I have inexplicable, excruciating back pain.

August 24, 2006 9:15 AM

I have inexplicable, excruciating back pain. Help me figure out what to do/who to see about it.

I don't know if the chiropractors I've made fun of developed more effective voodoo dolls or if I wrenched it in my sleep or what, but this is a pretty far out there kind of pain. I will be going to some sort of doctor today, but I have some questions.

First: it's not in my lower back. Lower back is fine and dandy. It's the upper half of the thoracic spine. It extends all the way out to the shoulder blades. Is this unusual as far as back pain goes?

Second: accompanying all this is a soreness and tightness that wraps around the lower part of my pectorals. I don't know if this is like a sympathetic pain or if it's caused by the tightness of my back or something else entirely.

There is a position that is bearable. If I use perfect posture but roll the shoulders slightly forward the pain is significantly lessened; a deviation of as little as 10% from this produces a sharp stabbing pain right in the middle of my back.

So: what kind of doctor should I see? I GP? A physical therapist? Should I request any specific tests? X-Ray? Does anyone have experience with this sort of upper back pain?

Honestly, the only way I was able to sleep last night was to take some left over Percocet and it still really really really hurt. So I need some sort of actual fix. Thanks.

(Asking for Optimus.)

posted by curie to health & fitness (21 comments total)

Back pain is fairly common, but often it is low back pain. The first step to having this pain evaluated is seeing your regular doctor/GP. He or she would most likely start with X-rays of your back to help delineate the problem. He can also provide you to a referral to a specialist, possible and orthopedist. The answer to "which Dr. should I see" should be answered by your GP, he will know how to navigate the system and point you in the right direction.

I am a doctor.
posted by cahlers at 9:25 AM on August 24, 2006

sounds like a pinched nerve causing muscle spasms. Maximal Normal treatment is muscle relaxants, anti-inflamitories (to reduce swelling where nerve is pinched in the spine) and staying in bed.

Don't take my word. See a GP.
posted by MonkeySaltedNuts at 9:25 AM on August 24, 2006

For immediate, short-term relief, try a heating pad. But definitely see a doctor.
posted by orange swan at 9:34 AM on August 24, 2006

what kind of doctor should I see?

Osteopath. That way you have the best of the chiropractic world *and* the best of the traditional medicine world (x-rays, pain killers, etc.).
posted by ilsa at 10:06 AM on August 24, 2006

I'm with Ilsa. Osteopath if you can find a good one. Chiropractor's are more common. I don't go to a regular MD unless I have something that medicine can fix. Pain medication would make it feel better but usually won't fix anything beyond simple muscle spasms.
posted by The Mauve Frog at 10:30 AM on August 24, 2006

Sounds like a pinched nerve to me, but IANAD, just someone with a long and storied history of back pain. Best painkiller in the meantime is going to be lots of ibuprofen.

Also, I wouldn't put heat on it just yet, until you get the okay from your doc -- depending on what in fact the problem is, heat can aggravate it rather than help.
posted by scody at 11:23 AM on August 24, 2006

Thanks, scody. Everyone is telling me to heat it or ice it, but it seems like those would have radically different effects, so how do you choose? Still trying to get in with someone today, we'll see. :(
posted by Optimus Chyme at 11:34 AM on August 24, 2006

It's possible that it could be referred pain from acute hyperacidity as well; I've had that happen a couple times. Have you ever had problems with GERD or things like that?
posted by baylink at 11:50 AM on August 24, 2006

I had something like that - upper back pain, excruciating at times. Went on for years. Divorce cured it. (No, I am not making a joke.)
posted by Kirth Gerson at 12:21 PM on August 24, 2006

It's not something that will fix what you've got now, but for preventing flare-ups in the future, you could try a course of lessons in the Alexander Technique. My lessons have done wonders for my posture and I have very few aches and pains in my back now. You can track down a teacher here.
posted by greycap at 12:25 PM on August 24, 2006

I have the exact same symptoms, going back about three years. An X-Ray showed a spot of arthritis... Muscles spasm, girdle the pecs, sometimes feels like a freaking heart attack... When it happens I react by rubbing my chest- people think I'm having 'chest pains'. Anyway I went to a chiropractor for a few sessions, and felt worse so I stopped that. Now I take muscle relaxant and a perscription strength naproxum sodium (Aleve). good luck , because if it is anything like mine it will come and go. Try some subtle streching. On your hands and knees and lift opposing limbs and stretch gently. another one is to scrunch your shoulders back with your elbows tucked in and hold for 10 seconds.
posted by Gungho at 12:35 PM on August 24, 2006

It's possible that it could be referred pain from acute hyperacidity as well; I've had that happen a couple times. Have you ever had problems with GERD or things like that?
posted by baylink at 11:50 AM PST on August 24

No. I have serious indigestion/heartburn maybe once a year. It's certainly possible that it's the cause but I think sitting at a goddamn desk for eight+ hours a day is the culprit. I'll check it out though, thanks.

