Dealing with Chronic Pain: What Are My Options?
Profile Overview: - 35 years old, female, Caucasian, weighing 118 pounds, height 5'2" - Medical History: Scoliosis, mild psoriasis, anxiety and depression, ADHD, irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), thalassemia minor. - Medications Currently Taking: Lexapro 30 mg daily, Concerta ER 27 mg daily, Spironolactone 75 mg daily, Omeprazole 20 mg daily, Meloxicam 15 mg daily. - Supplements: Multivitamin with iron, Vitamin D 1000 IU, Magnesium 200 mg, B-12 500 mcg, Probiotic. Symptoms Overview: - **Back Pain:** - Experiencing discomfort in the upper to mid-back region, particularly near vertebrae T1, T3-4, and T7, with sensitivity to pressure during flare-ups. - Occasional throbbing pain near the spine, possibly affecting the rhomboid area. - **Shoulder Issues:** - Sensations of tingling or numbness in the right shoulder blade while seated. - Sharp pain affecting the tops of the shoulders (associated with levator scapulae). - **Wrist Discomfort:** - Dull pain in the wrists extending to the metacarpals and occasionally knuckles, with sharper pain on the ulnar side. - Possible diagnosis of De Quervain's tenosynovitis. - Notable ganglion cyst measuring 7 mm on the ulnar side of the left wrist. - **Other Concerns:** - Occasional dull pain in the left hip when walking. - Intermittent pain in the left knee, exacerbated by inclement weather. - Several tender points throughout the body that trigger sharp pain when pressed. After undergoing numerous tests due to a combination of these symptoms and a family history of autoimmune diseases, I found only mild abnormalities, with a positive ANA test (1:160 speckled, golgi-antibody), without significant findings otherwise. While these symptoms have been chronic, they tend to be sporadic and transient. However, about 12 weeks ago, I encountered a significant flare-up of back pain, which is normally manageable with over-the-counter NSAIDs. Unfortunately, this episode has proven resistant to such treatment. A six-day Medrol dose pack provided no relief. Currently, I’m taking Meloxicam, which offers some assistance but not complete relief. The pain often returns in full force once I stop taking it, and it has also extended to my shoulders and wrists, along with occasional neck pain on particularly bad days. An X-ray has been conducted (as mentioned), revealing no concerning findings according to the radiologist. I have begun physical therapy (completed approximately five sessions), during which therapists identified several issues pertaining to my shoulders. **Current Dilemma:** My doctor has referred me to a spine specialist for potential advanced imaging. However, I am curious if there is another type of specialist who would be better suited to evaluate my shoulder and wrist issues concurrently with the spine assessment?
Answers (1)
6/14/2025, 3:30:50 PM
OpenHealth AI
You're dealing with a complex set of pain-related issues, and it's understandable to seek multiple perspectives on managing these conditions. Let's focus on your primary concerns: chronic back pain, shoulder issues, and wrist discomfort.
Key Points:
- You have a history of chronic pain with several flare-ups affecting multiple areas.
- Current treatments (NSAIDs and physical therapy) provide limited relief.
- You're considering a spine specialist but may benefit from evaluating your shoulder and wrist simultaneously.
Explanation:
Chronic pain can stem from various factors, including musculoskeletal issues, inflammatory conditions, or nerve-related problems. It's important to have a comprehensive approach to managing and alleviating this pain. Given your symptoms, reaching out to multiple specialists might help provide a more complete diagnosis and treatment plan.
Prioritized Next Steps:
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Consult with an Orthopedic Specialist: This specialist can evaluate musculoskeletal issues, including your shoulders and wrists. They can provide specific insights into potential conditions like De Quervain's tenosynovitis and any shoulder-related problems identified by your physical therapists.
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Follow-Up with a Rheumatologist: Since you have a positive ANA test and a family history of autoimmune diseases, a rheumatologist can assess whether any autoimmune conditions could be contributing to your symptoms. They can also help differentiate between fibromyalgia, which might explain the tender points and widespread pain, and other causes.
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Continue Physical Therapy: Even if your current sessions haven't provided complete relief, physical therapy is valuable for strengthening muscles and improving mobility. Discuss your progress openly with your therapist; they may be able to adjust your program based on your feedback.
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Pain Management Consultation: A specialist in pain management can offer alternative treatments, including medications, nerve blocks, or non-pharmacological methods like acupuncture or massage therapy, which may help relieve pain without needing to increase current medication dosages.
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Lifestyle and Home Care:
- Stay Active: Engage in low-impact exercises like swimming, walking, or yoga, which can help maintain flexibility and reduce stiffness.
- Pain Tracking: Keep a pain diary to note triggers and relief strategies that work. This can guide discussions with your healthcare providers.
- Ergonomic Adjustments: Make sure your workspace supports good posture and reduces strain on your back and shoulders.
Remember, pain management often requires a multidisciplinary approach, and it's okay to seek out the specialists who you feel are right for your needs. Each step can contribute to better pain management and improved quality of life. If you have further questions or need specific recommendations, feel free to ask.
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