Exploring Options for Chronic Pain Relief: Help for Trigger Points
Hello, everyone, It may sound a bit odd, considering my background as a medical student, but at the age of 29, weighing 147 pounds and standing at 5'10", I've been grappling with persistent pain in my neck and upper back since I was just seven years old. Curiously, I can't pinpoint any specific incident that triggered this discomfort. The pain emanates mainly from two significant knots located at the C5/6 level, right beneath the transverse process, and another at the T3/4 area, just medial to the superior angle of my scapula. Pressing on the upper knot leads to spasms in the lower one, and when I bring my arm closer to my face, I also experience spasms at the T3/4 site. Throughout the day, tightness develops between my shoulder blade and spine (spanning from C7 to T8), requiring me to apply pressure to alleviate the tension. However, these efforts provide only temporary relief, and during peak pain periods, I rate it as an 8/10. With such pronounced and localized taut bands that lead to referred pain and spasms, there seems to be an underlying structural issue at play, perhaps involving some degree of muscular fibrosis. This problem has significantly hindered my activities, to the extent that I struggle to assist in surgeries at medical school, as I can barely hold retractors for longer than 15 minutes. This has led to some misconceptions regarding my commitment. Here's a summary of the treatments I've attempted so far: - Multiple sessions of physical therapy (approximately twelve) - Exercises and stretches prescribed by my physiotherapist - Dry heat therapy - Deep tissue massage (my physiotherapist commented on the numerous knots, indicating the source of my pain) - Dry needling - Cupping therapy - TENS/EMS machines - Use of massage balls and foam rollers - A diagnostic block of the facet joint, which did not yield success - An MRI scan that returned clear results apart from a minor herniated disc at T3, which is deemed unlikely to be the cause of my pain - A steroid injection aimed at the muscle without positive results - Two botox treatments in the same muscle, offering relief for about a month each time - Daily administration of baclofen (20mg, three times a day) for over two years, helping me maintain some functionality - Recently, I’ve embarked on a progressive overload gym program to strengthen my back further. Is there any additional treatment I should consider? Are there surgical interventions that could potentially offer relief? I've come across a procedure for trigger point excision in the US, but I reside in the UK, where my NHS pain specialist has attributed my pain to exam stress and seems reluctant to provide further botox treatments. Luckily, I have private insurance and am open to consulting anyone who might provide assistance.
Answers (1)
7/2/2025, 11:40:47 PM
OpenHealth AI
It sounds like you are experiencing significant persistent pain in your neck and upper back, along with muscle tension and spasms, which has affected your daily life and activities, especially your medical training. Your comprehensive approach to managing this pain shows your dedication, and it's understandable to seek further relief and options. Let's delve into your situation and consider next steps.
Main Points:
- Persistent neck and upper back pain with associated muscle knots and spasms.
- Extensive prior treatments have offered limited success.
- Interest in further treatments, including potential surgical options.
Explanation:
Your symptoms, particularly the localized knots and spasms, suggest a chronic pain condition possibly compounded by muscular issues. It’s great that you've explored many avenues for relief, and while some treatments showed brief efficacy (like the Botox injections), others have not been as beneficial.
Given that you have a history of extensive treatments that did not yield satisfactory results, it's natural to consider surgical avenues like trigger point excision. This procedure is designed to remove the specific knots causing pain. However, surgery is typically regarded only after less invasive methods have been exhausted or if there is a clear anatomical problem contributing directly to pain, which seems unlikely in your case given the MRI findings.
Prioritized Next Steps:
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Consult a Pain Management Specialist: Given the complexity of your case, seeking a second opinion from a pain specialist with experience in chronic musculoskeletal pain might provide new insights or alternative treatment plans that you haven't yet considered.
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Consider Multidisciplinary Approaches:
- Investigate multidisciplinary clinics that incorporate various specialists (physical therapists, pain psychologists, and occupational therapists) to work cohesively on your pain management. Cognitive Behavioral Therapy (CBT) can also help in managing the psychological aspects of your pain, especially if exam stress is a factor.
- Explore other medical options such as nerve blocks or advanced pain management techniques, like spinal cord stimulation or newer medication strategies that might not have been discussed yet.
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Explore Alternative Therapies:
- If you have not yet tried acupuncture or specialized forms of physical therapy like myofascial release or trigger point therapy, these could be worth exploring as adjuncts to your treatment plan.
- Ongoing engagement with your progressive overload strength training program is beneficial; consider consulting a trainer specializing in rehabilitative exercise to ensure proper techniques that prevent strain.
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Lifestyle Modifications:
- Regularly practicing relaxation techniques, such as yoga or mindfulness meditation, can help reduce muscle tension and improve your stress response, which may alleviate some of your pain.
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Seek Surgical Consultation if Necessary: If all conservative measures fail, it may be worth getting a surgical consultation about trigger point excision or other interventions. Ensure this specialist is experienced in dealing with persistent pain cases.
It is important to persist in finding relief, and I encourage you to continue advocating for your health as you've been doing. Let me know if you would like more details on any of these approaches.
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