Agony during sleep, neck/back pain all day and night

[AThorn]

Hi All,

34-year-old, 6 foot 4 male here.

- I have virtually constant pain at the neck/back intersection on the left side. The shoulder pain I describe herein is only during movement in certain ways or stretching. The neck/back pain is horrible and is the one I'm worried about, and I'm wondering if the shoulder problems actually tie in with it.

- My left shoulder clunks whenever my upper arm is rotated back (i.e. displaying my palm in some manner) No idea if this is anything to do with it. Only a little bit of an ache there afterwards if it's happened it a few times. Minimal pain when it happens.

- If I put the arm directly up my left shoulder gives me .. unusual pain which I cannot move past to make my arm go back any further.

- If I put my arms out perpendicular to my body with my shoulders back there is this incredible tightness that runs down my left arm all the way to my palm. In certain stretching positions it can produce a 'zapping' feeling jolting down the arm to my fingers, but mostly it's just so tight I can't move it any further.

- Everything on the right side is fine. My right arm, shoulder, back and neck never have any problems. Full range of motion. No pain. No clunking. Nothing.

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[AThorn]

- I can intensify this neck/back pain to almost agony by lying down with my left-shoulder tucked under me i.e. sleeping on my left-side (note: there's no pain in the actual shoulder during this) If I happen to sleep this way I'm in awful pain during the 'sleep' and for the entire following day, and normally a day or two after that as well. Normally it would happen every night, which would make the really bad pain days EVERY day, but I've put something in place to help curb that a little (something to hold my arm in place so I cannot sleep on my left side) but it doesn't always work

- Bending forward is also terrible for the neck/back pain. It feels like something is perhaps tearing? (it doesn't actually even hurt until maybe thirty seconds later - but I know when I've done it .. it just feels different, then the pain kicks in and lasts all day)

- I've had pain-killer injections directly onto the spine at a spinal clinic because I was going to possibly undergo a nerve-burning process - the initial injections didn't seem to help much, so I didn't go through with it, although I'm not sure they got the right area.

- I've had both xrays and .. some other test where they scanned me a few years ago (MRI maybe?) and some scoliosis was noted, but no damage to the spine structure detected. They only focused on scanning my spine. I've never had my shoulder scanned.

- 'Cracking' my neck used to give me around fifteen minutes relief, then it would come back five times worse. I've stopped doing that (and the pain has come down slightly) Same result from chiropractors.

- I've tried exercising to strengthen the muscles there. This only seems to make things worse as well, usually, although I've undertaken standing out from a wall and reaching back with my hands beside my ears behind me and pushing on the wall, and leaning my head right back so my whole spine is curved backwards. I feel this helps, but because my shoulder can't move properly, it's difficult to really strengthen that area.

- During the day, if I maintain a rigid posture with my head pulled right back in and tilted up as well, this also seems to help (at least helps to keep me from bending forwards and making it worse) Doing so does tighten me up eventually, but it's normally preferable to the neck/back pain.

- I cannot sit on any regular chair without aggravating the neck/back condition, even when I do everything I can to maintain correct back posture. I've noticed there are certain chairs that aren't as bad for it as others, though.

- I've had this for at least fifteen years. It has been really bad for around ten.

- Normal painkillers help when it's only light pain. The pain does reach a point where regular painkillers basically do nothing to affect it, though.


I don't know what to do next. Do I need to see an osteopath, an orthopaedic surgeon, a physical therapist? I've already tried a chiro as I said. My doctor has renewed my referral to the spinal clinic, but I am convinced it is a musculoskeletal problem that's either pinching my nerve(s), or tearing something in there.


I know I've written a lot here, but browsing other threads I see it's better to have some extra information than not enough.

Any advice is welcome.

Thank you.

