Lower back Bulging Disc/Degenerative Disc Disease and Upper Back Pain

by Michelle
(Hawthorne ca)

I have a disk problem in the lower back, why does my upper back hurt the most?

I go to a chiropractor every month because of upper back pain, and it used to help, but this month it didn't help at all. I am afraid my condition is getting worse. It is all I can think about.

My upper back stabs me all of the time, I used to get relief if I lie down but now its even bad when I lie down. The MRI did not show anything except a mild disk problem in the lower back. I also have rheumatoid arthritis, fibromyalgia, interstitial cystitis, and tendinitis in both hips. I also have possible plantar fasciitis (doctors are not sure what it is) in my feet. None of these bother me like my upper back.

I wanted to add that your article about living with pain was very inspirational to me. At first I was angry, then depressed, then gradually I began to accept it and found strength, as I was a full time student and proud of it.

After college at 44 years old my back got worse and I gave up and slowly became content to lie in bed isolating and watching netflix. I did not see a way out. I am going back to school in June because I cannot live like this anymore and I have been worried I cannot handle school but, your article helped me to see that I can. If I can make the pain become just background noise, I can start living again!

I do not like going places, because I like to be close to somewhere I can lie down when the back pain gets really bad. It’s bad all of the time but activities make it worse. Just wearing clothes makes it hurt more, so it is easy to just stay home and difficult to get dressed do makeup and get out. Sitting hurts so I stopped going to church and socializing with friends. I want to live again and living in bed is not living at all! Do you have any advice on breaking old habits?


Hi Michelle,
Gee Whizz, sounds like you have really been through a lot already. You must be a very strong person to make the decision to go back to school. But I applaud you, and I think that is exactly what you need to do, because you are 100% correct "living in bed is not living".

What to do? Well I can think of a few things that may help, but some of these you may have already tried.

The first thing to do is maximize all available treatments. I notice that the other conditions that you are dealing with all contain a large inflammatory component. I mean rheumatoid arthritis, fibromyalgia, interstitial cystitis, tendonitis, and plantar fasciitis all have one thing in common, inflammation. It is the inflammation and the inflammatory response that makes all of these conditions so painful.

It is hard to know if inflammation is what is causing your upper back pain, but inflammation does play a big part in all of the most common possibilities. Things like rheumatoid arthritis, osteoarthritis, and degenerative disc disease which may be causing your upper back pain all have a huge inflammatory component. So maybe focusing on relieving the inflammation in your body will help to relieve many of your different aches and pains.

Treatment could begin with OTC anti-inflammatory medications such as Advil or Aleve, taken up to the maximum dose for at least two weeks. If that is not helpful you could talk to your doctor about stronger prescription strength anti-inflammatories such as Meloxicam or Diclofenac. All of the anti-inflammatories are very similar, but we do find that one will work better for one person and another one will work better for someone else. So it may be worthwhile to try a few different ones.

Another possibility to consider is shifting to an anti-inflammatory diet. Many different foods will tend to generate a pro inflammatory or anti-inflammatory response. There is a lot of free information available on the Internet as well as many different books that you can buy.

The next slightly more aggressive step would be to seek out a rheumatologist. These doctors specialize in treating autoimmune and inflammatory conditions. There are many different drugs that are available for reducing inflammation and they can be much more effective than standard anti-inflammatories. But as you progress into more aggressive treatments the risk of side effects and other problems increases. These stronger medications can be very helpful but they need to be followed closely by your doctor.

More specifically to your upper back pain, you don't mention any evaluation or treatments you may have tried. Have you had an x-ray of your thoracic spine, or an MRI? What did it show? Have you ever been to physical therapy? Have you ever had any injections in your back?

Imaging studies such as x-rays or an MRI can be helpful for diagnosing many different conditions that may be causing your pain, the possibilities may include osteoarthritis in the facet joints, degenerative disc disease, or changes related to your rheumatoid arthritis. Any of these could be causing the pain that you describe.

Another possibility is upper back muscle pain related to chronic muscle imbalances that can develop over a lifetime of pain or improper posture. Evaluation by a trained physical therapist can help determine what is causing your pain. They can teach you exercises for strengthening weak muscle groups and maintaining your spine in proper alignment. This can be helpful for improving your sitting tolerance which may be a problem when you return to the classroom.

Depending on what the imaging studies show injection therapies may be helpful for your upper back pain. Steroid injections into the facet joints or into the epidural space can help relieve the inflammation and swelling. Trigger point injections with steroid medications or local anesthetic can be helpful for myofascial pain.

We also need to remember that we need to have realistic expectations. Even with all of these hi tech imaging studies and modern day medications, there is probably nothing that is going to make your pain go away completely. These treatments can help to control your pain and allow you to live your life, but there is likely some degree of discomfort that you will need to put up with.

You will need to use the best pain management tool of all, your brain. You can use your brain and your mental strength to push whatever pain cannot be relieved into the background. You can change the way you think about pain, and however you choose to think about it is how it will be.

If you decide that your pain is severe, horrible, and unbearable, then that is probably how it will be. If you decide that your pain is annoying, irritating, and bothersome, then that is how it will be. It is not the strength of the pain that matters; it is the strength of your will and your brain power that makes the difference.

When you think about your pain, frame it in your brain as discomfort or as an ache, and push it to the back of your mind. Then find something to focus on, something for your brain to really concentrate on, and let your pain just become background noise.

I did not say that it was easy because it is not. It takes work, mental work, and the ability to concentrate to put your pain in its place.

