Seeking Answers: Navigating Chronic Pain and Unexplained Symptoms

Hello, doctor?

Hello Doctor, about four months ago, I started experiencing a feeling of discomfort and pain in my upper abdomen, and sometimes my stomach would suddenly spasm.
I visited a gastroenterologist and underwent an endoscopy, which revealed only mild gastritis.
I also had an abdominal ultrasound, colonoscopy, and abdominal CT scan, but no cause was found.
I have lost about 8 kilograms in weight.
Subsequently, the pain began to radiate from my upper abdomen to my chest and then to my neck.
I have had a chest X-ray, echocardiogram, exercise stress test, ECG, neck ultrasound, neck CT scan, neck X-ray, and laryngoscopy, but no diagnosis was made.
The chest pain is generally a dull ache, and sometimes I experience pain when urinating, lifting objects, or changing positions; the pain lasts for a few seconds.
The doctor suspects it may be neuropathic pain.
In my neck, I sometimes experience sudden sharp pain or numbness in the front of my neck, and I occasionally wake up from pain while sleeping.
I also have rashes on my chest and neck that are itchy.
Recently, I noticed several black lines growing on my nails.
Initially, I had difficulty swallowing, but I can eat normally now.
I consulted a neurologist, who indicated that there might be issues with nerve conduction in my ears and hands and feet.
The neurologist suggested I see a neurosurgeon, but the neurosurgeon reviewed the reports and stated that this does not fall within his scope.
Over the past four months, I have seen specialists in gastroenterology, general surgery, family medicine, neurology, cardiology, pulmonology, and dermatology, and have undergone numerous blood tests and imaging studies.
The pain has now spread from my upper abdomen to my neck, with varying pain symptoms causing significant anxiety.
Currently, I can only manage the condition with pain medication.
I would like to ask the doctor for advice on which specialty I should consult next, or if I should continue relying on pain medication.

Kunrao de ren, 20~29 year old female. Ask Date: 2021/07/22

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
I noticed that you have experienced symptoms of dysphagia along with multiple areas of muscle pain, which may be related to rheumatology.
If you have seen many specialists without a clear diagnosis, I recommend that you visit a rheumatologist for further evaluation.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital is here to assist you.

Reply Date: 2021/07/22

More Info

Navigating chronic pain and unexplained symptoms can be incredibly challenging, especially when multiple specialists have been consulted and various tests have been performed without a clear diagnosis. Based on your description, it seems you have been experiencing a range of symptoms, including upper abdominal discomfort, chest pain, neck pain, and neurological symptoms, which have persisted for several months.
First and foremost, it’s important to acknowledge that chronic pain can stem from a variety of sources, including gastrointestinal issues, musculoskeletal problems, nerve-related conditions, and even psychological factors such as anxiety and stress. Given that you've already undergone extensive testing, including endoscopies, imaging studies, and consultations with various specialists, it may be beneficial to take a step back and consider a more integrative approach to your health.

1. Gastrointestinal Evaluation: Since you mentioned experiencing upper abdominal pain and having undergone tests that revealed mild gastritis, it might be worthwhile to revisit a gastroenterologist. Sometimes, conditions like functional dyspepsia or irritable bowel syndrome (IBS) can cause symptoms that are not easily identifiable through standard imaging or endoscopy. A gastroenterologist may recommend dietary modifications, medications to manage symptoms, or further testing such as a hydrogen breath test to rule out conditions like small intestinal bacterial overgrowth (SIBO).

2. Neurological Assessment: You noted that a neurologist suggested potential nerve conduction issues. If you haven’t already, consider seeking a second opinion from another neurologist, particularly one who specializes in pain management or neuromuscular disorders. Conditions such as fibromyalgia or neuropathic pain syndromes can sometimes present with diffuse pain and may require a different treatment approach.

3. Musculoskeletal Evaluation: Given the pain you experience during certain movements and positions, consulting with a physical medicine and rehabilitation (PM&R) specialist or a physical therapist could be beneficial. They can assess your posture, movement patterns, and any musculoskeletal imbalances that may contribute to your pain. A tailored physical therapy program may help alleviate some of your symptoms.

4. Psychological Support: Chronic pain can often lead to or exacerbate anxiety and depression, creating a cycle that can be difficult to break. Engaging with a mental health professional who specializes in chronic pain management could provide you with coping strategies and support. Cognitive-behavioral therapy (CBT) has been shown to be effective for many individuals dealing with chronic pain.

5. Pain Management: While you are currently using pain medications, it’s crucial to discuss this with a pain management specialist. They can offer a comprehensive approach that may include medications, physical therapy, and alternative treatments such as acupuncture or biofeedback. They can also help you develop a plan to manage your pain more effectively without relying solely on medications.

6. Lifestyle Modifications: Incorporating lifestyle changes such as regular exercise, mindfulness practices, and a balanced diet can also play a significant role in managing chronic pain. Gentle activities like yoga or tai chi may help improve flexibility and reduce stress, which can, in turn, alleviate some of your symptoms.

In summary, while it may feel overwhelming to navigate this complex situation, taking a multidisciplinary approach can often yield better results. It’s essential to advocate for yourself and seek out specialists who are willing to collaborate and consider all aspects of your health. Remember, you are not alone in this journey, and with persistence and the right support, it is possible to find relief and improve your quality of life.

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