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What treatment options do I have?

spooniemomsspooniemom Posts: 1
edited 06/04/2015 - 3:03 AM in Upper Back Pain, Thoracic
Hi all, I'm new to these boards. I have dealt with back pain as long as I can remember, since I was a teenager. I also have fibromyalgia and seronegative rheumatoid arthritis, for which I'm currently on methotrexate and likely will be starting a biologic soon. I'm no stranger to physical pain.

Recently, my regular long-term back pain became unbearably bad and my PCP ordered an x-ray. At the time of the x-ray, it was noted that I had severe degeneration of the bones (which were described as wavy and looked as though they were disintegrating). However, the report from the radiologist noted only a mild kyphosis of the thoracic spine. Because of the severity of the pain and some numbness I was having in my hands, I was sent for MRI.

The MRI results were:

Mild kyphosis of the T-spine.

2 mm disc protrusions at T6-T7 and T7-T8

Posterior annular fissure at C5-6 (which is what my PCP believes is causing my pain)

However, the worst of the pain is not in my C-spine. I'm having unbearable pain in my thoracic back, below my shoulder blades, directly on the spine. It hurts to breathe and it hurts to sit or stand for more than a few minutes. I am really miserable with this pain.

My PCP referred me to a neurologist who reviewed my MRI and said she couldn't help me surgically so she referred me back to my PCP and suggested I see a pain management doctor for injections. (She never saw me, just my records). Another spine specialist my doctor tried to refer me to said they don't deal with the T-spine at all.

I have an appointment with pain management in 2 weeks, which feels like a lifetime with how bad I'm hurting right now. (And I'm not a wimp when it comes to pain. I have four kids, I've had one of them with an unmedicated delivery with hardly a whimper, and this is hurting so badly I can hardly stand it). My PCP has been giving me Norco 7.5-325 until I can get in with pain management. At first 1 helped okay but my tolerance develops super quickly and now I have to take 2 to even take the edge off the pain.

I'm discouraged because it seems like the imaging findings are relatively minor compared to how bad my pain is. I'm hopeful that the injections might help, and I'm sure they'll want me to do physical therapy, but is there anything else they're likely to do? I'm concerned that they're going to think results this minor won't warrant pain medication and I'll be without anything to help. I honestly don't know how I would function without something. I find that Salonpas patches do help somewhat but as I already take a high dose of Mobic, I shouldn't use any other anti-inflammatories.

I'm a transcriptionist and a writer, and I type for a living. I've already had to quit one of my two jobs based on an inability to sit at my desk without tremendous pain, but I need to make a living. I'm so discouraged and frustrated that the neurologist won't see me and I wonder whether you all have any ideas or suggestions of what might happen next or why I'm in such terrible pain over what seems like some minor protrusions and one fissure (which doesn't seem like it should hurt that bad). Do you think pain management is going to take a look at my imaging and decide that it doesn't warrant pain meds? Are injections likely to help with the pain? Is there a chance that PT will do anything for this kind of pain? Is there anything else I can expect them to try at pain management?

Thanks so much. I'm hurting SO bad and just hoping for some help with this, trying to educate myself as much as possible for the best possible outcome when I finally get someone to look at this. Thanks.



  • SavageSavage United StatesPosts: 5,427
    edited 06/04/2015 - 1:23 PM

    Welcome to Spine-Health

    It would be very helpful if you could provide us with more details. So many times we read about members who have different tests and they all come back negative. The more clues and information you provide, the better chances in finding out what is wrong,

    Here are some questions that you should answer:

    - When did this first start?
    - Was it the result of an accident or trauma?
    - What doctors have you seen? (Orthopedic, Neurosurgeon, Spine Specialist, etc)
    - What Conservative treatments have you had? Which ones?
    - What diagnostic tests have you had? And their results (MRI, CTScan, XRay, EMG, etc)
    - What medications are you currently using? (details, dosage, frequency, etc)
    - Has surgery been discussed as an option? (If so, what kind)
    - Is there any nerve pain/damage associated?
    - What is your doctor’s action plan for treating you?

    Providing answers to questions like this will give the member community here a better understanding
    of your situation and make it easier to respond.

    Please take a look at our forum rules: Forum Rules

    Please remember that no one at Spine-Health is a formally trained medical professional.
    Everything that is posted here is based on personal experiences and perhaps additional research.
    As such, no member is permitted to provide

    - Analysis or interpretation of any diagnostic test (ie MRI, CTscan, Xray, etc)
    - Medical advice of any kind
    - Recommendations in terms of Medications, Treatments, Exercises, etc

    What could be good for someone could spell disaster for another.
    You should also consult your doctor to better understand your condition and the do’s and don’t’s.
    It is very important that new members (or even seasoned members) provide others with details about their condition(s). It is virtually impossible to help another member when all the details we have are
    I’ve had this for years, it hurts, I cant move my shoulder – what could this be, what treatment should I get?

    Diagnosing spinal problems can be very difficult. In many ways its like a game of clue. Especially, when the diagnostic tests come back negative – no trouble found! Then its up to the patient and the doctor to start digging deeper. The doctor is like a detective. They need clues to help them move along. So, you as the patient need to provide the doctor with all sorts of clues. That is like it is here. Without having information about a condition, its impossible for anyone here to try to help.

    Specific comments :

    Personal Opinion, not medical advice :

    --- Ron DiLauro, Spine-Health System Moderator :
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • SavageSavage United StatesPosts: 5,427
    You said you PCP referred you to neurologist who seems only interested in surgical repairs as reviewing your records he knew he could not help you surgically. My experience is that is the way it goes. If surgeon can't do surgery, they are done. We need to move along.

    For myself, pain management has been the best thing to happen to me.
    My PCP must of wrote a great referral, because at initial visit, I was told I would be treated as cancer patient and he immediately wrote script for fentanyl patches.

    He also ordered different testing. The EMG was most revealing to doctor. It indicated areas of my spine effected that I had not even given voice to.

    You said your PCP prescribed pain med for interim. You said one no longer held you so you take two.
    Is that within the directions of the prescription?

    If not, please notify PCP that the one as ordered is not holding and what does she suggest? Tell her if what you did, to take two, is okay and if so, she would document that into your chart.
    You don't want to go into PM appoint with already premedicating yourself.

    If PM doc not agree with your PCP reviews of your testing, big if, PM docs are to relieve pain while they continue to look for source or cause of pain.
    Just tell doc your history, the tolerance of meds you were previously on, just be honest.
    I wish you the best in speedy pain control

    Spine-Health Moderator
    Please read my medical history at: Medical History

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