Crippling, baffling upper-back pain

March 24, 2011 1:26 PM

Hey, for the third time in the last ten years or so the same part of my upper back has decided to cause me a spectacular amount of pain and discomfort for the last five days or so. The pain is all on the right side of my upper back, going up my neck to the base of my skull, accompanied with numbness in my shoulder and all down my right tricep, sometimes all the way down to my fingers. Along with the pain I'm nauseous half the time, possibly as a result of the pain itself. Sleeping, working and doing anything at all beyond moaning is really difficult, and the application of heat and cold has only helped temporarily. Last time I just took over-the-counter back meds for a week until I could get off the couch, and then a bit later went to a chiropractor who identified a problem in my upper spine and assured me he could fix it if I came around every week for the next 20 years and signed over my paycheque. This time I'm going to go to a proper doctor, but can anyone take a guess at what may be wrong and what sort of doctor I should try to see? Thanks!
posted by Antexit to health & fitness (10 answers total)

My guess is some sort of pinched nerve. That might explain the numbness in your arm.
posted by thsmchnekllsfascists at 1:35 PM on March 24, 2011 [1 favorite]

I would go to the ER for immediate relief (unbearable pain and symptoms of nerve involvement make that perfectly reasonable) and get them to refer you to a neurosurgeon or orthopedist who specializes in spine disorders. That has been pretty much my wife's course over the past few days, with the difference that her symptoms are in the lower back and legs, but now she knows what to expect and what treatment options there are and is slowly but surely improving. I won't go into detail about her diagnosis since you could have something completely different, but it is worth it to get yourself seen.
posted by TedW at 1:45 PM on March 24, 2011 [1 favorite]

Speaking only as a survivor of a herniated disc, I ended up with an orthopedic doc who practiced at the sports medicine hospital at the nearby university. While I cant speak too highly of that particular doctor, the physical therapist I had was a frikkin lifesaver. Took a while (like 7 months) but once the problem was identified the therapy worked wonders - and almost no drugs (beyond the first extraordinarily painful weeks) except for occasional OTC pain-killers.
posted by elendil71 at 1:58 PM on March 24, 2011

I had an accident many years ago that resulted in the exact type of pain you've described. In my case, I developed some type of scar tissue in the muscle area right around my shoulder blade. Whenever I re-injure that scar tissue, it can flare up like that, although it's never been as bad as the initial injury. What's helped me in the past:

-an immediate steroid injection from my doctor to stop the spasming/tingling fingers sensation and allow me to sleep.
-ibuprofen, as needed.
-acupressure therapy for 4 months (don't laugh! it really helped; she used a variety of implements to break up the knots in my back and neck.)
-physical therapy for 6 months.
-exercise, especially yoga; although I avoid most types of push-ups because that tends to make things worse (wall push-ups don't aggravate it though, in my case.)
-setting up my computer workspace to be more ergonomic.
-taking proper rest and stretch breaks.
-Back Buddy; haven't needed an acupressure treatment since I bought one of these. Best $30 bucks I ever spent.

You really need to get to a doctor for an evaluation.
posted by LuckySeven~ at 2:04 PM on March 24, 2011 [1 favorite]

I apologize for the brevity of this answer, as I am typing with my thumbs on my phone.

1) Go to your MD and get a prescription for physical therapy.

2) go to www.NAIOMT.com and look up a NAIOMT certified PT in your area, or go to www.APTA.org and look up a PT in your area with the letters OCS (orthopedic certified specialist) after their name. I am a physical therapist without these credentials, and if you came to me, I would probably send you to somebody who had them.

3) Feel better, buddy.
posted by jennyjenny at 2:33 PM on March 24, 2011

You have the same type of back pain as me! For the last ten years I've had a similar issue with my back, about once every 6 months to every 2 years I'll pull either one or both sides of my back out from my shoulder blades to the base of my skull. Sometimes I can't even move or get out of bed it's so bad, so I know what you're going through.

My saving grace (aside from staying on top of stretching) was finding a really really good massage therapist. It's not the type of thing you want to do right after you've injured yourself, but keeping up with your back once every month or two (with the right kind of massage) will work wonders for you, if you're anything like me. I believe the type of massage she does is called "myofacial release" but I'm not sure. All I know is that she get's in there real deep with her elbow or a rock or something and I can literally feel the knots and old injuries releasing their tension. It's amazing.
posted by Glendale at 4:04 PM on March 24, 2011

I would recommend the Egoscue Method. High-level summary: the human body responds to lack of motion and activity with physical restriction, musculoskeletal mis-alignment, dysfunction, and chronic pain. This is the body signaling you that you're doing something wrong OR not doing enough of what it needs. Give the body the daily movement it needs, and the body heals itself of these.

