raynauds, chronic pain

[veritas11771]

I have had pain in my left hand, and often my hand turns blue. The pain radiates from my hand into my arm -- sensations include both aching pain and pricking/burning pain. I also have a pain occurring between my second and third rib on my left side, although not always in unison with my hand pain, and I can pop my rib cage. I sometimes have swelling and pain in my left breast, although a mammogram and exam produces no reason for this occurrence. My bloodwork is normal; I have had my heart extensively studied (echo, EKGs, stress test, doppler) and nothing cardiovascular has been found to cause this problem. Rheumatoid factor series tests and thyroid tests also came back completely normal.

The pain had started in my palm, but has expanded throughout my hand and now lasts several hours. I have also started experiencing pain in my sacrum and left foot. I am so frustrated because no one can seem to find the cause of my problem, and I am in more pain each day. I have noticed that I never experience pain in the morning, that it usually begins in the afternoon, and that stress can be a trigger (although not the only one.) At times, the ligaments seem to swell, and I find my tendons very painful. When it stops, I have no pain in those areas. If it gets especially bad, I can feel as if it is pressing down on my left lung -- but no tests have produced abnormalities there as well. The pain seems to come in waves, at times feeling as if my veins are throbbing. I have never experienced any pain that disturbs my sleep. When I am not having a "bout," I feel perfectly fine.

What can this problem be caused by? I'm worried this may be cancer, but I realize it could be caused by something else. I would greatly appreciate any advice.

[inspiredmomof5]

I have chronic pain throughout my body. (How to make a long story short, wow). I have suffered from chronic back pain for the past 15+ yrs. I am 45 and a mom to 5 kids.
My mother had a huge problem with her back (multiple surgeries). I had a fusion in my neck in 2002 @ C4 & 5. Felt better for two yrs. In 2004 I had our 5th child. During pregnancy my mid back started to bother me. As I would nurse her my mid back would scream out with sharp pain (like a hot poker stabbing me all the way through from my chest to my spine. I dealt with it the best I could (I tried PT and chiropractic and it made it worse). In 2007 I had a female outpatient surgery (not a big deal). On the 3rd day of recovery, I awoke to my entire left side going numb. My OB said go to the ER immediately. I did. After doing an EKG and CT Scan (stroke.heart attack)came back normal, they chalked it up to an anxiety attack. Gave me some pills and sent me on my way. As the days went on the pain was becoming unbearable. I finally went to my fam. doc. He was stumped too. He ordered 2 MRIs (thoracic and cervical). They results came back that I have 2 disc buldges at C7 & T1. For the next 2 yrs. we did conservative treatment. I still suffer everyday with intense pain in the spine around my neck and esp. around my bra line. My doc said I have FMS. When anything lies on my chest, while I am lying down, it brings on that hot poker pain. If I am vacuuming, ironing, talking on the phone, my arms and fingers (all 5) go completely numb/tingeling/burning. The also turn cold.I haven't been able to hold my child since she could walk, unless I was sitting in a chair. When I am resting my spine feels like it is being chiseled away at it, like something is eating away at it.
It is like the slow drop off water constantly hiting the same spot over and over (for yrs. now). I am very warn out. I suffer great depression, thought about suicide 2 times, just because I couldn't/can't bear the pain anymore. Will it ever go away? I went to my neurosurgeon who informed me that surgery at the level is very risky and the outcome is not very good. (50-50%). not good odds. My fam doc has done all he can do. He has referred me to a spine specialist and a psycologist. I do not have insurance so that always poses a problem. Do you have any ideas what is wrong with me and is there anyway we could fix it?? I am tired and very weary. I haven't left my home in weeks. The doc has me on Lyrica which I believed packed the weight on me (50 pounds in 8 mos.)I want off of that so I am slowly weaning off. I also take soma and Tramadol, which certainly helps to take the edge off. I feel so hopeless in this whole endeavor and I have children to raise. They need their Mommy back.
I feel like I live in an 85 yr old body, instead of 45.It even shows up in my face.
Any thoughts or anwsers would be so greatly appreciated it. Thank you for your time and what you do to help people. Kelly Ferguson  

[J T Junig, MD PhD]

There is always a desire to explain all symptoms with one condition, but that can sometimes prevent the proper diagnosis--  sometimes a person ends up having more than one condition.  If we assumed that your pains are related, we would think of a way that one 'lesion' can cause pain in both the left hand, left sacrum, and left foot--  which would likely require something affecting the spinal cord--  or we would need to consider things which can give rise to multiple lesions, such as MS or Lyme Disease.  On the other hand, you could have multiple things going on-- carpal tunnel of the left hand, even tarsal tunnel of the foot, disc disease causing sacral pain...

To make a diagnosis will require a thorough history and physical and then indicated labs and imaging studies...  I would be throwing out random guesses, as the combination of symptoms that you are having are not 'classic' for any syndrome that I am familiar with.  For what it is worth, though, cancer does not come to mind as a likely cause.  It is possible I suppose... but cancer is more likely to present as a mass, unexplained weight loss or blood loss, symptoms directed at one location...  

There are a couple basic lab studies that can point in general directions;  an ESR or 'sed rate' is a nonspecific marker for inflammation, and if it is normal, it makes many things unlikely-- including chronic infection such as Lyme disease, a number or inflammatory conditions like lupus; The physical exam can help determine whether nerves are involved by looking for sensory loss or weakness;  whole-body imaging studies such as a bone scan can help determine whether the pain is coming from soft tissue vs bony tissue.

You mention stress-- as a psychiatrist I should mention that some pain conditions arise entirely from mental activity, such as somatoform disorder.

For this type of problem, a good doctor is invaluable;  random blood tests and MRI's rarely get to the bottom of things, but a careful, talented physician can sometimes deduce the cause using only a pin and a reflex hammer!  I recommend talking to people in your area to find out who the great docs are-- or even better, the docs who spend enough time to really listen-- and trying to explain things to that person, regardless of whether he/she is 'in network'.  Just my opinion-- although I realize that many people are living paycheck to paycheck and that is not a great option.

JJ