Question
Hi.  I have been having pain in my back for many years. Previous MRI have shown bulging discs in the C5 area as well as degenerative disc disease and multilevel degenerative facet disease ranging from mild (L1-4)to severe(L4 to S1 mainly on the right side and DDD of the thoracic spine.  Last summer I developed severe right sided flank and mid back stabbing pain and was treated with PT for 6 weeks with no relief.  It turned out that I had 2 large right sided kidney stones and was hospitalized for this.  this passed and I still had midback pain but it was bearable until about 10 weeks ago when the same pains started again only much more severe.  The pain starts in my mid back  and radiates to the right side sometimes at the base of the rib area and sometimes radiates into the lower right shoulderblade.  It ranges from a constant aching, burning pain to an extremely sharp stabbing pain with certain movement.  Also sometimes worse when I sit. Again I had MRI done of LS spine and Thoracic spine.   LS spine is same as above.  Thoracic spine shows Multilevel disc disease, spondylitic ridging with ventral cord contact confined to T7-8 and T8-9.  No thoracic disc herniation is noted.  I also had kidney studies done to rule out another episode of kidney stones and these came back clear except for a small stone in the LEFT kidney.  All of my pain seems to be concentrated on the right side.   I have just finished another round of physical therapy but the pain is still there with a vengeance.   I have been taking mobic and on occasion skelaxin.  I sometimes get a little relief with the mobic but more so with my neck area and low back.  I have occasions when I sit where my left arm gets numbness and tingling.  This does not happen when I am standing.  Today I woke up with an extreme sharp right sided pain radiating into the rib area and movement in that area exacerbates the pain.  Do you have any input or suggestions.  I am tired of feeling like this.  Thank you Linda G

Answer
Dear Linda,

Obviously you have multi-level degenerative issues in the spine, but this does not account for all the pain you have described.  The fact that you have been in chronic pain for such a long time is not good and means that your pain experience may now be the ultimate cause of continued pain.  You see the pain experience will start a positive feedback loop if not interrupted and turn into chronic pain through a phenomenon known as central sensitization.  This basically means that the nerves have been conditioned to continually send pain signals, and that the spinal cord has learned ot send pain signals that are not indirect response to any tissue damage or inflammation.  Other ways this is often termed are:  synaptic arborization, wind-up, neoneuralization, and neural placticity.  

Often times this type of neurologically generated pain responds to manual type of care such as chiropractic, deep tissue massage, and active release therapy or graston technique.  I would suggest that you research these techniques and look for a qualified provider in your area.  Make sure that you take all available MRI and X-ray findings for them to look over and evaluate.  I also encourage you to find a good acupuncturist as well.  I have had great pain reductions in patients that I have co-treated with certified acupuncture therapists and physicians.  It is another avenue to help reduce your pain and suffering so that you can become more functional.

Good Luck Linda.

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