Managing Chronic Pain: Seeking Solutions for Two Years of Discomfort

I have been experiencing daily pain for two years?

Hello Dr.
Wang,
Here are my medical records.
Due to the pain, I am unable to work and currently attend rehabilitation at Yonghe Gengxin Hospital daily.
I am undergoing treatment for proliferation, manual therapy, and neck traction.
The main pain is located around the inner and outer elbow, near the joints, biceps, coracoid process, and scapula.
Could you please advise which tests I should undergo or recommend a specialist at a hospital who can provide targeted treatment to resolve my daily pain that has persisted for nearly two years? Thank you.
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2020/10/12: At Demei Clinic, experienced acute pain in the left cervical spine and left shoulder the day after receiving the flu vaccine.

2020/10/14: At Demei Clinic, Dr.
Lin from the Rehabilitation Department suspected a herniated disc and arranged for a referral to Shuanghe Hospital.

2020/10/27: At Shuanghe Hospital, Dr.
Tseng from the Neurosurgery Department scheduled an MRI on 11/08, diagnosing cervical nerve compression and recommending surgery.

2020/11/20: At Shuanghe Hospital, Dr.
Lin from the Neurosurgery Department diagnosed arthritis and administered a steroid injection in the left back, left chest, and left elbow.

2020/11/20: At National Taiwan University Hospital, Dr.
Chen from the Neurosurgery Department diagnosed that surgery was not necessary.

2020/12/04: At Shuanghe Hospital, Dr.
Lin from the Neurosurgery Department suggested surgery and administered a steroid injection in the left back and left elbow.

2020/12/04: At Mackay Memorial Hospital, Dr.
Chen from the Neurosurgery Department diagnosed shoulder pain as cervical nerve compression at C3 and C4, along with tennis elbow and carpal tunnel syndrome.

2020/12/09: At Shuanghe Hospital, Dr.
Lin from the Neurosurgery Department canceled the outpatient appointment.

2020/12/10: At Xindian Gengxin Hospital, Dr.
Sun from the Neurosurgery Department reviewed the MRI and recommended high-frequency thermal coagulation nerve block.

2020/12/18: At National Taiwan University Hospital, Dr.
Wang from the Neurosurgery Department reviewed the MRI and diagnosed that surgery was not necessary, referring me to the pain clinic.

2020/12/25: At National Taiwan University Hospital, Dr.
Lin from the Anesthesiology Department administered a Medrol injection in the left upper back and left elbow, leading to recovery.

2021/01/08: At National Taiwan University Hospital, Dr.
Lin from the Anesthesiology Department reviewed the MRI and noted a white area in the spine, performing an evoked potential test.

2021/01/15: At National Taiwan University Hospital, Dr.
Lin from the Anesthesiology Department reported that the results were normal, diagnosing my symptoms as myofascial pain syndrome and indicating no need for follow-up.
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2021/04/02: At Fu Jen Catholic University Hospital, received stitches for a finger laceration, and left elbow pain began.

2021/04/09: 04/23: 05/14: At National Taiwan University Hospital, Dr.
Lin from the Anesthesiology Department administered Medrol injections.

2021/06/18: At National Taiwan University Hospital, Dr.
Lin from the Anesthesiology Department performed a peripheral nerve block.

2021/06/29: At Yonghe Gengxin Hospital, Dr.
Kuo from the Rheumatology and Immunology Department conducted an examination, which was normal, and referred me to Neurology.

2021/07/02: At National Taiwan University Hospital, Dr.
Lin from the Anesthesiology Department performed a peripheral nerve block.

2021/07/07: At Yonghe Gengxin Hospital, Dr.
Yao from the Neurology Department examined for dizziness and arranged for further tests.

2021/07/30: At National Taiwan University Hospital, Dr.
Lin from the Anesthesiology Department performed a peripheral nerve block.

2021/08/13: 09/03: 09/24: 10/22: At National Taiwan University Hospital, Dr.
Lin from the Anesthesiology Department administered Medrol injections.

2021/10/28: At Yonghe Gengxin Hospital, underwent muscle ultrasound and nerve conduction studies; Dr.
Yao from the Neurology Department diagnosed shoulder impingement syndrome and prescribed medication.

