Question
I have a chronic pinpoint pain in my upper back (directly between my shoulder blades) that can be quite severe. It's always in the same spot, between two vertebrae. Most of the time the pain is either mild or not really noticeable, though it never disappears entirely. It feels like a sharp burning kink in my spine. With too much use of my arms or upper back, the pain begins to intensify. After it reaches a certain point, the area between the two painful vertebrae seems to "pop", sometimes with an audible noise and a jolting sensation that feels like an electric shock. The pain after that is so severe that my chest and back muscles tighten up, and I cannot take a deep breath. I experience intense muscle spasms in my upper back and along my spine.

I visited a family physician a few years ago, who did a rather brief physical examination, and said that I had a lesion on my spinal cord covering that was causing the pain and inflammation (which he said was caused by excessive movement, which caused irritation and swelling in the area). He diagnosed this with an X-ray. He said that there was some minor swelling around the area, and prescribed some general anti-inflammatory pain relief. He didn't seem to think that it was very serious, and his explanation of his finding was rather vague.

It feels serious to me. At its worst, the pain is completely debilitating and unbearable. It feels like a live wire has been stuck into my back. I cannot lift my arms, I cannot take more than a shallow breath, and I feel like my body is locked into one big convulsion. The pain takes several days to fade after reaching that point, and it only lessens if I keep my back completely immobilized.

What is your opinion of my symptoms, and the family doctor's diagnosis? I have an appointment scheduled with another physician, who I know to be an excellent and very thorough and professional doctor. Unfortunately, I have a few weeks before the appointment, and the pain is currently quite severe. I am taking OTC naproxen for it, which seems to help the inflammation some, but the pain is worrying me. In your opinion, is it safe to wait that long to see the doctor? What can I expect from my visit? Is there a specialist doctor that would be recommended?

Any help or advice would be most appreciated.

Answer
Dear Mairi,

I do not think that the previous doctor you saw did a very good job of examination or explanation.  First of all the covering of the spinal cord is called the meninges and it cannot be evaluated by x-ray...it can only be seen on MRI.  Second, if he saw a lesion on the structure of the spine, why did he not follow-up and classify that lesion.  Your films should have been referred to a radiologist to identify.  The term lesion is generic and can mean anything...it is not a diagnosis, and does not describe anything. Third, a family physician is really not qualified to diagnose spinal conditions or tumors anyway...the experts in spinal dysfunction and pathology are chiropractic physicians, orthopedists with spine fellowships, neurosurgeons, and of course a pathologist if a tumor is present.  Lastly excessive movement will only cause either degeneration of the spinal joints (osteoarthritis) or degeneration between the vertebral bodies where the disk is located...but mostly this is caused by a lack of motion in the spine.  Your swelling/irritation was likely in the muscles that attach to the spine in that area (rhomboids, trapezius, and erectors), and could have been a trigger point.

I definitely recommend that you get a second opinion on this.  I would suggest that you get a full functional orthopedic evaluation of the neck and upper back which will include actual hands on orthopedic testing of the spine with compression, active and passive movement, resistive movement, range of motion, and new x-rays.  Depending on what is found, and MRI may be appropriate as well.  

I would recommend that you see a chiropractor for this exam or in addition to another medial exam.  Pain meds and anti-inflammatories will not cure the problem.  There is something functionally wrong here which could be related to degeneration, spinal fixation, poor biomechanical function of the spine, muscular imbalance, adhesions or scar tissue.  A chiropractic physician will look at you from a functional standpoint, and should evaluate your spine in the way I mentioned above, addressing these issues.  If there is something on the x-ray, the chiropractor will see it (we have extensive training in radiology, much more than is taught in medical school), and  will send it out to a radiologist for an over read if needed or order an MRI for clarification.  If there is a "lesion: on the spine somewhere...you should have been referred to a specialist long ago.

Keep your head up, think positive, and get the second opinions.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net