I Have Arnold Chiari Malformation Type 1, Thoracic Outlet Syndrome,

i have arnold chiari malformation type 1, thoracic outlet syndrome, in the past 4 months i have increase in nerve pains in shoulder, to hands, severe pain. taking oxy, norco, and neurontin 3600mg per day but it has attacked, physical theropy on shoulders made worse, is there med or surgery?