[gcoe]

Hi Athon

From what you have described I think it is quite clear that you have developed a chronic pain problem and unfortunately it seems to have taken over your life. Chronic pain is one of those very difficult areas of medicine where we don't have a great understanding of what is going on. However we do know it is the experience of pain that has taken over and that the central nervous system has changed in the way it works. We also know that on the whole the body has repaired itself and is generally not the source on the pain experience even if it takes a role in varying that experience. This can be very baffling for patients as you are constantly being given the message from your brain that you are injured or in the process of suffering tissue injury. However it has more to do with the abnormal activation of the very complex pain perception system in the central nervous system.

I note in your last comment that your doctor has referred you to the spinal clinic but if he/she means sending you to a chronic pain team then that is likely to be a good thing to do. I am not sure exactly what they would offer but it is important to understand that a chronic pain problem is primarily a nervous system problem. (please note this does not mean it is a psychiatric problem but is more of a neurological change) These problems often evolve from what may start off being a relatively simple musculoskeletal disorder but then the problem doesn't resolve then often gets worse, more extensive, more constant and can take on a very distressing quality. Such pain can continue to be modulated by what you do so certain activities will make it worse and certain activities, rest postures etc may relieve it somewhat but never resolve it.

Traditionally the chronic pain patient gets misdiagnosed, often for years and sees an endless supply of physios, chiros, drs, orthopaedic surgeons etc. these never really work and in fact can delay the realisation and accpetance that the pain is not mechanical in nature anymore and can't be fixed by mechanical means. You will find numerous therapists and Drs who are not well trained in chronic pain management who will take your case on board (including on this site) and will valiantly try to help and will no doubt fail. In fact these interventions do more harm than good, at best failing to work and at worst unnecessarily damaging the body as is the case with invasive surgical procedures that are not warranted.

The assessment and management of chronic pain needs to be carried out by an experienced specialist team that includes a pain specialist, physio, occupational therapist, psychologist and may be others. One of the key outcomes is to learn how to manage the pain so that it doesn't manage you. treatments often include effective pain modulation drugs (not analgesics and certainly not opiods), education on how to manage the pain, graded fitness training by the physio to help manage the pain and this can all be helpful. People living with chronic pain can find this approach very helpful but unfortunately can't cure you of the pain and this is one of the more frustrating aspects about chronic pain.

I suggest you have a read about chronic pain then go back to your Dr and have a frank talk about you and your situation. Here are a few sites with some info which may be helpful

American Chronic Pain Association

Chronic Pain Information Page: National Institute of Neurological Disorders and Stroke (NINDS)

Pain: Hope Through Research: National Institute of Neurological Disorders and Stroke (NINDS)

[AThorn]

Thank you very much for the response Gcoe.

Yes, this pain does rule my life and has for a very long time and I will certainly read the information in links you provided, as I do believe it's relevant to most of what I'm going through.

Although, from what you've said, it would seem that all of the things I've described are actually just the results of (or aggravated by) something else, which I didn't even mention at all.


If I feel relaxed and in basically no pain, and move my left hand/arm in a relaxed way to reach for something, there can be a sharp, shooting, instant, pain like nothing else I've described. It's something like directly on my spine on the left side and the pain is just PURE. There's no ache, no strain, no soreness, nothing else at all in this when it happens. Just sparks of pain that jolt me. It only ever happens when all the other pains I go through are at their lowest. At the exact same time these things happen:

- There are a few little crunching sounds
- I sort of feel something moving in there that I don't normally feel
- There are a salvo of pain ZAPs as described above

I can hear it happening (very small sounds - very different from any of the clunking or cracking I've described previously) and it's nothing like any of the other pain I've described.


Does anyone know what that might be, because I think this might be the very root of the whole problem?


