Why do I have rib pain, and who should I see?
December 1, 2018 7:58 AM Subscribe
I've had pain on my left side in my ribs for three months now. The pain is mostly in the back of left my ribs. I've attempted to get medical help, but I have had no success. Any suggestions on who to see or what this is would be much appreciated!
The pain started suddenly in September without any precipitating injury or fall. I'm unable to lie down on my left side due to the pain, and the pain is most intense when I am lying down. It occurs every night, without fail, and occurs to a much lesser extent during the day.
My physical therapist (who I was seeing for other reasons) was unable to lessen the pain. He referred me to a physical medicine & rehabilitation physician. Once he found out that I have a long history of depression and anxiety, he said that's why my rib is so sore. (He immediately asked if I'd read John Sarno's work about mind & body, and, yes, I had read several of his books several weeks before that.)
At this point, I don't know how to cope with the rib pain every single night. I don't know who else to see or what to do or why it's happening. Can anyone help?
The pain started suddenly in September without any precipitating injury or fall. I'm unable to lie down on my left side due to the pain, and the pain is most intense when I am lying down. It occurs every night, without fail, and occurs to a much lesser extent during the day.
My physical therapist (who I was seeing for other reasons) was unable to lessen the pain. He referred me to a physical medicine & rehabilitation physician. Once he found out that I have a long history of depression and anxiety, he said that's why my rib is so sore. (He immediately asked if I'd read John Sarno's work about mind & body, and, yes, I had read several of his books several weeks before that.)
At this point, I don't know how to cope with the rib pain every single night. I don't know who else to see or what to do or why it's happening. Can anyone help?
Response by poster: Sorry for threadsitting. I forgot to include some pertinent information.
I saw a primary care physician at a clinic, and he glanced at it and said "inflammation" and gave me some analgesic cream. The cream did not help.
posted by Four-Eyed Girl at 8:12 AM on December 1, 2018
I saw a primary care physician at a clinic, and he glanced at it and said "inflammation" and gave me some analgesic cream. The cream did not help.
posted by Four-Eyed Girl at 8:12 AM on December 1, 2018
I have experienced pain that I would describe this way twice, including the trouble laying down. Once was when I had mono and my spleen was inflamed, which cleared up as I got over the mono. The second time, my stomach had gotten really acidic due to a period of not great diet choices. A course of Prilosec calmed things down. The mono-related pain was worse than the stomach acid pain. So, agree with the above that it's not necessarily musculoskeletal.
posted by sk932 at 8:37 AM on December 1, 2018 [1 favorite]
posted by sk932 at 8:37 AM on December 1, 2018 [1 favorite]
Male doctors (and, unfortunately, some female doctors too) do have a tendency to dismiss women's symptoms. If you have health insurance, ask friends for recommendations and get yourself your own primary care physician, not just the random person who happens to be working when you go to a clinic. It also seems to me, from anecdotal evidence, that doctors often suspect patients who mention strange pains of really seeking drugs unless the doctor knows the patient and her history.
In the meantime, have you tried using a heating pad?
posted by mareli at 8:38 AM on December 1, 2018 [1 favorite]
In the meantime, have you tried using a heating pad?
posted by mareli at 8:38 AM on December 1, 2018 [1 favorite]
It's hard to be certain based on the info provided, but I may well have suffered something similar once (in fact, it still recurs occasionally). My story was long and frustrating insofar as I never got a proper diagnosis. I just had this problem (more at my side than my back per say) which manifested as extreme sensitivity. I remember wearing a shoulder-lap belt in the car was particularly difficult. As for sleeping, I ended up on my other side a lot.
Long story short. I switched family doctors at one point and the new one had a specialty in sports medicine. He wasn't sure what I had but he did mention that there was a tendon that ran along the bottom of the rib cage that sometimes got stressed, and that once stressed, tendons can be pernicious in terms of giving pain, discomfort. What he did recommend overall was taking better care of myself, eating better, getting in better overall physical shape, moving more, getting my core strength up, maybe losing weight in the process (but not to focus on weight loss). And it worked ... for the most part. I think, to a large degree, because I worried about it less. Thinking that it was probably a tendon as opposed to some kind of mysterious internal organ thing really, really helped.
