The left sided upper back pain with neck pain and headache can be myofascial pain syndrome. Muscles of the neck and shoulder girdle, namely; trapezius, scalene, sternocleidomastoid, levator scapulae etc can develop myofascial trigger points. These are hyperirritable tender spots in palpable tense bands of skeletal muscle that refer pain. This can be associated with degenerative disc disease in neck causing pinched nerves. Trigger points may develop after an initial injury to muscle fibers. This injury may be a noticeable traumatic event or repetitive microtrauma to the muscles. The trigger point causes pain and stress in the muscle or muscle fiber. As the stress increases, the muscles become fatigued and more susceptible to activation of additional trigger points. The treatment is following;
1) passive stretching of the affected muscle after application of sprayed vapocoolant.
2) physical therapy; simple muscle stretch, augmented muscle stretch, post-isometric relaxation.
3) deep electrotherapy; iontophoresis, phonophoresis, short wave diathermy, electrical stimulation, high voltage galvanic stimulation, biofeedback.
4) local analgesic patch / ointment / spray
5) anti-inflammatory analgesics; Ibuprofen (Motrin / Advil)
6) ischemic compression therapy; pressure on the points
8) steroid shots
Th e headache is what we term as cervicogenic headache. This headache is caused by referred pain from the upper neck (cervical) joints. The headache is caused by neck movement or sustained awkward head positioning. So people who work long hours on computers are liable to have this kind of headache. Migraine and tension-type headache can be the other possibility.
Physical therapy is the preferred initial treatment for cervicogenic headache. The other modalities employed for the treatment are done by pain management physician and are invasive modalities. These are;
1) Percutaneous radiofrequency neurotomy
2) Steroid injection
Your physician may consider a trial of Gabapentin or Pregabalin as an initial medical treatment to see the response with the physical therapy.
Laboratory studies and investigative work up like following are done to help rule out diseases with similar manifestations and to assist in diagnosis of certain inflammatory diseases that frequently coexist with fibromyalgia and chronic fatigue syndrome;
1) Complete blood cell (CBC) count and differential count,
2) Basic metabolic panel,
4) Thyroid-stimulating hormone: Hypothyroidism has many similar clinical features with fibromyalgia, especially muscle pain and fatigue.Seems to be normal in your case.
5) Creatinine phosphokinase (CPK) to rule out inflammatory myopathies
6) Erythrocyte sedimentation rate (ESR); already done
7) Antinuclear antibodies (ANAs): Many patients with SLE have comorbid fibromyalgia.
8) Rheumatoid factor
9) Sleep studies
If fibromyalgia, lupus, sleep disorders etc can be ruled out; other consideration would be;
1) chronic fatigue syndrome; unexplained, persistent or relapsing fatigue with unrefreshing sleep, muscle pain, concentration problems, headache, sore throat etc.
2) idiopathic fatigue; it does not meet the above criteria.
Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
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