Rib Pain

[Omanain]

Can a PMR flare cause disabling rib pain? The pain goes all the way round with a strange rippling sort of pain at the front. I am waiting for a doctor to phone me back and would like to put this to him, but they are not always very knowledgeable about PMR. Getting out of bed is the worst, but I can only sit at the table all day as the only way I can stand up is if I have something solid to push on. Two paracetamol and two tramadol have little effect and I am in pain all the time. Any ideas?

[Hidden]

Perhaps Costochrondritis? I have had it s couple of times on the right and was very painful. But if on left you need to mention that!!

nhs.uk/conditions/costochon...

[Omanain in reply to Hidden]

Thanks Poopadoopy, I have read the link and my symptoms do not agree with those for Costochondritis. My pain is in my back, both ribs and across my upper abdomen, there is no pain or tenderness around my sternum or upper chest. The doctor is sure it is to do with the injury to my back 7 weeks ago and has given me a small amount of morphine to take over the weekend. Here's hoping it gives me some relief.

Keep safe

Kate

[Hidden in reply to Omanain]

Yes. Mine followed that route....but make sure you give your sternum a really good press too. I have had a lot of rib injuries over the years and this wasn't that. It was like the top layer of a six pack, under both, but primarily right side of ribs going round into the the back of my ribcage. It stayed 6 weeks then eased. Came back for a slightly shorter period twice.

[SheffieldJane]

I had this earlier on in the disease. I used to call it the PMR hug. It is probably Costochondritis as Poopadoopy has suggested. It went away with rest. I remember worrying about pleurisy, which would be more worrying now. A covered hot water bottle is a comfort.

[PMRpro Ambassador]

Two possible answers are costochondritis or myofascial pain syndrome (MPS) which is often found in patients with PMR.

MPS is due to inflammation of the fascia, the transparent skin you will be familiar with from joints of meat, or of small areas of muscle fibres in the large back muscle groups. What you describe would fit it: the back muscles do a brilliant job of keeping you upright by achieving a balance of tensions against one another. Even a minor trip can be enough to cause what is often called whiplash where the muscles go into spasm to protect themselves and that causes severe back pain. MPS is characterised by the formation of what are called trigger points in pairs on either side of the spine, in the shoulders, about rib level and in the low back and they can be felt as local knots of hardened muscle fibres. They also put some strain on the rest of the muscle group they are in but can also irritate nearby spinal nerves which then cause referred pain in the areas they supply. The trigger points at rib level cause referred pain all the way around the ribs - much like sciatic would be in the leg.

The trigger points are concentrations of the same inflammatory substances that cause PMR - but trapped in the muscle fibres. They can be mobilised by manual techniques - and when that is done it release the substances and you may feel as if you are having a flare until you have washed them out of the system. They also respond well to local steroid injections.

[Omanain in reply to PMRpro]

Can you find and manipulate these trigger points yourself?

[Hidden in reply to Omanain]

Yes. They're the points that REALLY hurt. I build up to knuckles. It feels quite bruised and sore the next day but you should feel the lumpy bits ease a bit.

[PMRpro Ambassador in reply to Omanain]

Possibly - they are all in your back. The lower back ones can be attacked with a tennis ball I think. But I always get a physio/therapeutic massage therapist.

This site is usually pretty good - haven;t read this all though

painscience.com/articles/se...

[Ciar]

I’ve been having pain like this for the past 7 weeks. It seemed to come on suddenly. At first I thought I might be having a heart attack so I went to the Emergency room. They ran all kinds of tests to rule things out, and said it was in my back. 2 weeks later I went back because the pain was so intense I couldn’t bear it. They ran an MRI and found I had a herniated disk at T-7. I can’t recline or lie down except on my left side, and even that is fairly painful. The pain has made sleeping nearly impossible. I have the strange rippling pain in the front ribs that you describe, along with stabbing pain in front and ferocious back pain. I’m taking hydrocodone twice daily, but in between doses is very difficult. I already have a lot of painful issues, and at the same time this blew up I came down with my second round of diverticulitis this year. My doctor thinks the inflammation from that has been settling in my spinal nerves. This is a beast and I sometimes wonder if I will survive it. Of all my painful problems, this one is by far the hardest to bear. I feel for you, and I hope you get some help. My doctor tells me these things “tend to get better with time”, but my patience is getting thin.