Divorce cured it. (No, I am not making a joke.)
posted by Kirth Gerson at 12:21 PM PST on August 24

The only stressor is a change in ownership at my work. But things are going better there than they have in months, so I doubt it.

Okay back to the couch. :(
posted by Optimus Chyme at 12:40 PM on August 24, 2006

I've had similar issues with my back - it was an acute back spasm which I treated with relaxers and stretching. You absolutely need to see an M.D. I doubt a GP will have enough experience treat you if you are in "excruciating pain." If you have a PPO plan perhaps you can make an appointment directly with a specialist. Often there are spine specialists within the surgery department that will be available for consultation. To rule out a slipped disc completely I had both X-rays and MRIs done.
posted by dendrite at 1:31 PM on August 24, 2006

Oh, by "relaxers" I meant muscle relaxing medication like Flexeril.
posted by dendrite at 1:35 PM on August 24, 2006

I would get a diagnosis from a GB to rule out anything serious. In the meantime try massage and light stretching and possibly combine that with chiropractic. I would also try doing some weight training once you have ruled out major stuff. This helped my BFs chronic back pain. Weak back muscles can cause more strain on tendons, etc.
posted by livinginmonrovia at 3:24 PM on August 24, 2006

In the meantime try massage and light stretching and possibly combine that with chiropractic.

Do not take this advice from someone who knows nothing. The problem with pinched-nerve/muscle-spasms is that the pinch causes the spasm and the spasm causes further pinching. Flat on your back inactivity is best, and stay away from quacks.
posted by MonkeySaltedNuts at 4:00 PM on August 24, 2006

hey,
if it's a disc herniation or a rupture, generally the pain is so bad you get stuck without being able to move at all when it first happens. (i've been here)

if it just hurts when you breathe and radiates around the ribs it sounds like you just have a rib that's "out", I'd go to a chiropractor if someone one can recommend one to you. That's a good way to stay quack proof. If I'm right you will get immediate relief in about 30 seconds. (I've also been here)

Just to make it more complex, it could also be (less likely) a slightly unusual but known symptom of cardiac problems.
Note if it is worse with exertion. I hope not!

anyhow, I'd go to the doc, let him check me out, and simultaneously ask around to my friends and find a decent chiropractor. If you don't have chiro friendly friends, find a nearby sports team and ask them who they use.

Between the two you are going to be fine. If it were me, I'd get my butt to the chiro unless it is made worse by walking across the street. My money would be on your spine outa whack.

good luck and feel better soon. and don't forget to tell us how you are.
posted by janicea at 5:32 PM on August 24, 2006

Is this a very recent one-time thing? It sounds a lot like the beginning stages of shingles. My husband had three or four days of bad pain in that pattern before the rash started to show up.

I'd start with a GP to rule out shingles or other odd conditions. If it's strictly musculoskeletal, I'd then see a physical therapist; your GP should be able to point you in the direction of a good one.

Good luck.
posted by sculpin at 5:33 PM on August 24, 2006

I'll second the shingles. I recall my father having similar symptoms before he broke out in the aforementioned rash.

Here are google's search results...
posted by Jhaus at 10:49 PM on August 24, 2006

Update: I'm taking Flexeril and ibuprofen, prescribed by a doc at an urgent care clinic. Obviously they don't have the resources to do X-rays or MRIs or anything like that, but if it continues past Monday, I will get a referral from my PCP for a specialist and other tests. I feel quite a bit better today, but that may just be the drugs.

I appreciate even the far-out suggestions. Although I'm pretty sure I don't have shingles, I know to look out for the rash.

Gungho brings up an interesting point and our symptoms coincide pretty closely. For years my right shoulder blade would get "stuck" about once every couple months and I would have to roate it until it "popped." Never thought it would progress into something serious, but who knows.
posted by Optimus Chyme at 7:15 AM on August 25, 2006

In addition to seeing a doctor, try these books:

Trigger Point Therapy
Pain Free Check out the site too
posted by naveed at 8:59 AM on August 30, 2006