Chronic Back Pain Radiating to Chest: Causes and Treatment Options

Back pain with accompanying chest pain?

Hello, I have been experiencing back pain for over six months, specifically in the area near the right scapula.
The pain is persistent and radiates to my right chest, sometimes to the point where it makes me feel nauseous.
I have consulted traditional Chinese medicine multiple times and have undergone acupuncture many times, but there has been no improvement.
This condition has severely affected my daily life.
In June, I underwent a comprehensive health check-up, which revealed signs of sympathetic and parasympathetic nervous system degeneration, as well as chronic hepatitis and two areas in the liver that resemble hemangiomas.
Could these be related? What kind of examinations or treatments should I pursue? I would appreciate your guidance.
Thank you!

xue, 30~39 year old female. Ask Date: 2010/08/10

Dr. Zheng Zhong reply Neurosurgery

You may experience pain from your back to the left anterior chest, which is similar to thoracic nerve root pathology.
You should first consult a neurosurgeon and undergo a thoracic MRI for further diagnosis and treatment.
Dr.
Zheng's clinic hours are Monday afternoons and Wednesday mornings, in the surgical outpatient department.

Reply Date: 2010/08/10

More Info

Chronic back pain, especially when it radiates to the chest, can be a complex issue that requires careful evaluation and management. Given your symptoms and medical history, it is essential to consider various potential causes and treatment options.

Potential Causes of Chronic Back Pain Radiating to the Chest
1. Musculoskeletal Issues: Chronic back pain can often stem from musculoskeletal problems such as muscle strain, ligament sprains, or degenerative disc disease. The pain may radiate due to nerve involvement or referred pain from the back to the chest area.

2. Nerve Compression or Irritation: Conditions like herniated discs or spinal stenosis can compress spinal nerves, leading to pain that radiates from the back to the chest. This is particularly relevant if you have had previous imaging studies indicating degenerative changes in the spine.

3. Visceral Pain: Sometimes, pain in the back can be referred from internal organs. Given your history of chronic hepatitis and the presence of lesions that resemble hemangiomas in the liver, it is crucial to consider whether your liver condition might be contributing to your symptoms. Liver issues can sometimes cause referred pain to the back and chest.

4. Autonomic Nervous System Dysfunction: You mentioned experiencing sympathetic and parasympathetic nervous system decline. This could lead to dysregulation of pain perception and contribute to chronic pain syndromes.

5. Psychosomatic Factors: Chronic pain can also be influenced by psychological factors, including stress, anxiety, and depression. These can exacerbate the perception of pain and lead to a cycle of discomfort.

Recommended Diagnostic Steps
1. Imaging Studies: If you haven't already, consider obtaining an MRI of the thoracic spine to evaluate for any structural abnormalities, such as disc herniation or spinal stenosis. A CT scan may also be useful if there are concerns about the liver or other abdominal organs.

2. Neurological Evaluation: A thorough neurological examination can help assess any nerve involvement. Electromyography (EMG) and nerve conduction studies may be indicated to evaluate for peripheral nerve issues.

3. Liver Function Tests: Given your chronic hepatitis and liver lesions, regular monitoring of liver function tests and possibly a liver ultrasound or MRI can help assess the status of your liver condition.

4. Pain Management Consultation: A referral to a pain management specialist may be beneficial. They can offer a multidisciplinary approach, including medications, physical therapy, and possibly interventional procedures.

Treatment Options
1. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles supporting your back and improve flexibility. This can alleviate some of the pain and prevent future episodes.

2. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. If the pain is severe, your doctor may consider prescribing stronger pain medications or muscle relaxants.

3. Alternative Therapies: Since you have tried acupuncture without improvement, consider exploring other complementary therapies such as chiropractic care, massage therapy, or yoga, which may provide relief.

4. Lifestyle Modifications: Incorporating regular low-impact exercise, maintaining a healthy weight, and practicing stress management techniques can significantly impact chronic pain management.

5. Surgical Options: If conservative treatments fail and there is significant nerve compression or structural issues identified, surgical intervention may be necessary. This should be discussed thoroughly with a spine specialist.

Conclusion
Chronic back pain radiating to the chest can be multifactorial, and addressing it requires a comprehensive approach. Given your medical history, it is essential to work closely with your healthcare providers to determine the underlying causes and develop an effective treatment plan. Regular follow-ups and open communication with your medical team will be crucial in managing your symptoms and improving your quality of life.

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