(By the by .. the spinal clinic referral is not for pain-management. It's because they thought I may have a facet-joint injury)

[gcoe]

Hi Athon

If I feel relaxed and in basically no pain, and move my left hand/arm in a relaxed way to reach for something, there can be a sharp, shooting, instant, pain like nothing else I've described. It's something like directly on my spine on the left side and the pain is just PURE. There's no ache, no strain, no soreness, nothing else at all in this when it happens. Just sparks of pain that jolt me. It only ever happens when all the other pains I go through are at their lowest. At the exact same time these things happen:

- There are a few little crunching sounds
- I sort of feel something moving in there that I don't normally feel
- There are a salvo of pain ZAPs as described above

Not sure about that. The type of pain you described sounds like nerve pain. For example if there something like a neuroma that can give you an electric shock/jolting like pain. A neuroma is where a nerve has been cut and it grows back into a localised bundled tangle. Alternatively a nerve is getting compressed during the movement. The crunching sounds and feeling something moving may or may not be significant. It could be just to do with the amount of muscle tension on your joints which crunches around when you move or it could be something more than that.

Does anyone know what that might be, because I think this might be the very root of the whole problem?

However the "elephant in the room" is that you have a chronic pain problem and such pain on movement can be explained why what is known as alodynia - that is a sensory stimulus (in this case your reaching movement) which is normally quite pain free is experienced as painful. Alodynia is one of a number of painful phenomena you get with chronic pain. So I am not really so sure about this being the cause of everything.

If you like tell us about how it all started all those years ago.

(By the by .. the spinal clinic referral is not for pain-management. It's because they thought I may have a facet-joint injury)

No you are quite right this is not for pain management and in my opinion it is grasping at straws that a facet joint injury could be causing what you have now.

[AThorn]

Hi again Gcoe, and thank you very much again for your response!

Hi Athon

Not sure about that. The type of pain you described sounds like nerve pain. For example if there something like a neuroma that can give you an electric shock/jolting like pain. A neuroma is where a nerve has been cut and it grows back into a localised bundled tangle.

That sounds familiar, maybe. Sometimes when I've had a sleep with my arm thing on and I have avoided sleeping on that bad side, if I am careful what I do I will be somewhat pain-free in the morning, then it will get to a certain time in the day and I might just be walking or standing somewhere and then I will feel something like .. I don't know how to describe it. Like a worm or something wriggling around in there for two seconds or so? Right near that same spot. If I am having a morning where there's not much pain, then I feel that happen, within ten minutes I'll be aching away and the rest of the day will be very painful for me. The 'worm' part doesn't actually hurt in itself. It's just a squirmy little feeling in there.

what is known as alodynia - that is a sensory stimulus (in this case your reaching movement) which is normally quite pain free is experienced as painful.

I'm sure I probably do experience that as well as part of the bigger picture of suffering from chronic pain, and, I'm no Doctor, but what I'm experiencing with this specific, sharp, sparking pain doesn't sound like it matches up to the Alodynia description. What I'm talking about is a movement that I can't actually replicate except in one circumstance - when that area is extremely relaxed. I can feel different muscles/tendons/whatever is in there kick in. The whole thing is a bit of an alien feeling to my normal movements. It just moves a bit differently and feels different. Normally that area is tense all day, and I simply cannot relax the area enough to duplicate the move. My shoulder must be relaxed to a certain degree, my back, my neck, it all has to relax to a point where I just move without the tension that I normally do, totally forgetting that it's going to crunch me.

Imagine you're going around all the time every day holding your head to the side with a tennis-ball between your cheek and your shoulder, holding it there. Head tilted, shoulder raised, muscles bunched. Then at night you get home and sit down and watch some movie for a couple of hours and the ball falls out without you noticing and your shoulder drops down to it's lowest position and your head moves back upright, or even a little bit toward the other side. You see something on the shelf next to you and go to reach for it just with your arm (no real neck or shoulder movement to go with it) Right then when your arm is almost fully extended. Crunch! It's not the same movement with different results. I'm utilizing different stuff and moving things in there in a different way, activating things that are never normally activated because of the tension that is usually maintained in that area.

In my example you're probably just pulling a muscle of some kind, but this feels and sounds nothing like a pulled muscle.

