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Thoracic Pain, need some ideas.

Jay61581JJay61581 Posts: 5
edited 06/11/2012 - 9:00 AM in Upper Back Pain, Thoracic
Hello everyone

I just joined this forum with the hope of getting some ideas to present to my doctor during my next appointment.

I have been suffering from severe chronic pain in my upper back for about a year now. Chiropractic and massage used to help a little, but became ineffective even when done two or three times a week. Since I started seeing a doctor for this back pain I have lost 75 pounds, took up walking and biking, stretched and flexed constantly, and exercised my stomach and back muscles. I even bought an inversion table.

None of this seems to be helping.

I had a very thorough physical June 2011. All the blood work came back fine. My chest xray showed mild scoliosis and mild disc degeneration.

I had an MRI done December 2011 and all four medical professionals that have looked at it said everything is normal. The MRI report said everything was normal "aside from small Schmorl's nodes involving the endplates at the T5-6 level and the inferior endplate of T6 as well".

My doctor, which is actually a PA at a community health center, has not been very aggressive as far as sending me to specialists or trying to figure something out. All she has done is prescribe me a daily dose of 800mg of Tramadol which doesn't even touch my pain most days.

I told her that I'm paying a fortune out of pocket to keep my insurance active so I want to use it. I requested that we run any and all tests in an attempt to figure out whats wrong with me.

So these are my questions-

1. What are some possible diseases/conditions that we should be looking for?

2. And what kind of tests should we be running?

3. What kind of specialists should I be seeing? Orthopedic? Neurologists?

Thanks for the help and any ideas!


  • a neurosurgeon or a spine-fellowship trained orthopedic surgeon? One of the two should read your MRI and do a thorough exam of your spine.

    They can give you a diagnosis and treatment plan, ie proper physical therapy, proper medication, if you should be seeing a chiropractor and if your current exercise/stretching/inversion table is even appropriate for your diagnosis.

    Hope this helps,

  • 800mgs of tramadol is a lot! They should switch you to a different kind of medication.

    I have also been suffering from mid/upper back pain since my fusion. No one knows whats causing it either. Very frustrating.

    Sorry I am not much of a help, I am with you in spirit!
    ACDF C4-5 June 23rd, 2011

    Another surgery in the near future. I am 26 years old.

    Current Meds- Norco 7.5/325, Cymbalta 60mg, Gabapentin, Adderall 20mg
  • I haven't yet seen a neurosurgeon or orthopedic surgeon. I'm hoping my doctor had foresight enough to refer me to one, since PA's and family doctors are NOT spine specialists. Good idea though, thanks.

    My mistake on the 800mg of Tramadol, it's actually 400. My previous doctor in Wahington (state) had prescribed to me 10mg hydrocodone which actually worked well for my back pain, better than anything else I've tried. Now I'm across country in Maine and evidently there's quite a problem with prescription drug abuse here and you have to be a patient for one month before they will even consider prescribing anything that actually works, hence the Tramadol.

    My doctor also mentioned osteopathic something or other...never heard of it? Do they specialize in spine problems?

  • Hi Jay :wave: & welcome to SH :)

    I am in full agreement with what the other members have suggested to you.

    Unless they are a specialist they can easily over look something "small" (small to the naked eye but large in how it effects your body).

    What BS about a month on one set drug before they actually treat you as a individual!!! GRRRR!

    That stereo type junk just PO me off ;)

    Please keep us updated...

    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • Jay,
    the wrong sort of exercise can be as bad (or worse) than no exercise. Really you shouldn't do any flexing and stretching etc until you have been properly diagnosed.
    It took me over two years to be taken seriously let alone get a correct diagnosis.
    My advice: Be persistent until you are satisfied. Heavy medication might shut you up, it won't sort out your problem.

    I'm not young enough to know everything - Oscar Wilde
  • I should add that I did physical therapy for month in spring 2011 at the request of my doctor. The stretching and light back exercises they taught me did nothing for the pain. In fact, all it did was increase my range of motion (which wasn't bad to begin with) by a couple degrees. Needless to say that since it didn't help with the pain and cost me a $30 co-pay every visit, I quit going.
  • Thoracic pain is terrible to get a diagnosis. It took me 2-3 years to get proper one.
    Several things in thoracic can and do cause pain. Annular tears ( only seen with discogram most of time), smorls nodes, herniations, DDD all can cause pain in thoracic. What you need is to find out which one yours is coming from. Before getting to far in make sure you are dealing with doctor who has exp. treating thoracic patients.
    I posted a study here somewhere on smorls nodes that were painful and upon removal and fusion patient got full recovery. Smorl nodes are basically a herniation of the disc but instead of into the spinal area it herniaties through a weakened endplate. It is often a precursor for future DDD and can have an inflammatory response much like annular tear.
    Once a proper diagnosis is given you can work of stopping the inflammation that is causing your pain, being nerve inflammation from disc or facet inflammation or something impinging on nerve.
    I suggest you research as much as you can on thoracic and dont rule out cervical can refer pain down there in some circumstances. Dont let doctor get you out without answering questions, and I suggest you write them down prior to appt.