2021/11/18: At Yonghe Gengxin Hospital, Dr.
Jan from the Pulmonary Medicine Department conducted a chest X-ray, which was normal.

2021/11/15: 11/24: 12/08: 12/20: 12/29: At Yonghe Gengxin Hospital, Dr.
Su from the Rehabilitation Department administered sugar water injections along with manual therapy.

2022/01/10: 01/19: 02/07: 02/16: At Yonghe Gengxin Hospital, Dr.
Su from the Rehabilitation Department continued sugar water injections and manual therapy.
After reviewing the MRI, diagnosed cervical stenosis at C3, C4, C6, and C7, recommending a referral to Neurosurgery.

Alex Wang, 50~59 year old female. Ask Date: 2022/02/19

Dr. Wang Zhaomin reply Rehabilitation

This platform provides medical consultations but cannot refer specific individuals.
Based on the medical history provided, all relevant specialties related to the symptoms have been consulted, and necessary examinations have been conducted.
Specialists from neurology, rheumatology, pulmonary medicine, pain management, and rehabilitation have all been involved, and they are all qualified physicians.
Except for surgery, most treatments have been attempted.
It is recommended to select one or two hospitals for comprehensive treatment.
As for whether surgery is necessary, this should be determined by the treating physician's recommendations for subsequent treatment directions.

Reply Date: 2022/02/19

More Info

Managing chronic pain can be an incredibly challenging journey, especially when it has persisted for two years, as you've described. Your detailed medical history indicates that you've seen multiple specialists and undergone various treatments, yet the pain remains a significant barrier to your daily functioning and work.
Chronic pain, particularly in the context of your symptoms involving the elbow, shoulder, and neck, can often be multifactorial. It may stem from structural issues, such as cervical spine problems, or from conditions like myofascial pain syndrome, which you've been diagnosed with. The interplay between physical and psychological factors can also complicate the pain experience, making it essential to adopt a comprehensive approach to management.

Given your extensive medical history, it seems that you've already undergone a variety of diagnostic tests, including MRIs and nerve conduction studies, which have ruled out some serious conditions. However, the persistent nature of your pain suggests that there may still be underlying issues that need to be addressed. Here are some recommendations for further evaluation and management:
1. Comprehensive Pain Management Evaluation: It may be beneficial to consult a pain management specialist who can provide a holistic approach to your pain. This specialist can assess not only the physical aspects of your pain but also the psychological components, which can be significant in chronic pain syndromes.

2. Physical Therapy: While you are currently receiving rehabilitation, consider seeking a physical therapist who specializes in chronic pain management. They can develop a tailored exercise program that focuses on strengthening and flexibility, which may help alleviate some of the discomfort.

3. Psychological Support: Chronic pain can lead to emotional distress, including anxiety and depression. Engaging with a psychologist or psychiatrist who specializes in chronic pain can provide coping strategies and possibly medication to help manage the psychological aspects of your pain.

4. Alternative Therapies: Some patients find relief through complementary therapies such as acupuncture, chiropractic care, or massage therapy. While these should be approached cautiously and discussed with your healthcare provider, they may offer additional relief.

5. Medication Review: It may be worthwhile to revisit your medication regimen with your primary care physician or a pain specialist. There may be alternative medications or combinations that could provide better pain control.

6. Interventional Procedures: If conservative measures fail, interventional pain management techniques, such as nerve blocks or epidural steroid injections, may be considered. These can provide temporary relief and help you engage more effectively in physical therapy.

7. Lifestyle Modifications: Incorporating regular low-impact exercise, such as swimming or walking, can improve overall physical health and potentially reduce pain levels. Additionally, mindfulness practices such as yoga or meditation can help manage stress and improve your pain coping strategies.

8. Second Opinions: If you feel that your current treatment plan is not effective, seeking a second opinion from another specialist, particularly one with experience in chronic pain, may provide new insights or treatment options.

In summary, managing chronic pain requires a multifaceted approach that addresses both the physical and psychological components of your experience. It’s crucial to communicate openly with your healthcare providers about your ongoing pain and any concerns you have regarding your treatment. By taking an active role in your care and exploring various treatment avenues, you can work towards finding a solution that improves your quality of life.

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