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Suggest Treatment For Pain In The Back And Neck
Question: Hello I have been experiencing mid back pain/near bra, and neck pain since 4/2106. I have tried ice, heat, NSAIDs, activity modification; with no effect, affecting ADLs. I have gained a little more than 10 pounds since. I recently had an MRI of the cervical and thoracic spine that revealed a C4-5 disc bulge with an annular tear. My neck pain is not as pronounced as the pain in my thoracic spine; although I am experiencing some numbness in my left arm/hand. I experience a dull pain to that region when I lift small objects, or do a household chore as simple as taking wet clothes out of the washing machine. The right thoracic spine/near my bra line region is very tender to touch. Why might my pain be more in the thoracic spine?
Brief Answer:
Probable causes of thoracic spine pain
Detailed Answer:
Hi XXXX, thanks for asking from HCM.
I can understand your concern. You have described few pain characteristics like
- Dull pain
- Increased pain after doing activity
- Long duration history
- Pain resistent to painkillers
As you are young and MRI revealed only disc bulge at C4-5 (not disc herniation or protrusion, which are more severe), that means there is still hope that you will recover with conservative treatment. Your pain could be due to two causes
- Dural compression - Disc bulge at C4-5 can cause dural compression. Dura is a covering around spinal cord and it is very sensitive structure.
- Paraspinal muscle tear - Your pain is dull and increases on doing activity, such type of pain is mostly due to muscular spasm or tear.
The combination of two pathologies might be the cause behind resistant pain. To get relief, you need to keep patience and follow few tips
- Do not stop NSAID's. You can take painkiller like Aceclofenac and Paracetamol combination for 7 days and observe response.
- Rest of muscles and spine is must. Do light activities, but avoid activities like bending/washing clothes/sweeping. Only rest can heal torn muscles.
- Ask for diathermy and ultrasonic therapy at pain site. These therapies relieve pain and swelling.
- Continue with diclofenac gel local application at pain site, thrice a day for initial few days. Then change it to twice a day.
- After significant relief, under physiotherapist and gym instructor guidance, start muscle strengthening exercise. So that it does not happen again.
- For cervical pain, you can use soft neck collar while travelling. It will prevent any jerk at neck.
- If still there is no relief, you can ask doctor for injection of lignocaine+Bupivacaine at pain site. It provides instant relief.
Hope it will help you. If still no relief, do let me know.
Thanks. Take care.
Probable causes of thoracic spine pain
Detailed Answer:
Hi XXXX, thanks for asking from HCM.
I can understand your concern. You have described few pain characteristics like
- Dull pain
- Increased pain after doing activity
- Long duration history
- Pain resistent to painkillers
As you are young and MRI revealed only disc bulge at C4-5 (not disc herniation or protrusion, which are more severe), that means there is still hope that you will recover with conservative treatment. Your pain could be due to two causes
- Dural compression - Disc bulge at C4-5 can cause dural compression. Dura is a covering around spinal cord and it is very sensitive structure.
- Paraspinal muscle tear - Your pain is dull and increases on doing activity, such type of pain is mostly due to muscular spasm or tear.
The combination of two pathologies might be the cause behind resistant pain. To get relief, you need to keep patience and follow few tips
- Do not stop NSAID's. You can take painkiller like Aceclofenac and Paracetamol combination for 7 days and observe response.
- Rest of muscles and spine is must. Do light activities, but avoid activities like bending/washing clothes/sweeping. Only rest can heal torn muscles.
- Ask for diathermy and ultrasonic therapy at pain site. These therapies relieve pain and swelling.
- Continue with diclofenac gel local application at pain site, thrice a day for initial few days. Then change it to twice a day.
- After significant relief, under physiotherapist and gym instructor guidance, start muscle strengthening exercise. So that it does not happen again.
- For cervical pain, you can use soft neck collar while travelling. It will prevent any jerk at neck.
- If still there is no relief, you can ask doctor for injection of lignocaine+Bupivacaine at pain site. It provides instant relief.
Hope it will help you. If still no relief, do let me know.
Thanks. Take care.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Answered by
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