It's now over twenty years later and I still get occasional reminders, but rather than worry, I tend to focus on the fitness aspect, working more basic exercise into my life, eating better, taking overall better care of myself.
Hope this helps.
posted by philip-random at 8:58 AM on December 1, 2018 [1 favorite]
Long story short. I switched family doctors at one point and the new one had a specialty in sports medicine. He wasn't sure what I had but he did mention that there was a tendon that ran along the bottom of the rib cage that sometimes got stressed, and that once stressed, tendons can be pernicious in terms of giving pain, discomfort. What he did recommend overall was taking better care of myself, eating better, getting in better overall physical shape, moving more, getting my core strength up, maybe losing weight in the process (but not to focus on weight loss). And it worked ... for the most part. I think, to a large degree, because I worried about it less. Thinking that it was probably a tendon as opposed to some kind of mysterious internal organ thing really, really helped.
It's now over twenty years later and I still get occasional reminders, but rather than worry, I tend to focus on the fitness aspect, working more basic exercise into my life, eating better, taking overall better care of myself.
Hope this helps.
posted by philip-random at 8:58 AM on December 1, 2018 [1 favorite]
Could be a strained muscle, or mono, or angina. Note that those are all super different things, but with the information provided it's impossible to narrow this down. There are hundreds of things it could be. You should go back to your doctor and say "Hey, this is still a problem and the cream isn't helping. It's affecting my quality of life. What's the next step?"
posted by Anticipation Of A New Lover's Arrival, The at 9:32 AM on December 1, 2018 [2 favorites]
posted by Anticipation Of A New Lover's Arrival, The at 9:32 AM on December 1, 2018 [2 favorites]
Then it’s time to go back to your physician and tell them that the anti inflammatory cream didn’t work and you need them to investigate the issue further.
posted by lydhre at 10:00 AM on December 1, 2018 [6 favorites]
posted by lydhre at 10:00 AM on December 1, 2018 [6 favorites]
Nthing go back to the doctor, tell them the cream didn't work and they need to try something else.
posted by bunderful at 10:27 AM on December 1, 2018 [1 favorite]
posted by bunderful at 10:27 AM on December 1, 2018 [1 favorite]
A few years ago I was dx with an interstitial muscle sprain for severe rib pain. It kind of healed and then I had another bout that was even worse. I couldn't lie on it, kept me awake, was totally horrible. Anyway finally my doctor did an X ray. He said the X ray was fine. But the radiologist saw a tiny hairline fracture on my rib, something the GP missed before he sent it along to the radiologist.
Because I'd clearly had a repeating fracture I was given a bone density test and it turned out I had premature osteoporosis.
So, I would suggest you consider a rib fracture, make sure a bone fide radiologist reads it if the GP doesn't see anything bc it could be hairline and still hurt like crazy.
posted by velveeta underground at 10:46 AM on December 1, 2018
Because I'd clearly had a repeating fracture I was given a bone density test and it turned out I had premature osteoporosis.
So, I would suggest you consider a rib fracture, make sure a bone fide radiologist reads it if the GP doesn't see anything bc it could be hairline and still hurt like crazy.
posted by velveeta underground at 10:46 AM on December 1, 2018
Based on location, another of the various scattered possibilities is pancreatic issues. I agree with everyone who says you should be persistent with your GP.
posted by praemunire at 11:10 AM on December 1, 2018 [1 favorite]
posted by praemunire at 11:10 AM on December 1, 2018 [1 favorite]
Nthing go back to that (or another) primary care physician and, describe the situation and how it's affecting you, and ask what the next steps might be. No doctor I know would turn a hair at hearing that, and if they do, find another doctor. They've tried the most obvious solution, now time to investigate further and/or try another.
posted by altolinguistic at 11:13 AM on December 1, 2018 [1 favorite]
posted by altolinguistic at 11:13 AM on December 1, 2018 [1 favorite]
Osteopath, osteopath, osteopath. After 6 months of a sports physician, physio and chiropractor that improved things but didn’t resolve it I went to an Osteo on a Friday because everyone else was closed and I was terrified of a weekend of pain and a week later I realized I hadn’t thought about my neck. I have 2 more appointments and should be finished.