This interview with Pete Egoscue lays out his experience and method. He got shot in Vietnam and declined the diagnosis of permanent disability the docs gave him. If there isn't a clinic proper or and Egoscue-certified therapist near you, I'd recommend the book Pain Free. My wife Lexi got herself off of HEAVY opiates after 4 days of doing the e-cises out of the book. She's now doing calisthenics and commutes daily on her bike. Egoscue has been central to both of us recovering from debilitating, bone-breaking (or near-breaking) injuries a couple of years ago. Today, we're stronger than ever.

As half a couple who come from a history of pain and dysfunction, PLEASE look into Egoscue before you let any of the bio-carpenters talk carving you up. Sometimes surgery is what's called for. But they surgeons know a whole lot less than they seem, their results are a whole lot less impressive than their wonder-worker reputations, lots of people die on the table every year during routine surgery, and if you can get yourself out of pain without drugs or surgery the way evolution designed you to, isn't that automatically the preferred option?

Also, find a way to get out of that chair you spend your days in. It's killing you in addition to contributing to your bad posture and misalignment. (Yes, that's a guess. But, I think, not a wild one).

Best of luck.
posted by Pirate-Bartender-Zombie-Monkey at 4:28 PM on March 24, 2011

Through a referral, or if you can go straight away would be better, you need to get to a neurologist and they'll do a series of tests from X-Rays to CAT Scans to MRI's. They'll probably be the only one who can tell you what's going on.
A doctor, even a sports doctor who's seen a lot of cases like this, might not be able to do much for you. Their toolbag is usually limited to a knife or pills, both of which probably won't help you. If they offer a Coritsone shot then just realize that doesn't fix anything except get rid of the pain.

Offhand it sounds like you might have some kind of Cervical Radiculopathy or Neuropathy. You can look at a chart of the Brachial Plexus and may be able to take a good guess at which nerves are affected. I had a friend who had to deal with some of this stuff. They went to a couple of different people. One was a an ART practioner, who are usually helpful with bound up muscles. Another was a sports PT who did Trigger Point Therapy which is also hugely useful for painful muscular symptons. The last was a doctor who specialized in sports physiology and was able to wittle down what it probably was. He also suggested taking some extra B12 a couple of times a week.
You can see an ART practioner or someone who does Trigger Point right away and that might eleviate a lot of the pain you're experiencing. And if it was only some bound up muscles pinching the nerve that would save yourself the time and money from having to see a doctor.

Good luck.
posted by P.o.B. at 5:08 PM on March 24, 2011

I've never heard of the Egoscue Method that Pirate Bartender mentions above, but the theory sounds interesting.

I used to suffer from pain very similar to what you are describing...crippling, numbing, accompanied by nausea, sometimes vomiting, and horrible migraine-like headaches. But since I have started working out regularly, the pain has all but stopped (knock in wood!) It used to happen twice a month, but I can't remember the last time I was in that amount of pain. So, for me it was vigorous exercise several times a week. My back muscles also got stronger, meaning I can sit up straight easier and I think this helps as well.

FOr a shorter-term solution, I found that yoga really helped (even if only for a few minutes) when I felt the pain starting. Often it would make the pain stop completely before it got bad.

Good luck. I know how bad it is to suffer through this.
posted by bearette at 8:22 PM on March 24, 2011

You almost definitely have some sort of nerve impingement, likely at the c7 root. You might even have a herniated disc. This usually resolves on its own. Proper neck posture (I would bet good money you spend a lot of time in a head forward position) is essential to help in the healing and prevent future attacks. McKenzie neck exercises can help. I am having trouble finding a good tutorial but they involve tucking your chin and retracting your head, and when you can do that adding a tip backward of the head and gentle and small side to side rotations with your head tipped back and chin tucked.

I would recommend seeing a neurosurgeon who specializes in cervical spine surgery. He/she can order an MRI and x-rays to assess the current disc damage and prescribe physical therapy. If you go to PT make sure you get a good therapist. The therapist should help you with posture and will likely provide massage and other treatments to relieve the associated muscle spasm and pain. You will probably also do stretching to relieve a head forward position and perhaps some neck range of motion.

Hopefully this all resolves for you without surgical intervention. Educate yourself about posture and stretching to prevent future attacks. I have heard good things about the Egoscue program from folks with lumbar spine issues. It may also work well for cervical spine issues. Even if this just resolves on its own don't ignore the problem. If you keep having these attacks you may eventually herniate the disc. Don't let that happen if it hasn't already.
posted by caddis at 6:05 PM on March 25, 2011