[Omanain in reply to Ciar]

Hi Ciar,

I have just read again your response to something I posted a couple of months ago and would like to compare notes.

I suddenly hurt my back in February, I simply turned from the fridge to the table to pick up a bag of mushrooms and a terrible tearing pain shot across my back between my shoulder blades. By the evening my whole rib cage hurt, and I could hardly walk. I have been told by one doctor that I have probably herniated a thoracic disc and by another that it may be a stress fracture, but the dexa scan I had last year was normal. I have had no x-rays or scans.

I have read my notes on-line and find I was diagnosed with Kyphoscoliosis (curvature and twisting of the spine). As I have lost two inches in height over the last few years, I think this must be degenerative disc disease. I am very worried as I have a lot of low back problems, on my records as Caudia Equine, which make exercise very difficult and can set of nerve pains that are difficult to treat.

I am still in a lot of pain, but unlike you, once I lie down, which is still a painful process, I can sleep without pain.

I saw a doctor a few weeks ago because I was worried about the sudden protrusion of my abdomen and the horrible pain just below my rib cage at the front. He examined me and said everything was quite soft so he didn’t think it was anything to worry about. Later I sent him a letter bullet pointing all the pain I was in and asking him to arrange an x ray. He phoned and told me they didn’t x-ray that sort of thing??!! He then suggested I give myself a kick up the backside. I really hope you are faring better with your medics.

Has your pain eased any yet? Please let me know how you are getting on.

Kate xo

[PMRpro Ambassador in reply to Omanain]

I hope you have reported him?

[Ciar in reply to Omanain]

Hi Kate, I hope you find a better doctor. That’s ridiculous...of course they do imaging for this! What a #*&#$! I got my MRI showing the herniated disk at the emergency room. Otherwise it could have taken weeks to months to get. I’m still taking my 2 hydrocodone per day, still have a lot of pain there, but it has improved to the point of being bearable most of the time. I hope it continues to improve, but who knows. Lately when I try to do too much my back spasms until I rest. Sometimes heat helps. Still can mainly only lie on my left side, but I can be on my back or right side for a short bit now. My diverticulitis is still a problem and I’ve been on antibiotics for many weeks now. Eventually I will get in to a gastroenterologist and I think they will want to do surgery, which I would rather avoid.

Your story sounds just like mine. In February I simply turned to the right to reach for something while sitting and got the searing pain between the shoulder blades, followed by months of miserable pain in the ribs and back. I also have low back issues, in my sacral spine from a huge cyst that I had removed 10 years ago. Fortunately I have avoided cauda equina so far but they worry about it with me. I’m with you on the nerve pain, it’s rough. I’ve also been having trouble getting much exercise for the past year since I first got diverticulitis. During the first go around the inflammation settled in my lower back and hip joints. I’m just falling apart all over.

Do find another doctor, I hope this Covid stuff hasn’t shut down your medical facilities. It sure has made it hard to get any help around here (NW USA). My doctor says the herniated disk thing tends to get better over time and that it can take a year sometimes. There is still hope for us.

[Omanain in reply to Ciar]

Thanks for your reply, it does give me hope. I was beginning to think it was always going to be like this!! At the moment we can only make telephone appointments with doctors, if you want a particular doctor you may have to wait for weeks, which is why I ended up with the one I did. (East Yorkshire, England) I would like to wait for a face to face appointment with my doctor but because of Covid these might not be available for some time. Is hydrocodone a good painkiller? I have Tramadol but I'm not finding it particularly effective.

[PMRpro Ambassador in reply to Omanain]

You could always try A&E - which IS open for emergencies, in a lot the staff are sitting aorund waitng for business, and I think I might count a possible herniated disc as an emergency. Particularly if you have cauda equina on your medical notes already.

[Omanain in reply to PMRpro]

When this first happened, 5 days after I had seen the GP who thought it might be a prolapsed disc, I was in terrible pain and rang 111. Because the pain was in my front as well as my back they thought heart attack and sent an ambulance. The para medic did the test and said my heart was fine but decided it was best to take me in anyway. I saw an orthopaedic surgeon who looked at my back and said it might be a wedge fracture, told me to keep taking the painkillers and sent me home.

I do feel a bit alone in this!

[PMRpro Ambassador in reply to Omanain]

But didn't do an x-ray to look? Blimey - thank goodness our hospital is rather more caring than that!!!

