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This question was answered on Fri 12, Jun 2009 09:50am by Dr. Monica, MD

Second follow up RUQ and back pain


    
Asked by rebches (Male; 48 ) on Wed 10, Jun 2009 03:27pm
Priced at $29.00

This is another follow up to my RUQ question that has now also developed into a a right mid/upper dull back ache since November 08. I provided details of my symptoms and medical tests in my last post in January. Since then, I have been back to the GI doctor who has ruled out 99% that my condition is related to a liver or GI issue including the hemangioma. The pain levels have been relatively constant (3-6 level) and have not subsided for 7 months now. I went back to my primary care doctor last month after some physical therapy which was not effective. He did not want to order another x-ray since I have had so many tests that have been negative and it would have shown up. His final diagnosis is a chronic pain syndrome possibly brought on by the loss of my wife in 2006. His recommendation is deal with it or try a pain management specialist. My question is should I pursue this any further with more tests or should I accept the diagnosis? I just read about a case of a guy with upper back pain that turned out to be lung cancer that made me a bit nervous. My doctor has ruled that out, but I am still skeptical. I believe I asked you last time if the thoracic and cervical spine MRI would have identified a lung tumor causing pain on a nerve since both came back with no mention of the lungs but I'm not sure you directly addressed it. Would it? Wouldn't the pain have progressed after 7 months or other symptoms show? (My Dr. believes the longer I have this, the less likely it is a serious condition). Should I just go to the ER and get an x-ray? I would like your opinion on the likelihood that this is a cancer since there had been no noticeable progression or respiratory symptoms? What would you recommend as my next step? Thank You.

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Answer by Dr. Monica, MD  on Fri 12, Jun 2009 09:50am:

Hi, You have had this RUQ pain for over two years now and back pain for about 8-9 months. Its appears from your description that it is a dull aching constant pain. All the investigatons performed on you for this pain have failed to reveal any abnormality except the liver hemangioma. It would be helpful if you could provide information about the size and location of the hemangioma. What medication have you received for the pain? Are you currently on any medication for the pain? You seem to be concerned about cancer, but this possibility seems unlikely in your case. Most cancers will show significant progression over this time frame. A cervical and thoracic spine MRI is quite likely to pick up a lung tumor causing nerve compression. Psychological stress can sometimes manifest as chronic pain. In such cases investigations will not show any abnormality. Sometimes, no apparent cause can be found. You may get an X-ray done since this will allay your fears to some extent. As your doctor suggested, it may be a good idea to consult a pain management specialist. Additionally you may also want to consult a Psychologist. There are various options for treating chronic pain including analgesic medications, accupuncture or accupressure etc. You may benefit from psychotherapy, relaxation techniques, coping techniques, biofeedback, excercises etc. All the best and God Bless!

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