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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 13222
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I am asking this question on behalf of my girlfriend, who has

Resolved Question:

I am asking this question on behalf of my girlfriend, who has been experiencing chronic pain in her upper right back/shoulder/neck area. It is a persistent pain, but definitely worsens after she has been at work - she works at a sub shop. I believe her symptoms increase because of her constant leaning over the counter to make sandwiches. If she has several days off in a row the pain lessens but does not disappear entirely. This leads me to believe the motions she performs at work exacerbate her symptoms, but are not the cause (and she did exhibit these symptoms before starting this job). Advil, Aleve, hot/cold packs have not helped. Massaging the area for her only offers temporary, minimal relief. Before going to sleep last night, she informed me that she can barely lift her arm and is in extreme pain, so it seems to be getting progressively worse. Naturally, the instinct would be to seek immediate medical care, but she does not currently have any health insurance. We hope to resolve that and find coverage soon, but that doesn't help her at the moment. Not being an expert, I do not know if her pain is caused by a pinched nerve, rotator cuff damage, etc. So I am not sure how to proceed currently. Massage therapy? Chiropractor? Seek out a free clinic? Any insight would be greatly appreciated.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
It will help if you could provide some additional information:
Is she unable to lift her arm because of weakness or pain? If both are present, which is the most limiting?
Is there tenderness to pressing in any of the areas of pain?
What dose of Advil and Aleve was tried? How many mg per day?

Customer: replied 1 year ago.

Weakness doesn't seem to be an issue - it's the pain that is limiting her mobility. Tenderness also does not seem to be present. When I have massaged the affected area for her, a definite "sweet spot" regarding pain has been just inside her right shoulder blade (perhaps a bit higher towards her neck as well). Advil: 200 mg. Aleve: 220 mg (per bottle info). I do not believe she has ever exceeded the 24 hr dosage recommendations on the packaging. For example, when she has reached for the Aleve, she would take two tablets, but then no more for a few days. Definitely utilized for temporary relief and not as a regimen.

Expert:  Dr. D. Love replied 1 year ago.
Thank you for the additional information.

It is impossible to make a diagnosis based solely on the symptoms. It can be said that the most common cause of pain such as you describe in a young adult is muscular pain, such as from chronic muscle spasm. A rotator cuff injury also can cause many of the symptoms that you describe, but there would usually be tenderness in the area of the shoulder. Degenerative changes in the neck causing a pinched nerve is also a possible cause of such symptoms, but it is less common to develop this in someone of her age.

Generally speaking, the next step would depend upon the severity of the pain. If the pain is more severe and intolerable, then being seen in an emergency room or urgent care center would be appropriate. Otherwise, it would be appropriate to be seen in a free clinic. If you are uncertain whether there is a free clinic in your area, you can check with the local health department or you can search an online database to look for federally funded clinics near you at http://findahealthcenter.hrsa.gov/Search_HCC.aspx.

Another option would be to consider using a higher dose of the Advil or Aleve. The over the counter strength is designed for relief of pain, such as headache. However, the same medicines can be used to relieve inflammation associated with a variety of musculoskeletal condition, but a higher dose is necessary. There is a prescription strength of the ibuprofen of 800 mg and of the naproxen of 500 mg (or 550 of naproxen sodium), each designed to be taken 2-3 times per day, but it also would be OK to take an equivalent amount of the over the counter strength. If taking a higher dose of one of these medicines for a couple weeks eases the pain, then no further evaluation or intervention is necessary, but if the symptoms persist, it would be appropriate to be seen.

If you have any further questions, please let me know.

Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 13222
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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