I wanted to clarify about the volume of that sound, too - I'm not sure if it'd be all that audible to others unless they were right next to my neck. That's the sound I'm referring to. It's not some booming noise going on in case I've given the wrong impression (not that you indicated I had, just trying to be as honest as I can)

Another thing which I'm not sure would have any relevance or not - I noticed around the time that when the pain first started to get to me, if I was under the shower, that if I kept the water beam fairly small and had it pointed directly at the spot where the pain always is, that I could pretty much turn it up to extremely hot temperatures and never feel it. If I moved off that spot it would be stingingly hot, but on that spot I could (and still can) pump the temperature up to pretty much anything and not feel it. It doesn't feel particularly numb to touch the area in a shallow way, but I did intentionally hit it with objects a few times when I was younger out of frustration, and I remember quite clearly that it was fairly numb to any and all blows I delivered, and, as I said, I simply have no temperature sensation in that specific place there at all.

If you like tell us about how it all started all those years ago.

Hundreds of hours in front of a computer screen with no concern for posture, carrying a huge bag for miles stacked with books always on the one shoulder, a fall where a chunk of hay landed on my back (it winded me, but I never felt anything other than what you'd expect and was fine afterwards), my Mother and Grandmother would get aches in that area too, sometimes, but I don't think either of them ever had any real problems with it - at least not like I have.

I think it might have the most to do with sitting in front of a computer for day after day after day, and that heavy bag. Sounds a bit stupid to say it, because then it turns out that it's all been my fault. Normally Doctors jump on the 'hay landing on me' thing, but people remember incidents that hurt them or make them feel or move differently; I don't remember that doing any of that. It knocked the wind out of me, but I never noticed anything lasting out of it.

No you are quite right this is not for pain management and in my opinion it is grasping at straws that a facet joint injury could be causing what you have now.

Well I must say I think you're very right - if you want to know the truth I was pretty disgusted by the way the diagnosis came about. The Doctor didn't even really test me. Laid me face-down, pushed on one spot (and one spot only) not even hard .. he asked 'Does that hurt?' .. it felt nothing like any of the pain I normally experience - it hurt minimally because he was pushing on a soft spot where I think anyone would report discomfort - I said 'err .. a bit', noncommittally. He stopped, and in a friendly manner said 'Get up', I was like 'What?', he said 'Get up, it's okay, I've seen enough' ... I was befuddled. He hadn't done anything. He didn't know anything about my case except the very brief introduction to it I'd given him that day. He booked me to come back in a couple of months time, gave me some injections and took a lot of my money.

I don't mean to speak ill of a Professional in the field - it's not like I'm naming anyone - and I'm not bitter about it, but I really wasn't impressed with that (I still sent in the post-injection results when they were due), just never went back. And, maybe it even is a facet-joint injury, but you'd never ascertain it from an examination like that.

Anyway, there's wall of text and a bit more of my story!

AThorn

[gcoe]

Hi Athom

Thank you for your full and descriptive reply. I won't respond to all your points but i do have a few comments:

Like a worm or something wriggling around in there for two seconds or so? Right near that same spot. If I am having a morning where there's not much pain, then I feel that happen, within ten minutes I'll be aching away and the rest of the day will be very painful for me. The 'worm' part doesn't actually hurt in itself. It's just a squirmy little feeling in there.

Yes this is a well recognised chronic pain experience and the fancy term for the 'worm' sensation is a dyesthesia - this simply means an abnormal, unpleasant sensation that is not necessarily painful, and can be evoked or just come on spontaneously. They come in all 'shapes and sizes'. One patient I had experienced the sensations of frogs crawling under her skin but she never mentioned it to the Drs because she feared they would send her packing to a psychiatrist *- she had had that feeling for 20 years and never told a soul 'til it came out on one of our sessions

