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How do you tell the difference between Nerve pain and Muscle Spasms?

AnonymousUserAAnonymousUser Posts: 49,578
edited 06/11/2012 - 7:29 AM in Chronic Pain
I am hoping someone can tell me how you tell the difference between Nerve pain and Muscle Spasms.

After my C6-C7 ACDF I had a really bad pain in my left shoulder blade. My OS sent me to a PM doctor who did SNRB's and trigger point injections twice over a 2 week period. My pain only seemed to get worse so we stopped. Now the pain seems to be more of a burning pain across my whole upper to mid back and across both shoulder blades. The muscles are still sore but what is with the burning pain now? Is that a sign of nerve pain? Does anyone know if these pains eventually go away?

Since I am unable to take any types of strong medicine, I am having a real difficult time with this and can't stop myself from crying since I don't know how I can continue living this way.

Any responses would be appreciated.




  • In my experience, muscle spasms feel like a tightening up, knotted, catchey type of pain/feeling. The nerve pain that I've had has been like the burning, hot/cold, zaps, tingling, feeling. I hope that helps you. Burning is supposed to be nerve related like you were saying, but spasms could feel like a stressed burning too.

    From your surgeries and fusions in June and this past December, you could still be having muscle issues as well. With every fusion, it changes our posture and physical makeup. Things don't move that use to. Did your OS suggest you could be healing and the nerves are regenerating? You might want to see a neurologist or neurosurgeon for a second opinion.

    I'm all for the shots to a point, and then I think steriods are bad for our total bodies if you take them for a long time. It's like a bandaid. In your case, they didn't even help a little. Are you taking any kind of muscle relaxer??? I would ask the OS for one if you can take something like that?? Robaxin, Soma, Flexeril are all some good ones.

    I have upper back pain and soreness, but not burning too much. When I have burning, it's from standing too long or sitting on a hard surface. When I lean or try to stretch it out, it feels better. Have you tried some light stretching??, pulling one arm at a time over your head and lean to the side a little...stretches out the shoulder blade and "wing" area. Heat always helps me too a lot when I'm having tightness.

    I hope you get some relief soon. I know you are worried about returning to work. I was too. My NS let me return part time for a few weeks, which helped, but it was so hard anyway. Keep us posted.
  • thoracic outlet syndrome and the nerve pain is how you describe its like a burning sensation and i get weakness in my hands too .as for muscular pain i dont think that the weakness is as pronounced .but both can be very painful.try a TENS and use ice as well as your pain killers and rest also helps..too many people try to battle on with pain .and i can tell you from experience that it will only make things worse !
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  • Hi candle,

    I am taking Soma 3 times a day but I have no idea if it is doing anything. I also take Fiorocet which is not even meant for this type of pain but it seems to dull it and I can tolerate taking it however, it wears off in 3 hrs.

    My OS has given me so many different possible reasons for my pain that I honestly think he is grasping at straws at the moment. First reason was that when he opened the area to remove the disk, the left shoulder muscle got pulled (like whiplash) and it would go away. Next reason, I'm not fusing as quick as before and he thought that it was due to my losing about 6 lbs. Told me to gain them back asap. Ordered me a bone stimulator and sent me to a PM doctor.

    The PM doctor was a little concerned when his SNRB's and trigger points were making things worse, he ordered an MRI. Now is where things get crazy.....The MRI showed that two of the screws in my neck may be in too far and pushing up against the thecal sac. PM doc said I should get another opinion along with speaking to my OS.

    Went back to my OS with the new MRI per my PM. Didn't want to throw the PM doctor under the bus so waited to see what my OS said. He walked in, threw the MRI on the table and said everything looked fine. Moved up my CT Scan date to the following day due to my level of pain now. He went as far as saying he hoped I wasn't fusing as that would explain everything and he may have to do another surgery. Before we left, my BF asked about the screws being in too far (saying that we read it in the MRI report). My OS looked at the written report and said "the person who read this report is an idiot and the screws are in perfect". He even said being in far was a good thing.

    Ok...Had my CT. Went back to my OS. He says I am starting to fuse but two screws are loose (not what the written report says). He said it was due to too much movement. This was the next reason for my pain. He put me back in the soft collar 24/7, gave me Neurontin and sent me on my way.

    I have since faxed all of the requested records to the specialist that my PM doctor recommended for a 3rd opinion.

    This is all so very hard for me since I have trusted my OS for so long and now I am not sure if I do anymore.

    Sorry for the long response. I tried to make a long story short but it didn't work real well.

    Thanks again for all replies.