    Good luck, unfortunatly I am slowly getting back into thoracic club after chiro did some test where he pressed down on my head. I feel that old twinge, but it is amazing how less worried I am now that I have a treatment, ESI and surgeon who can do surgury if that does not cont. to work.
    Herniated T6-7, multiple herniations in cervical, tears in T5-T8. Stenois at levels and smorls nodes from thoracic thru lumbar
  • In complete agreement with Mick, Jay & Anelsen. Personally I Have spent so much in PT and really got NO-WHERE but it did keep me aggravated (flarred if you will). I have a few smorls nodes along with several HNP's all the way down the T-Spine -they are painful. My NS has told me eventually if all goes well the pain will lessen and the vertabrae will fuse together naturally. We are talking several years.

    If you can get into a NS or OS (who is fellowship trained) they can monitor your spine and if they feel it warrants surgery they will tell you. They can also refer you to Pain Managment. Thoracic spine issues are very hard to treat. Doctors don't seem to eager to "go there" with patients.

    I had to ask my NS for an MRI at one of my follow up visits after my neck fusion. In tears I said I need you to order an MRI, he sent me for a nerve block first then when the PM doc told him to order the MRI after seeing my T-spine during the floroscopy he finally did. What a can of worms this has been.

    It is a slow process- be patient. Sorry I don't have magic words of wisdom :)

  • Julie A,

    Did the neuro say the smorls nodes u had could be painful? My discogram was positive for pain at smorls node level. I was always curious about them and never found straight answer except in research. When I read about them after first MRI i was like , a herniation into the endplate, shit that sounds pretty bad to me. They are just another piece of the puzzle I guess.
    Herniated T6-7, multiple herniations in cervical, tears in T5-T8. Stenois at levels and smorls nodes from thoracic thru lumbar
  • As far as Schmorl's nodes go, I've gotten a variety of answers from doctors - they don't hurt, they do hurt, they hurt when healing, etc. I haven't found too much information abou them I'm my research but I haven't given up.

    I got I to my doctor yesterday and took a list of concerns I wanted addressed with a referral to a specialist in thoracic back pain and disorders at number one. She is setting something up with an orthopedic surgeon she knows and finally got me a prescription for something that controls my pain better than Tramadol.

    So far it seems like we're making some progress, I hope they figure it out quickly because I'm miserable.
  • I would definitely get to an expert. Does your insurance allow you to see specialists without a referral? Pain management doctors are used to seeing ALL kinds of problems, especially the back. A PM at some sort of "spine center" would be even better. Best of luck to you!
  • My doctors say they are "understandably painful". I have no idea which one problem hurts the worst though :) I have so many different things going on in my Thoracic spine- endplate edema w/smorls nodes, the annular tears, floating disc fragments, floating bone fragments, the simple paracentral disc bulge/herniation etc take your pick.

    Do you have any associated nerve pain? I have pretty serious pain in my T4-T6 nerves (ring of fire around my breast/ribs with shooting pain in my left upper thigh and my left upper arm/arm pit and now my elbow has joined in as well.

    I am lucky that my pain medication does help considerably (I take more than I care to). However there are times (like now) when nothing seems to work (I just turned off my tens unit) I am on my third batch of ice and it is after 11 pm. I will not get much sleep tonight.

    Feel better >:D<
  • Hi Julie

    I do in fact have nerve pain similar to what you described. When my back is really hurting it will radiate around into my ribs and stomach muscles. Its terrible pain but luckily it isn't constant.

    I just had three visits with a new chiropractor...They used the electric shock device, whatever the proper name is, but that was a dead end. I would walk out of the office loosened up and relatively pain free but it only would last about two hours before the cramps and back pain hit me like a ton of brick. Plus it was considerably more painful than when I WASN'T going to the chiropractor.

    So that's the end of that..

    I happened to find a local neurosurgeon who wasn't very busy next week so I made an appointment with him to go over my MRI results, maybe he will see something everyone else overlooked.
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