The triggering nature of these sensations is quite common. It may have something to do with perseveration. You know when you have a tune in your head that is dreadful but you just can't help replaying it or you have a negative thought that you just can't stop ruminating on. These are examples of perseveration and it seems to have something to do with how our brain proceesses information in recurrent loops -circuits that keep replaying the same information and if not inhibited can get amplified and just keep going. Perseveration is such a rudimentary process that we see it in lots of clinical (as well as healthy) situations: in brain injury in speech or expression, in mental health in OCD etc. So in the chronic pain situation you see some sort of trigger or just spontaneously and it can just set off a domino effect of pain and unpleasant sensation.*

if I am careful what I do I will be somewhat pain-free in the morning, then it will get to a certain time

As a clinician this suggests to me a good prognostic sign. My understanding is that in people with chronic pain who have constant unrelenting pain are much less amenable to treatment than when there is some time during the day when you are pain free.

I'm sure I probably do experience that as well as part of the bigger picture of suffering from chronic pain, and, I'm no Doctor, but what I'm experiencing with this specific, sharp, sparking pain doesn't sound like it matches up to the Alodynia description. What I'm talking about is a movement that I can't actually replicate except in one circumstance - when that area is extremely relaxed. I can feel different muscles/tendons/whatever is in there kick in.

yes I can understand your skepticism about this as your experience doesn't seem to match up. In my clinical experience *I would maintain that this may well be just another of your chronic pain experiences even though it seems very somatic to you. The brain is unbelievably complex and capable of simulating all manner of sensory experiences. However it is beyond my expertise, particularly over the net to make a diagnosis. When it comes to chronic pain we all should approach these things with some humility and an open mind as we often do get things wrong.

Idon't mean to speak ill of a Professional in the field - it's not like I'm naming anyone - and I'm not bitter about it, but I really wasn't impressed with that

When people with chronic pain finally do get to a chronic pain team they often give a long history of bad experiences with all sorts of practitioners: over-confident claims, glibb diagnoses and one of the worst is blaming the patient for their situation and pigeon-holing them as mad when they don't respond to their ministrations. From a clinicians point of view this arises out of lack of education and also frustration when things don't go well. Patients can also be living in a world of distress with things like depression, anxiety and anger - and this can affect the way drs and therapists react.

I noticed around the time that when the pain first started to get to me, if I was under the shower, that if I kept the water beam fairly small and had it pointed directly at the spot where the pain always is, that I could pretty much turn it up to extremely hot temperatures and never feel it. If I moved off that spot it would be stingingly hot

this may have been an anaesthetic area if you had a pinched nerve at the time. Alternatvely...well if I say it is a phenomenon of chronic pain I will be sounding like a broken record won't I :-)

I think it might have the most to do with sitting in front of a computer for day after day after day, and that heavy bag

It sounds like it was a slow onset sort of thing. And these things happen- when it slowly gets worse and there doesn't seem to be one incident *that started it off then we can let things get really bad before seeking help. Don't beat yourself up about it. These incidious pnset type prpblems are by their nature harder to work out.

So...I have a question for you: from what we have discussed what do you think you will do from here?

[Vanc_WA_PT]

Look up foraminal stenosis with cervical nerve root impingement and see if that sounds like what you have.

[AThorn]

Hi again Gcoe. Thank you for your continued responses. I really do appreciate you taking the time.

As a clinician this suggests to me a good prognostic sign. My understanding is that in people with chronic pain who have constant unrelenting pain are much less amenable to treatment than when there is some time during the day when you are pain free.

Good to hear. The way I avoid pain, which I haven't really mentioned, is by putting my left arm up fairly hard behind my back. This both lowers my shoulder and forces it back a bit, and is pretty effective. That's the position I try to keep it in during sleep. It is quite uncomfortable, but if I can have it there the whole night I'll normally be fairly pain-free for the first part of the morning. This doesn't happen often. I also put my arm up behind my back like that during the day when I can, which can alleviate pain as well, but only during the time it is in that position. If the pain has gotten really bad then that arm-behind-back thing doesn't really help at all.

yes I can understand your skepticism about this as your experience doesn't seem to match up. In my clinical experience *I would maintain that this may well be just another of your chronic pain experiences even though it seems very somatic to you. The brain is unbelievably complex and capable of simulating all manner of sensory experiences.