posted by catspajammies at 12:03 PM on December 1, 2018
posted by catspajammies at 12:03 PM on December 1, 2018
going to a PM&R guy, even if he'd been a good one, won't get you a right diagnosis if it isn't a PM&R problem, and a physical therapist isn't able to judge if it is or isn't.
can you say to a doctor, without being untruthful, that the pain is in your side generally, rather than your ribs? presenting the problem as persistent debilitating (sharp?) pain in your left abdomen/side may give them very different ideas about what might be the matter than soreness in your ribs per se. it may be just inflammation/costochondritis like the one doctor said. and if it is, no harm will be done by ruling out any chance it's pain from your spleen or a kidney stone or even referred pain from the other side of your torso.
if you don't have access to anything but an urgent care clinic, it's still worth trying there again - either you'll get a fresh doctor or, if you get the same one, you can tell him you're following up because his treatment had no effect and you're in a lot of pain. this isn't something you have to strategize an approach for, just tell him. sometimes for their own workflow convenience, they won't worry about tests unless you do persist in following up a few times. they count on a certain proportion of complaints going away on their own. but if it's been a week or more you can just go back and tell him it didn't.
I do not advise being forthcoming about a history of depression and anxiety unless it's already in your records. it is not going to contribute to your quality of care when dealing with any doctor except a psychiatrist. it should, but it won't.
posted by queenofbithynia at 5:14 PM on December 1, 2018 [3 favorites]
can you say to a doctor, without being untruthful, that the pain is in your side generally, rather than your ribs? presenting the problem as persistent debilitating (sharp?) pain in your left abdomen/side may give them very different ideas about what might be the matter than soreness in your ribs per se. it may be just inflammation/costochondritis like the one doctor said. and if it is, no harm will be done by ruling out any chance it's pain from your spleen or a kidney stone or even referred pain from the other side of your torso.
if you don't have access to anything but an urgent care clinic, it's still worth trying there again - either you'll get a fresh doctor or, if you get the same one, you can tell him you're following up because his treatment had no effect and you're in a lot of pain. this isn't something you have to strategize an approach for, just tell him. sometimes for their own workflow convenience, they won't worry about tests unless you do persist in following up a few times. they count on a certain proportion of complaints going away on their own. but if it's been a week or more you can just go back and tell him it didn't.
I do not advise being forthcoming about a history of depression and anxiety unless it's already in your records. it is not going to contribute to your quality of care when dealing with any doctor except a psychiatrist. it should, but it won't.
posted by queenofbithynia at 5:14 PM on December 1, 2018 [3 favorites]
Response by poster: Thanks, everyone!
I now have an appointment with a female primary care doctor who I haven't seen before, and I'll try again. Unfortunately, they will have access to records that show my history of depression and anxiety. I can't really see anyone who doesn't have access to those records due to insurance reasons.
I decided against going back to the doctor at the clinic because they're very good at easy, everyday medical problems, but not necessarily anything that could be more complicated. I looked for an osteopath, but that's not possible with my insurance.
posted by Four-Eyed Girl at 7:08 AM on December 2, 2018 [1 favorite]
I now have an appointment with a female primary care doctor who I haven't seen before, and I'll try again. Unfortunately, they will have access to records that show my history of depression and anxiety. I can't really see anyone who doesn't have access to those records due to insurance reasons.
I decided against going back to the doctor at the clinic because they're very good at easy, everyday medical problems, but not necessarily anything that could be more complicated. I looked for an osteopath, but that's not possible with my insurance.
posted by Four-Eyed Girl at 7:08 AM on December 2, 2018 [1 favorite]
If you're still struggling with figuring this out, maybe try a chiropractor? I had stubborn neck pain that only happened while laying down and my PT couldn't figure it out. I finally went to a (non-woo) chiropractor and it turns out the top two vertebrae were "stuck".
Also, do you know about trigger points? See if you can find some and maybe that will help ease the pain. If not, or no trigger points, then perhaps it is an internal or organ issue.
posted by evening at 5:46 PM on December 2, 2018
Also, do you know about trigger points? See if you can find some and maybe that will help ease the pain. If not, or no trigger points, then perhaps it is an internal or organ issue.
posted by evening at 5:46 PM on December 2, 2018
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