain began).  All docs say is to see a pain management specialist.  He's on large doses of fentanyl, and MS Contin, and soma, plus lyrica.  He's tried several other anti-depressants and pain meds in the past.

We've seen many types of docs and don't know where to turn.  The pain meds are going to destroy him in time, but if he doesn't have them he will be in the ER (first year of illness was in ER 20 times before they got him on a high dose of pain meds).  Even with the pain meds (fentanyl 150 mcg every 48 hrs, 4 MS contin/day, 4 soma per day), he's still in major pain (some days worse than others - weather (cold and humidity) can make it worse).  He has major insomnia too and cannot sleep.

We are desperate for a diagnosis.  We don't know where to turn since w/out a diagnosis we don't know what type of doc to see.  We really need a medical mystery type of doc, or someone who can give us direction.

Other basic notes - have been married since 1997, have a 5 1/2 yr old son (from 2 round of IVF).

Any advice you can give would be appreciated.  thanks, Lisa

[Kevin Pho, MD]

There clearly has been a comprehensive evaluation done with multiple specialists.  It is unlikely that I can come up with something that hasn't already been thought of.  

With the testing that has already been done, many of the major pulmonary and GI causes would have been ruled out.  

You can consider a referral to a physiatrist (rehabilitation specialist) to further evaluate for costochondritis.  

If there is concern about the heart, a stress echocardiogram and a referral to a cardiologist can be considered.

If this workup is non-revealing, then I agree that pain management would be an appropriate next step.

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

Kevin, M.D.
www.kevinmd.com

[tyraaz]

Is it possible that this could be lyme disease?  I have heard that people get arthritis type symptoms from it (although his pain is only in his chest).  We did travel to Wisconsin about 11 months before the pain started.  Is this something we should consider?