Question
dear doctor
i had receaved a question from a nice lady called april and wanted to hear your comments on the matter. i'm a physical therapist working in the orthopaedics field for 6 years and trying like you to answer questions trought the allexperts site. thanks in advance for your help
this is her story:
"Greetings! I have been experiencing an unknown problem with my body and have gone to numerous doctors, neurologists, rheumatologists, but am left without an answer. I am desperatly hoping that you will be able to suggest what my problem might be. I am not looking for a diagnosis, but simply ideas to point me in the right course of treatment, etc.
First of all, I am a 27 yr. old caucasion female in graduate school. I am 5'10", and weigh 140lbs. I exercise regularly and eat a good diet. I do not smoke and never have...do not take drugs. I am on orthotricyclen, neurontin, and strattera (for ADD...I've been on this one year). I have never broken any bones, and have never been hospitalized. I am psychologically stable and in very good overall health. My blood work comes out excellent with blood pressure within normal range (120/80), pulse usually 90-103 resting, and ANA (anti-nuclear antibodies) at 350, but sedimentation is low (not indicative of lupus!). Cholesterol is normal. Autoimmune diseases do tend to run in family...celiac (spru), hashimotos, thyroid disorders, etc. I have been tested for all of these and tests come back negative.
My problem is concerning the right side of my body. I have had this problem for five (5) years, and it has increased in intensity over time. I have had several cat scans and MRIs, which come back as normal with a little arthritus in my neck. The pain runs from the base of the right side of my neck, to the right muscles in my jaw, to my throat area, to my shoulder/arm, to the muscles in my right side abdominals, to my hip, and down to my calf and into my foot. The pain is not in my joints, but seems to be localized only in my muscles. The pain is most intense in my right shoulder blade area. I can describe the pain as continual; I feel it to some degree all the time. At minimal, it is a nagging pain...almost like an itch in my muscles. At maximum, it feels like someone is pulling me on a string from the top of the right side of my body down to my right foot...almost like my muscles are so tense they will tear. I get frequent debilitating migraine headaches again at the right side of my body localized in my head only on the right side, which seems to be somewhat related to the right sided pain. I am very tired most of the time.
The curious thing is that it is only on my right side. My right foot and hand are frequently tingly and get considerably warmer and redder than my left. My right arm at times goes very warm then numb. My right eye at times gets very red. Massage therapy feels unbelieveably good at the time, but seems to worsen the condition several hours later. Exercise and strength training improves the problem if done consistently over time.
I am desperatly looking for any possibley answer to this problem and am open to ANY suggestions of what it might be...maybe even a blocked artery, nerve problems, spinal cord issues, etc., nutritional info., etc. I am weary of seeing countless neurologists who have no answer or idea of what it might be, as my MRIs and xrays and cat scans are all very normal, only with a little arthritus in my neck. Please please tell me all the information you may know of what this problem could be. I am desperate for answers. Thank you for any information you can give to me.

and this is my  answer:

--April  
Answer:  quite a nice question...
i have some ideas but there are a little hard to explain to a non professional or even to a new pt. try to search info about the sympatetic nervous system. a part of this system seats behind the thoracic part of the spine and it is responsible for a lot of things . pain, hair, sweating, regulation of blood vessales--readiness of the skin, swelling... ("My right foot and hand are frequently tingly and get considerably warmer and redder than my left. My right arm at times goes very warm then numb. My right eye at times gets very red.")
there are techniques to mobilize this system of nerves ( the slump thechniques ) and also electrotherapy to the area (TENS- trans cutaneuos electrical stimulation ), hot and cold thechnique, acupuncture...
you shoud see a physical therapist that is specialized preferably a MA in manual therapy or even in manipulative therapy OR A REALLY GOOD CHIROPRACTOR ( the problem with those is that a good one can make wonders an d medioqrue one can put you in a weelchair for the rest of your life.)(sorry for the spelling - english is not my native language and i'm not living in US )  

Answer
Dear Iulian Cogan,

I've received the same question from the lady. My answer was:

Hello April,

The type of pain you describe is usually not a result of Spinal problems. If you have had a thorough evaluation done with no clear cause found, it is safe to assume that no major medical problem is missed. In these situations, treatment is usually symptomatic. I think you might find it helpful to consult with a pain specialist that can direct you further.

Sincerely,

Dr.N.Rahamimov