severe upper ack Pain for 20 Years

[pain_queen]

Iam a 37 year old woman, who has suffered from upper back pain for almost 20 years now. The pain has subsided at times, and increased at times with the combination of a stressful lifestyle and extreme physical exertion.  The pain has recently started to become so bad that it is interfering with my lifestyle and to the point, where voltaren, lyrica, tremadol and your over the counter pain killers no longer help. It is a constant pain between the shoulder blades, and right scapula. I feel the need to be constantly massaged in my upper back, but biofreeze and patches are no longer a solution.  I finally had an mri done of the cervical and thoracic parts of the back, with the following report;
No obvious compression of spinal nerve roots is seen in the lateral canals or in the neural foramina. The craniovertebral junction and cervicomedullary junction are normal. No gross para-spinal pathology. Impression; Rectification of the mid-cervical lordosis, suggesting paraspinal muscle spasm. Minimal disc desiccation at C3-C4,C4-C5 and C5-C6 levels. Mild posterior disc bulges at C4-C5 and C3-C4 levels, causing ventral aspect of the thecal sac, without any cord/radicular impingement or spinal canal stenosis.  

Impressions: Focal nodular hypotrophy of the left ligamentum flavum at D11-D12 level, causing deformation of the left posterolaterl aspect of the thecal sac and mild compression of the left posterolaterl aspect of the spinal cord.

I should mention when the pain started in my late teens it was not due to any injury, however I have been in a couple of whiplash car accidents since then.

Iam not sure what the report means and my GP has recommended physio. I would really welcome any expert opinions on my severe pain and any course of action.

[hunterinthehouse]

I am 62 year old woman who injured my back in 1989, I have been on narcotic pain meds for 20 years.  My diagnosis in 89was pulled, by now I have a very long list of injuries.  Please go see a pain management specialists, although I have by this time a basic mistrust of most doctors, I have some great doctors,and some quacks.  By now I have a good quality of life, I take 30 mg extended release morphine and 10 mg Percocet 3 X-ray.  Also due to nerve damage
I take neurontin, my life is good but I went thru hell those early years.  Please take care and go see someone who can and will help you.

[Tuckamore]

Hi Pain Queen,

Welcome to our Pain Management Forum. There are no "experts" on this forum and indeed no medical experts within MedHelp. We are experts in pain - as we all suffer with Chronic Pain of some sort.

To best understand your MRI break it down by word. For example the ventral means the front. The thecal refers to the covering of the spinal canal and the sac enclosure or pouch. The thecal sac is simply the membrane that covers the spinal cord and spinal nerves When you break these words down it's easier to understand.

Disc desiccation is one of the many diagnostic terms used to describe disc degeneration. It's also known as DDD (Degenerative Disc Disease). DDD happens to most of us as we age. When I say age it doesn't necessarily mean 50 or 60. It occurs are many ages.  When discs desiccate, they dry out and shrink, losing mass, circumference and diameter. This often produces pain, often chronic pain.

The left posterolateral aspect of the thecal sac means the left side of the sac. This finding will rarely affect the actual cord, but possibly could affect the nerve roots which exit at the side of the vertebra. And so on!

I assume you know the levels of the spine. The C (1-7) signifies the Cervical Spine (neck). Below the Cervical Spine is the D (1-12) or Thoracic Spine. Below the Thoracic is the L (1-5) Spine is the Lumbar Spine.

The pain you are experiencing in your upper back is most likely due to the  suspected paraspinal muscle spasms. It's often true that even a slight change in the normal structure of our spine can cause pain and spasms. We unconsciously "guard" these painful areas- tensing our muscles and changing our gait and motion - which also adds to the pain and spasms. It can be a vicious cycle.

I'm hopeful that a good physio will help you. Voltaren (diclofenac) is a nonsteroidal anti-inflammatory drug (NSAID) which should be helping inflammation. While this works for many it's not effective for everyone. We all respond differently to medications. There are other choices that may be better suited for you. Discuss this with your Pharmacist or PCP.  

Tramadol is a less potent opiate than many others. Physicians still prefer to RX it over more potent ones. Due to the note of spasms you may benefit from a short term Muscle Relaxer. Again I would discuss this with your PCP.

Back pain is the leading cause of visits to medical providers. We know how Chronic Pain can effect our daily life and normal functions. I encourage you to be assertive. You deserve good care as well as good pain management. Physio seems to be the appropriate place to begin. If it doesn't relieve your SX (symptoms) insist on more treatment - and/or a referral.  

I hope I've answered some of your questions. If not - please be specific and I'll do my best to reply. I hope you'll keep in touch and let us know how you are doing. I wish you the very best.

Take Care,
~Tuck

[remar]

I'm not an expert on MRI's but it's obvious that you do have spine issues going on and that's the reason for your pain. The car accidents may have been the cause along with extreme physical exertion.
Have you tried physical therapy and or getting massages on a regular basis? Both might help you a lot. This is where I would start. Since over the counter medications aren't helping you may need to get in to pain management.A good pain Dr will offer you several options as far as treating your pain. From physical therapy, trigger point injections, pain medication and so on.
We have wonderful and very knowledgeable members here that I'm sure can offer you more advice and tell you what your MRI results mean.
I'm so sorry you're going through this. I suffer with back issues myself so I do understand how you feel.