Well Michelle, I am sure there are more things to talk about, but I hope you can find something in here that will help. I really would like to hear from you again so please keep in touch. Let me know how you're doing, and what you have tried, and how it has worked out. Maybe we can come up with some other ideas or figure out where to go from here.

And good luck with returning to college, you don't mention your age now, but you did say you were 44 a while back. I was 40 years old when I first went to college so I know how hard it can be. I say "good for you", and I know you can do it.

Best Wishes,
Dave

Comments for Lower back Bulging Disc/Degenerative Disc Disease and Upper Back Pain

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Lower back bludging disc/Degenerative disc disease and upper back pain
by: Michelle

I cannot rule Fibromyalgia out, because it feels like I have the flu all of the time. My Rheumatologist said I had severe fibromyalgia after checking the pressure points for pain. I have ruled it out as the cause of the stabbing pain only because fibromyalgia has never produced that kind of pain it’s always more of a dull aching pain all over my muscles.

I think the back pain is coming from my muscles, because when I get a massage there are huge bumps and if they are worked on they do get smaller and then the pain is less I believe as a result. I appreciate the time you have taken with me very much. I feel so isolated; because I am always in pain I no longer do social events.

I do not have much money but when I do go out and I am around people it helps tremendously with the depression. After a while you begin to think you no longer matter. Going back to school will be very good for me; I am betting everything on it. When you are disabled you do think about the possibility of being homeless if you cannot support yourself.



Hi Michelle, it is good to hear from you. I think you are correct; going back to school will have many benefits for you, including social interaction as well as increasing your employment opportunities. The thought of losing your income is never pleasant.

You mention a couple of things that I want to respond to:

The bumps or knots in the muscles of your back maybe trigger points that would respond to trigger point injections. This is a myofascial type of pain and is somewhat different than fibromyalgia pain. If the massages help it is most likely not fibromyalgia causing the pain in that specific area. Massages especially deep tissue massage is tend to make fibromyalgia pain worse or are so painful that people are unable to tolerate to massage. Your rheumatologist may be able to help you out with a trial of trigger point injections.

You also mentioned depression, are you being treated for depression? If you think you have depression (which is not uncommon in people with chronic pain) and it is not being treated you need to schedule an appointment with a psychiatrist or other mental health professional for evaluation. Depression and anxiety are like a magnifying glass on pain. A little bit of discomfort that you could normally just shrug off, can turn into a giant weight that you cannot get away from.

Well Michelle, that is all for now. Keep in touch. I do enjoy hearing from you.
Good Luck and be Strong, I know you can do it.
Dave

re: Lower back bulging disc/Degenerative disease and upper back pain
by: Dave

I usually do not post on sites like this one, because I do not expect an answer. You are very kind. I have felt bad about myself for quite some time now and you said I must be strong despite my giving up for a while. I actually teared up reading your very kind nonjudgmental response and was so embarrassed that I gave a fictitious name.

To answer your questions I am now 47 years old and I have had an MRI nothing was found in the upper back on the MRI.

I am an attractive woman who looks younger than my years but feels much older. People do not think I am unhealthy nor can they understand my pain. I do walk my dogs and do some yoga stretching but I feel like I am in my 80's, not my 40's. Thank you for your comments and feedback they are appreciated more than you can know.

I will check into the things you mentioned, last time I saw my pain doctor he said the stabbing pain was probably the fibromyalgia. I disagree and I know from past experience that doctors don’t have all of the answers, sometimes you must be your own advocate and find the answers yourself.

I started taking Krill oil, because you mentioned inflammation being the common factor and Krill is supposed to help it.

I already see a Rheumatologist if I did not I would be in bed with swollen knees unable to even walk to the kitchen. I stopped the medication for seven months and found out the hard way that I need it.
Thank you!



re: Lower back bulging disc/Degenerative disease and upper back pain
by: Michelle


Hi Michelle,
You mention people not understanding and I had to respond because you are so right, people do not understand.

You cannot see pain, and there is no objective test or other way to prove you have pain, or how severe your pain is. The situation gets even more difficult when your doctors don't believe you or don't understand your pain.

Unfortunately, that is the situation and we have to deal with it. Nobody chooses to live with chronic pain but that is the hand that some of us are dealt, and we need to make the best of it by getting up everyday and making the best life that we can.

Just like you going back to school, that is how you get back to living your life. Get busy doing something. It won't make the pain go away, but when you get busy with something to concentrate on besides the pain, the pain gets pushed into the background.

You mentioned fibromyalgia, and I know that some doctors will use that as a diagnosis of last resort when they can't think of anything else, but don't be too quick to throw it out the window. I think fibromyalgia is real, but the problem is that there is not a lot of good treatments for it.

Do you feel like your upper back pain is in the muscles? Or in your spine? Trialing some injections may help rule out fibromyalgia if they make any difference.

Trigger point injections can diagnose myofascial pain if they help.

Thoracic epidural steroid injections may indicate rheumatoid or osteoarthritis or other inflammatory conditions in your thoracic spine.

Injection therapies will not help the pain of fibromyalgia. Aggressive stretching and cardio physical therapy can sometimes help with fibromyalgia.

Ok Michelle(or whatever your name is:) ) you keep getting up everyday and getting on with your life, I think you are doing great. Keep working on the anti-inflammatories and let me know if you think the Krill makes a difference, and please keep in touch and let us know how you are doing.

Best Wishes,
Dave

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