[Ciar in reply to Omanain]

The whole world is a mess. Same issues for me...video only, haven’t seen any specialists. We already had a doctor shortage in this region before the pandemic. Hydrocodone is supposed to be a bit stronger than tramadol, I believe. It’s a hassle to get here due to politicians getting into medical care because of the opioid epidemic. When my pain is horrendous I occasionally take an extra half pill (10 mg total -full dose) and it helps, but makes me loopy. Usually, I just tough it out, I’m only allotted 2 pills per day, and I really don’t want to add more because if I ever get off this stuff I will have to taper down just like prednisone.

[Omanain in reply to Ciar]

It would be hard to taper with tramadol as the are capsules! There have been times when I also have taken an extra one, but as you say, it makes me a bit loopy. I don't think I am at a point where I can tough it out yet though.

[Ciar in reply to Omanain]

I meant I tough out the bad days by not taking extra. I’m not reducing my pain killer yet unfortunately. I’m pretty sure I wouldn’t be able to sleep without it. I’m not ready to cut back either.

[Omanain in reply to Ciar]

It's a long job then. The GP who diagnosed my herniated disc said it would take about 6 weeks!!! Why do the do that? It just makes us worry when there is little improvement in that time.

[Ciar in reply to Omanain]

Maybe most recover in 6 weeks?

[Uglow in reply to Ciar]

It’s so frustrating the more docs I talk to the less i get answers. Iv had no end of tests but nothing is conclusive. I get worried enough without feeling I have no support APART for you all.

[PMRpro Ambassador in reply to Uglow]

"Negative" tests are actually as valuable as "positive" ones - and sometimes there aren't answers.

[Uglow in reply to PMRpro]

Yes a better way of looking at things.

[Omanain]

I can't find any sore bits, it just hurts like hell all-around my lower rib cage. The doctor has given me some Oromorth to take along side the other

medication,this has helped me to get in and out of bed without blubbing but I am very tired. I can't see a therapist at the moment because of Corvid19!

Thank you both for your valued advise

Keep Safe

[Hidden in reply to Omanain]

In that case don't poke and prod. If you have a tumble dryer (I don't) then put towels in and wrap them round your rib cage re.laxing on a bed.

[Miserypants]

My rib pain was caused by 2 wedge fractures on my spine due to osteospirosis. Told it was pulled muscles.

Three months later and a thoracic x ray showed it up which the chest x ray hadn't.

MRI showed that the nerves from the spine were being trapped by the ribs.

Had to wear a back brace for 6 weeks as T7 unstable. Not healing because of my steroids.

[nuigini]

You spoke of the injury to your back about 2 months ago. Were you able to get an x-ray?

The pain you are suffering is much like I had a few years ago when I suffered a back trauma. I had an x-ray at the time but they only did my lumbar spine. I discovered 2 years later that there was a T12 fracture.

Mind you, my situation improved within about 6 to 8 weeks with gentle stretching exercises and over the counter pain meds but yours seems to be continuing. I also had prescription pain meds for five days or so.

As others have said pushing for further assessments and a proper diagnosis is in order.

Best of luck to you.

[Omanain]

I wonder if I should contact the rheumatology clinic. They organised a scan of my hip which showed an insufficiency fracture. The GP put it down to arthritis or deferred pain form the problems with my lumber region.

I am being seen by the eye clinic at the moment because of suspected GCA but I don’t think I have been discharged by the rheumatology department.

Thank you all for your help, I will contact the rheumatology department on Monday.

[bunch1974]

Yes, I know exactly what you are talking about and it is one of the things that signals a flare for me. If I have too much stress or overdo for too long the pain begins and gets very severe, even causes me to take shorter breaths. Mine does seem to accompany costochrondritis which I also get with flares. After resting for a few days and the stress passes, it goes away.

Hope you find answers and relief soon 💕

[artfingers]

Oh this is VERY helpful to me. I wrote mine off as being Dercum's disease as it is on both sides under lowest ribs in the same spots, can feel lumps. I shall do some research now on this. Thank you! I told my Rheumatologist during my telephone conference, but she just skimmed over it. I also told my GP but she also thought it was no big deal. I have lumps (lipomas) all over which is another disease and no problem. I need to go be on Dr. Pimple Popper (she deals with this) not sure you have that show but I'm not that vain anymore. I used to find the myofacsitis was relieved with massage, but no massages right now!