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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 34727
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Hi there, I am a 34 year old woman who has been suffering

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Hi there,

I am a 34 year old woman who has been suffering from horrible chronic back pain. It is mostly on my left sideright under my shoulder blade and very near my rhomboid muscle. It hurts 24 hr/7. The pain when its at its radiates up thru my neck to my left temple causing a throbbing headache> it has affected me so much with my daily life. But besides the pain. I sleep at least 9 hours a night, eat right, drink alot of water...and for some reason I never wake up refreshed. Alsways tired and it takes me at least 2-3 hours to get my full energy up. I wake up stiff and achey and it only gets worse through out the day...the damp humid weather make the pain worse, the only tme I get some relief is when its warm out or i excersie i feel like my muscles are stretched so i feel relief. I have seen every type pf Dr. they have done many tests and cant figure it out? I am on Effexor right now and muscle relief. I made an apt with a rheumotoligst my last hope maybe they can figure soemthing out? my last thought is that I may have some type of arthritis? in my back? what are your thoughts? Thansk Allie

Greetings Alexandra .


I am Dr. Phophalia and would assist you today.

What were the investigations done by the rheumatologist?
Were the diagnosis like chronic fatigue syndrome or fibromyalgia considered?

Customer: replied 4 years ago.



I haven't seen the rheumotologist yet; but I am not holding on to hope b/c other Doctors havent found anything....


fibro mas considered...but the weird part is that I only have the pain mostly on the left side. I haven't been checked from chronic fatigue syndrome...

Customer: replied 4 years ago.

Hi there


I forgot to mention, I have had my thyroid gland tested and also an ESR test performed.

Hello Alexandra,

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

7) massage

8) steroid shots

9) acupuncture


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,

3) Urinalysis,

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.

Thanks for using JustAnswer.


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