  • My NS tried that deal on me, when one of my cages moved out into the spinal canal, that that wouldn't cause my increased pain in my lumbar. I had to insist on having hardware added to stablize my fusion. I had movement which was evident by the cage moving. He finally said, well, it's probably a good idea to add the hardware (ARGH!). Then when I had that surgery, he actually added the L3/L4 hardware because that vertebra would moveable to the touch. My facet joints were degenerated away. Something they couldn't see as well from the Anterior fusion. So I really needed all the above fixed. He kept telling me my pain was due to not fusing yet, it was just nerve pain from healing, blah blah blah. My lumbar area is 98% better now. I don't think they actually moved the cage back in, but took off some bone material that was in front of the cage, giving the nerves more room.

    For the cervical area, the spinal cord is more important, carrying nerves to all parts of the body. Any bulge or compression will cause more problems and pain than the lumbar area. You can also be paralyzed from cervical spinal cord impingement, especially from a loose screw. I would say that your situation is dangerous or at least has the possibility of becoming dangerous.

    I would go back in and insist the your OS to address the loose screw issue. They can order more tests or a CT to see the exact position. The squeaking wheel gets the grease, so be forceful. This isn't something to play around with from the sounds of your MRI. It's documented. There are many surgeons out there that will not admit they have made a mistake, so you may have to change doctors or get a second opinion. Good luck. I feel for you. Please don't let this go until you are sure that the loose screw or out of position screw is safe.
  • Speaking of becoming paralyzed, you just reminded me that my OS also said "if the screws were in too far then you'd be paralyzed".

    Also, before the CT Scan, when he was thinking he may have to do another surgery because of non fusion, he was talking about adding more hardware to make it more stable. He talked about possibly going in posterior if he had to.

    I am SO confused. I hope the 3rd opinion doctor contacts me soon about an appointment.


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  • I was informed that if I could pin point the pain, exactly where it is, that is a muscles spasm. But if the pain is deep, but I cannot really locate it, like it is everywhere, that is nerve. I have lumbar problems not neck, so maybe it is different.
  • This happened to me as well after my last cervical surgery as well. I had a screw move out of place and had pretty extreme pain. MRI's and CT scans revealed that the screw wasn't touching anything vital and my surgeon explained to me that the screws aren't long enough to violate the spinal cord area. My pain continued even after I fused and there was no more movement in my cervical spine and it turned out that I had TOS. I'm not telling you that this is your problem, only to leave no stone unturned when looking for answers for your "mystery" pain. While I was fortunate to have a surgeon that didn't stop until we had answers, many aren't that lucky.

    Have they done flexion and extension x-rays? That's a quick way to tell if the cervical spine is unstable. Just keep at him until you get answers. It's not his neck, it's yours and you may have to fight for what you need. It troubles me that he told you that he pulled the shoulder muscle. Those suckers scar like the dickens with trauma and need to be treated. I'd ask him about that as well.

    I really hope you find answers soon. I know how it is to get the run around and hope that yours ends quickly.

  • Laurie,
    Why would not fusing yet... hurt? If there is hardware in there, the lack of a fusion would not make a difference unless you're doing cartwheels - you're not, right? ;-) Ha, ha - we spineys need to be more funny.

    I am interested in this thread as I still have pain 18 months after my ACDF C5-6 including a weak and painful right hand, arm, shoulder, and neck. Before it fused, it felt the same and after it fused it felt the same. It's as if I never had surgery except for the scar and knowledge that the levels above and below will likely worsen.

    Did you get an appointment for that 3rd opinion?
  • When it's surface muscles, I can tell the spasms because I can sit and watch my skin crawl around without any help. :O But when you get into some of the deep muscle spasms, it's almost impossible to tell which is spasm and which is nerve pain just by what you feel. I had to have an EMG and NCV for my doctors to sort out which was the source of my pain. As it happens, it was a combination of both; I have nerve damage, scar tissue, and pyriformis muscle spasms, which all feels pretty much the same.
  • I'm also trying to identify which I have throughout the day and night, as they require different treatments.
    It seems that the majority of mine is from the muscles, but they then impinge on some nerves so in comes the nerve pain.
    They can both occur at the same time, so you can't tell what is what.
    I'm starting to recognise the muscle pain as it is the type I get the most. So it is easier to notice the nerve pain as it is different. More of a very specific pain or ache in the spine, and can affect the eyes.
    Not much help to you, I'm sure, but at least you know others are also trying to sort it out!
    Speaking with my Dr, physio and masseuse, plus some research, has convinced me that muscle pain is a far bigger culprit than is usually suggested. Fix the muscles and you may well reduce your pain substantially, perhaps entirely.
    My new PT and massage routine should deliver the benefits in 2-3 months, but already I can feel the improvement.
    A key thing for me is to stop myself from getting tense by reacting badly to things that happen.
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