Question
QUESTION: Hello Dr.  I hope you can help me.  I am 33, 6' tall and 250 lbs.  I have had pain in my lower back last lumbar vert.) for about 3 years now.  I sleep horribly, and within the past few months, I have developed pain in my "flanks" of my back as well.  I have been seeing a chiropractor for about 3 years now and I firmly believe that he is not helping my situation out.  

I fall asleep, and what wakes me up within about 4 hours is my upper/thoracic intercostal pain.  Almost as if they are stiffening from being in one position for too long...but i don't think that's it.  I went out a year ago and bought a $3,000 Sleep Number bed to think that might help, and it isn't.  It's beginning to hurt me into the day now.  If I raise my arms over my head while standing, for example, and bend to the right or left, i get pain in my back, mid thoracic region.  My chiropractor said that there are no muscles there except for the intercostal muscles.

I did go for an MRI for my lower back pain (this was months ago before I had pain in my intercostal region) and it was found that I had a "SLIGHTLY herniated disc" at L4/L5.  Not enough to warrant anything major......

What do i do?  I can't/don't want to be on medication all the time.....next week I want to make an appointment with my doctor to see what specialists I can go to about it, but I want to be more knowledgeable before i go.  Can you please provide any insight?

Thanks in advance,

Ross

ANSWER: Hi Ross,

Have your doctor run some blood work, this should include a CRP, ANA, CK, RA Factor, CBC and chem screen. This will rule in/out inflammatory or autoimmune arthropathy.

The pain in your back/flank area is probably costochondritis, CK and CRP can narrow it down.

3" from the midline at or below the 7th rib, intercostal muscles are pretty much it. I want to know if you have a friction rub in your chest, this means pleuritis(inflammation of sac around lung). I would entertain the thought of getting on a short term dose of steroids to knock it out if it's inflammatory. A medrol dose pack works good if the cause is inflammatory.

Not all Chiropractors are created equally, like M.D.'s, there are good ones and not so good ones. If I wasn't getting results after 2 weeks with any doctor I would bail.

Get that other opinion, I think you need more than an MRI, this of course can cause pain in the low back but not where you are complaining. The tests I mentioned are routine and should be ordered, letting this go on as long as it has without a concrete diagnosis is unacceptable. Let me know if you need more help.

Dr. Timothy Durnin
drs.chiroweb.com

---------- FOLLOW-UP ----------

QUESTION: Thanks for the quick reply.  I REALLY appreciate it.

The things you suggested it might be (other than the things I can take steroids for) -- are they at all serious?  Can they be treated with meds -- basically, if it is one of the things you suppose, will I feel normal again?

Thanks!

Ross

Answer
Hi Ross,

The things I suggested are to rule out an inflammatory or autoimmune arthropathy. Being male, you have better odds of not having most of the things I am checking for. If you indeed do have positive findings for the above, it can be treated effectively before joint destruction takes hold. I recommend that your doctor order these tests since the earlier something is diagnosed the better the outcome. There are literally hundreds of specific conditions that these tests can weed out, to speculate which ones are curable vs. treatable is reckless. I only wish that the correct diagnostic protocols are met to ensure competent care. From your post above, it is clear that the treating physician doesn't know what he/she is treating. Once you know what you do/don't have, it makes finding an effective treatment that much easier.

A good start would be to get these tests done, see if oral steroids knock it out and go from there. Some conditions may require long term medication, some very short and some not at all. Before further speculation can be made, these simple blood tests should be performed.

The more I know, the more help I can be. For now, all I can do is advise you on the correct diagnostic tests that need to be performed. I didn't mention it earlier but should be obvious to your physician, kidney problems.

This is quickly and easily ruled out if examined properly but it never hurts to ask.
Your doctor should know this, if he doesn't, I would find another one.
If you like, write the tests down and show them to the doctor, see what he says.


Dr. Timothy Durnin
drs.chiroweb.com