Question
I have had back pain for at least ten years.  I am only 22, and I was diagnosed with a very mild case of scoliosis many years ago.  With adjustments from chiropractors, I usually had managed the pain on a level of about a four daily.  However, in the last year, it has gotten to be a nine or ten daily.  I do have a very small frame and large breasts.  I have been denied twice for a breast reduction by my insurance; however, we are still working on getting it passed.  The pain always is surrounding my shoulder blades, and when it worsens it will move to my neck, middle of my spine, and arms.  I have seen every doctor imaginable.  I have been told I have Fibromyalgia, but that didn't seem to check out.  I have been told that I might need surgery, but with the x-rays, doctors always end up agreeing I do not.  I have been told that I have chronic muscle fatigue (I think that was what it is called).  I usually take Diazepam daily.  On a bad day, I take vikadin, diazepam, and tylenol with codeine.  Also, one of my chiropractors put me on a magnesium/calcium herbal treatment to stop the spasms.  It seems to make me far too sleepy though.  In addition, I have had acupuncture, but it just aggravated my condition.  Do you have any ideas for what is causing this?  Do you think the reduction is the answer?  If not, what medication would better my pain management?  ANY help would be REALLY appreciated.  I am on a 9 pain level for the last week, and I really don't know what to do anymore.

Answer
Nicole,

Thank you for your question.

Although you provided a good deal of information regarding your condition, I can't answer your question specifically regarding the cause of the pain between your shoulder blades, as I don't have the benefit of knowing all the clinical facts that pertain to your case.

However, in general, because the pain you describe moves from in between the shoulder blades (especially if the pain is centrally located on your spine) to your neck and arms, it does seem possible that you are experiencing compression of the brachial plexus, the bundle of nerves and blood vessels that pass from the lower neck and upper back to the arms and hands, producing a condition called thoracic outlet (or thoracic inlet) syndrome. Large breasts in proportion to a small frame have been implicated in these types of symptoms.

Symptoms of thoracic outlet/inlet syndrome include pain that progresses to arm, finger, and hand numbness. Wearing bras that are too tight can also cause these symptoms. If your symptoms tend to decrease when you lay on your back or when you are not wearing a bra, then it would seem likely that your symptoms could have a mechanical cause. If that is the case, then the only long-term solution would be breast-reduction surgery. As you probably know, there are risks of internal and external breast scarring with surgery, although the literature seems to indicate that most women undergo such procedures successfully.

However, because I don't have access to your clinical information, I can't definitively say that this is the cause of your symptoms.

Your symptoms as described are not consistent with chronic fatigue syndrome or fibromyalgia syndrome, which present with a constellation of symptoms completely different than those which you have described here.

In the interim, you might experience some relief of your symptoms with maneuvers that allow you to perform positional changes, particularly backwards-bending maneuvers, such as supervised Pilates exercises or yoga.

I hope that this answers your question.