Aye, I know, and it's entirely possible that you're right. There is no perfect way to distinguish if your brain is tricking you or not in circumstances like these, but the fact that I can alleviate the pain through certain physical measures is enough to give me hope that at least the core of it might be physical.

When people with chronic pain finally do get to a chronic pain team they often give a long history of bad experiences with all sorts of practitioners

heh don't get me started on that!

this may have been an anaesthetic area if you had a pinched nerve at the time.

Not sure if I've read you correctly there, but it's like that all the time. 100% of the time. I cannot feel heat on that spot, ever. No matter time of day/night or pain-level.

So...I have a question for you: from what we have discussed what do you think you will do from here?

At the moment I take anti-depressants, and, as strange as this may sound, I don't actually like to take action on this because every time I have it has failed miserably and I've gone into further depression. I am thinking that when I need the new script (which is soon) I will sit down with my local GP and speak to him with the knowledge I have gathered here, and see what he says. Really I don't know. Every doctor to date has failed me. I haven't talked to osteopaths, acupuncturists or orthopediatricians. The main reason I'm posting here is because I'm really after some guidance from people like yourself on what I should do next.

[AThorn]

Look up foraminal stenosis with cervical nerve root impingement and see if that sounds like what you have.

Hi Vanc_WA_PT, Thank you for the reply. I had a look at the foraminal stenosis with cervical nerve root impingement and it sounds very much like what I'm experiencing, although I only get the pain down my arm when I stand completely straight. Shouldn't I be experiencing pain down my arm at the same time my neck's hurting? I don't use my left arm very much - it's pretty weak, and clunks around a bit, and obviously there's something not quite right there, as it doesn't move in it's socket like it should - but I've no idea why it's not radiating pain at the same time as my neck/back.

[Vanc_WA_PT]

By standing up straight you might be extending your neck just enough to pinch the cervical nerve root? In any event, this is a complicated case made all the worse with the amount of time it's been going on. I'd recommend sticking with the pain management group, but I'm not sure the nerve burning would improve a significant amount of your symptoms as it is usually to minimize pain from cervical facets. Can't remember if you've seen a physio, but finding one that has spine experience would be helpful. Just like all professions, there are good and not so good PTs so ask some questions before you sign up. I'd recommend you see someone who spends time doing manual techniques vs just handing you exercises. If you find a therapist who takes the time to peel back the layers of your dysfunction to find the root cause, then you may have a shot at improved pain management. Regards.

[AThorn]

Can't remember if you've seen a physio, but finding one that has spine experience would be helpful. Just like all professions, there are good and not so good PTs so ask some questions before you sign up. I'd recommend you see someone who spends time doing manual techniques vs just handing you exercises. If you find a therapist who takes the time to peel back the layers of your dysfunction to find the root cause, then you may have a shot at improved pain management. Regards.

I've been to chiros and the spinal clinic, as I said. Not seen any physical therapist yet. I've had a number of them respond to my queries over the last month and am in the process of organizing to see probably 3-4 of them within the next couple of weeks to see what they say. Funny that they are all pretty much charging the same for consultation but one of them charges four times the amount of everyone else! (This is another spinal specialist, though, not a PT) Thanks everyone for their replies and links - no doubt I'll be back here posting results and further questions to you guys after these consultations! I started to try some new back exercises of my own but they went a bit funny because my whole body started ... kind of shaking/trembling for maybe 20 seconds and I felt a bit sick and the sight in my left eye went really strange ... like I couldn't see out of it really. Probably not good things. Not too keen to try that again. Anyone else has ideas/suggestions in the mean-time please feel free to post them.

[webrey227]

The back ache during sleep is sometimes natural said by a doctor. He said that it is because we are sleeping their is a tendency that we have get it because of a deep sleep and we didn't notice it. Sometimes have gone to a practiced back pain Hampshire to treat my back pain.