Question
Hello,

   I feel as if i am going nuts.  2 years ago i was involved in a serious vehichle accident.  I was a passanger and we were hit head on from a big pick up truck.  after the impact if felt as if my ribs on teh left side were broken.  There was extremem pain, i could not breath and very bad tenderness.  xrays were taken but i was told that if they did break it might be a hairline fracture and to go home and rest.  i also hurt my knee and back.  it has been 2 years and my ribs still hurt.  i can't do my daily activities without wanting to scream out.  i was put on advil and volataren, both anti inflamatories.  I have also taken naproxen sodium and tylenol 3's. my life style does not allow for me to take anything stronger nor do i feel i should have to.  I would like to know if you have ever heard of a rib not healling after 2 years.  I plan on going back to my doctor but i dont think he believes me mostly because i won't take the vicoden.  please help!!!!!

Answer
Dear Pati,

Yes I am aware of continual rib pain after trauma.  Unfortunately this area of the body does not have specific treatment protocols and can become a chronic pain generator because of associated scar tissue formation as well as an increase in the pain generating nerves after trauma (it is called neoneuralization, synaptic arborization, or neurological wind-up).

Your GP doesn't have specialized trainning with these types of phenomenon, and will most likely not be aware of the neurological aftermath.  You need to find a physician certified by The American Academy of Pain Management, or The American Academy of Pain Medicine.  These physicians will be aware of the above mentioned conditions/sequela, and will have training in ways to help such as biofeedback, accupuncture, and pain management injection proceedures.  Hypnosis is also a valid way to decrerase your pain perception.

As always, it is a good idea to call offices as well and ask questions of the satff and see if you can get a free consultation with the doctor.  Remember that pain is subjective and requires interpretation in the brain for significance, but is mostly generated through abnormal processes or trauma of tissue.  You are not crazy, you just need to get to a physician who has the training to help.  Good Luck.

Respectfully,
Dr. J. Shawn Leatherman