Chronic Pain: From Lymphadenitis to Muscle Discomfort

Chest tightness, hard lumps under the armpits, muscle pain, neck pain, back pain, and facial pain?

Hello Dr.
Liao: I am a 40-year-old mother, and I have been troubled by pain for the past few months (some of this pain actually started several years ago), but it has worsened recently.
I visited a clinic, and the doctor said it was lymphadenitis and prescribed anti-inflammatory and antibiotic medications.
However, now I want to go to a hospital for further examination, but I am unsure which department to consult.
I hope Dr.
Liao can give me some advice.
About 2 to 3 months ago, I first experienced muscle pain on the outer side of my left knee, which gradually extended to the outer side of my right knee.
Then, I began to feel discomfort in the outer sides of both hands, as well as pain in my back, neck, and armpits, which slowly progressed to chest pain (and I have difficulty breathing; sometimes I wake up at night because I can't breathe properly).
Now, the pain has even reached my face, with a sensation of discomfort in my nose, under-eye area, and throat, along with gastrointestinal discomfort.
The most distressing part is that even my head is now affected.
Years ago, I occasionally experienced pain in the lymph nodes under my armpit, and I also have a history of depression.
The pain I described can sometimes be managed, but it has become unbearable lately.
Dr.
Liao, I really need your help; I am in so much pain.
Thank you very much! 🙏

Zhu Zai, 40~49 year old female. Ask Date: 2016/10/18

Dr. Liao Zhongxin reply Internal Medicine

Dear readers, regarding the issues of "chest tightness, hard lumps under the armpits, muscle pain, neck pain, back pain, and facial pain," I suggest the following:
1.
Being a homemaker is a demanding job that often goes unnoticed or unappreciated by family members.
It may be helpful to arrange for family members to share household responsibilities to alleviate work-related stress.

2.
Generalized body aches indicate that after labor, adequate rest and recovery have not been achieved.
Consider asking family members to assist with massages or rehabilitation exercises.

3.
There may be too many specialties to consult, but often the examinations return normal results.
It might be beneficial to schedule leisure activities on weekends or participate in community events.

Thank you!

Reply Date: 2016/10/18

More Info

Chronic pain can be a complex and multifaceted issue, often involving various physiological and psychological factors. Based on your description, it seems you are experiencing a range of symptoms that have progressively worsened over the past few months. You mentioned initial pain in your left knee, which then spread to your right knee, hands, back, neck, and even your chest, leading to breathing difficulties and discomfort in your face and throat. This pattern of pain can be indicative of several underlying conditions, and it’s essential to approach this systematically.

Firstly, the mention of lymphadenitis suggests that there may have been an inflammatory response in your body, possibly due to an infection or another underlying condition. Lymphadenitis typically presents with swollen lymph nodes, pain, and sometimes systemic symptoms like fever. If your doctor prescribed anti-inflammatory and antibiotic medications, it indicates they were addressing a potential infection or inflammatory process. However, if the pain persists despite treatment, further investigation is warranted.

Given the widespread nature of your symptoms, it may be beneficial to consider a few potential diagnoses. One possibility is fibromyalgia, a condition characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. It often coexists with other conditions, including anxiety and depression, which you mentioned having. Fibromyalgia can be challenging to diagnose because it does not show up on standard imaging tests or blood work, but it is a recognized condition that can cause the symptoms you describe.

Another consideration is myofascial pain syndrome, which involves trigger points in the muscles that can refer pain to other areas of the body. This could explain the pain radiating from your knees to your hands, back, and neck. Stress and emotional factors can exacerbate this condition, leading to a cycle of pain and tension.

Your symptoms also suggest a possible neurological component, especially with the involvement of your chest and breathing difficulties. Conditions such as thoracic outlet syndrome or cervical radiculopathy could lead to pain and discomfort in the arms, neck, and upper back, potentially affecting your breathing if there is significant nerve involvement.

Given the complexity of your symptoms, I recommend seeking a comprehensive evaluation from a multidisciplinary team. You might consider starting with a visit to a rheumatologist, who specializes in musculoskeletal disorders and autoimmune diseases. They can conduct a thorough examination, order necessary blood tests, and possibly imaging studies to rule out conditions like rheumatoid arthritis or other inflammatory disorders.

Additionally, consulting with a neurologist may be beneficial, especially if you continue to experience neurological symptoms such as numbness, tingling, or weakness. They can assess for any nerve-related issues that may be contributing to your pain.

Lastly, addressing the psychological aspect of chronic pain is crucial. Since you mentioned having depression, working with a mental health professional can provide support and coping strategies. Cognitive-behavioral therapy (CBT) has been shown to be effective in managing chronic pain by helping patients change their pain-related thoughts and behaviors.

In summary, chronic pain is often multifactorial, and a thorough evaluation is essential to identify the underlying causes. A multidisciplinary approach involving rheumatology, neurology, and mental health support can provide a comprehensive strategy for managing your symptoms and improving your quality of life. Don’t hesitate to advocate for yourself and seek the care you need.

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