Chronic Pain Dilemma: Which Specialist Should You Consult?

Hello, Dr. Chang?

The following situation has already affected my life...
I have been seeing doctors for over a year without any results...
I experience intermittent abdominal pain, which has led to almost 24-hour daily pain in my lower back to the front and back of my ribs, accompanied by a sensation of pressure, tightness, and an indescribable feeling of discomfort.
Sometimes, I also experience involuntary muscle twitching in various spots on my skin...
The abdominal pain does not occur every day for 24 hours, but the discomfort from my lower back to my ribs is constant.
The discomfort in that area is not fixed; it tends to be in the same spot for several consecutive days before shifting to another location...
Sometimes it is in the front of my right lower back, sometimes in the front of my left lower back, and sometimes in both.
It can also occur in the back of my right lower back, the back of my left lower back, or both.
Occasionally, it is in the front of my left rib, the front of my right rib, the back of my left rib, or the back of my right rib...
In summary, the discomfort is not localized.
This situation has persisted for over a year, with abdominal pain also lasting for more than a year, but the abdominal pain is not constant.
The discomfort from my lower back to my ribs is daily, and this discomfort began only after the abdominal pain started.
Previously, I had no such issues.
I have consulted gastroenterology, gynecology, urology, and allergy and immunology specialists, all of whom found no problems.
The gastroenterologist diagnosed me with irritable bowel syndrome, but after taking medication for over a year, there has been no improvement in my abdominal pain or lower back discomfort.
The gastroenterologist stated that they could not determine whether the discomfort from my lower back to my ribs is related to gastrointestinal issues...
I have undergone endoscopy, barium X-ray of the colon, abdominal ultrasound, and stool tests, all of which returned normal results.
Some doctors have referred me to orthopedics, while others have suggested neurology...
I would like to ask a professional doctor for advice on which specialty I should consult for my discomfort from my lower back to my ribs? Orthopedics? Neurology?

I'm sorry, but it, 10~19 year old female. Ask Date: 2012/09/18

Dr. Zhang Jiahao reply Orthopedics

If you are unable to decide, you can first visit a family medicine clinic.

Reply Date: 2012/09/18

More Info

Chronic pain can be a complex and frustrating condition, especially when it affects multiple areas of the body and persists over an extended period. In your case, the symptoms you describe—persistent discomfort in the lower back and rib area, along with intermittent abdominal pain—suggest that a multidisciplinary approach may be necessary to address your concerns effectively.

First, let's clarify the nature of your pain. Chronic pain can arise from various sources, including musculoskeletal issues, nerve-related problems, or even visceral pain from internal organs. Given that you have already consulted multiple specialists, including gastroenterologists, gynecologists, urologists, and rheumatologists, it seems that the gastrointestinal system has been ruled out as a primary source of your discomfort. The diagnosis of irritable bowel syndrome (IBS) indicates that there may be functional gastrointestinal issues at play, but it does not fully explain the persistent pain in your back and rib areas.

Considering your symptoms, it may be beneficial to consult a pain management specialist or a neurologist. A pain management specialist is trained to evaluate and treat chronic pain conditions and can provide a comprehensive assessment of your pain's origin. They may recommend various treatment modalities, including medication management, physical therapy, and possibly interventional procedures such as nerve blocks or injections.

On the other hand, a neurologist can help determine if there is a neurological component to your pain. Given your description of skin twitching and the variability of your discomfort, it is possible that nerve involvement could be contributing to your symptoms. A neurologist can conduct specific tests, such as electromyography (EMG) or nerve conduction studies, to assess nerve function and identify any abnormalities.

Additionally, it may be worthwhile to consider consulting a physical medicine and rehabilitation (PM&R) specialist, also known as a physiatrist. These specialists focus on restoring function and improving quality of life for patients with chronic pain and musculoskeletal disorders. They can develop a tailored rehabilitation program that may include physical therapy, exercise, and other non-invasive treatments to help manage your symptoms.

In the meantime, it is essential to keep a detailed pain diary, documenting the frequency, intensity, and location of your pain, as well as any associated symptoms. This information can be invaluable for your healthcare providers in diagnosing and treating your condition effectively.

Lastly, consider exploring complementary therapies such as acupuncture, chiropractic care, or mindfulness-based stress reduction techniques. These approaches can sometimes provide relief for chronic pain and improve overall well-being.

In summary, given the complexity of your symptoms and the lack of definitive answers from previous consultations, I recommend seeking the expertise of a pain management specialist or neurologist. They can provide a comprehensive evaluation and help develop a personalized treatment plan to address your chronic pain effectively. Remember, managing chronic pain often requires patience and persistence, so don't hesitate to advocate for yourself and seek out the care you need.

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