[bent98]

Here is my Story so please read through hold thing as will get to the part that’s troubling me right now. I tried to make it as brief as possible and there is a lot of test I am leaving out.
This is going to start out as a GI/ENT issue but its not.


I am healthy 39 year old male 5’ 10” 163lbs. I don’t have any issues with my voice, heart, lungs, or sinuses. I don’t have asthma or allergies to food or the environment. I don’t have a cough. I had a history of LPR reflux 2.5 years ago where I developed substantial mucus in my throat. There was so much mucus I had to continually clear my throat and spit mucus out. I saw a local ENT; he ruled out allergies, post nasal drip, and gave me a FEESST Test, which the SLP told me, “The green liquid came back up” and was put on Nexium 40mg once a day for LPR reflux. After 2 months on Nexium, the mucus went away but I never stopped taking Nexium and continued to have a poor diet. Fast forward 18 months (still on Nexium), I started to get intense globus in my throat and some throat clearing and mucus (Not nearly as bad as 18 months ago. The tightness was so intense; I thought my throat was closing up. It didn’t happen all the time; it just came and went sometimes 5-6 times a week. After a lot of research on LPR, I realized I needed to change my lifestyle. I followed everything by the book. Low fat/acid diet, bed elevated when sleeping, and no eating 3 hours before bed.
After doing that a few months, I eliminated mucus but my throat was still tight. In fact, it was tight all the time, just not as intense as before. Had an endoscope and Esophogram which were normal with no signs of EOE, Celiac or Esophageal erosion. They said I was stressed out and I need to relax. Stress was not the cause in my case.
I finally saw and ENT who properly diagnosed me through high resolution videostoboscopy and HD manometry.
Primary Diagnosis: LPR
Secondary Diagnosis: Right Vocal fold paresis
Tertiary Diagnosis: MTD/Cricopharyngeal Achalasia.
The first manometry showed UES dyssynchrony with the pharynx and closed prematurely. Also my overall motility was out of whack. Only 2 of 10 swallows were normal. It was hypothesized that reflux could have been causing the UES to misbehave. I took 10mg Domperidone 3 times a day and 15mg Prevacid twice a day.
By now my tightness went away and was replaced by trapped gas or pressure feeling between my upper middle chest to my throat. It continued for a month. The doctor put me on 10mg of amitriptyline and slowly raised 5 mg a week until I reached 25mg a day. Trapped air went away, swallowing felt better but started to develop burning pain in the middle of my chest shortly after I ate or drank. I initially thought amitriptyline was relaxing LES causing small acid exposure causing the burning sensations. My doctor did a transnasal scope into my stomach and everything looked normal. The doctor said it had to be nerve related because of my vocal fold paresis. I decided to wean off amitriptyline and chest pains mostly went away but tightness in throat came back with a vengeance. It felt like someone was strangling me. I had to go back on 10mg amitriptyline which helped relieved some of the globus but at that dosage the chest burning pains were tolerable but still uncomfortable. It was decided to do another manometry to see the status of my esophageal motility.
This second manometry was performed, and it showed a substantial improvement of my overall swallowing motility except for my UES. One thing that stood out was that I still had UES dyssynchrony and rebound pressures that were high. I was told the best option is to get Botox injection in my UES and to stay on 10mg Amitriptlyne for the time being.
I got 10 units of Botox on each side of my UES for a total of 20 units in office through the neck. The doctor did follow up Manometry which showed my swallowing was completely normal and the injection was successful.
A month went by and while I didn’t feel like someone was strangling me, I still had tightness sensation in my throat. The doctor felt this was nerve related and added Gabapentin to meds. I went up to 300mg 4 times a day and between 10-20mg of Amitriptlyne. I still had some burning and throat sensations and had an extremely dry mouth with the combination of those two meds. I switched to Lyrica 50mg twice a day but taking the second dosage in combination with Amitriptlyine gave me caffeine like jittery feeling and was not able to sleep.
Weaned of lyrica and went on Klonpin .5 mg one a day. Made me feel drowsy. I weaned off Amitriptlyne and Klonopin and then my chest burning pain was excruciating. It was burning for most of the day.
The only thing that helped the burning was rubbing my chest or a hot bath but as soon as I stopped rubbing it or got out of bath burning came back.


I feel the amitriyline triggered this burning in my chest somehow.
I had CT Scan of Chest and Neck, MRI of brain and MRI cervical Spine. C spine showed herniation in c5-c5-6 but very minor and was not pinching a nerve. All normal. Took several blood tests to rule out auto immune diseases, MS, etc. All normal.
I was told to wean off PPI to see if it was causing the burning pain which didn’t help.
Started back on Gabapentin 1,000 mg a day and it helped slightly with the burning pain. I cannot tolerate more medication since it dries out my throat. Over the next few weeks, burning was getting worse. I also occurring in my upper back,lower part of back of neck, shoulder and tricep which I am not sure if it started before or after I started taking the SSRI’s.
The only thing I could come up with symptom wise that matched was functional heartburn, so I worked with GI doctor and tried Lexapro, Zoloft for a week which gave some relief to burning in chest but caused nausea and my upper back burning pain was getting worse . Effexor seemed to make the burning worse. Celexa made burning in chest almost disappear but seemed to make the burning in my back and triceps worse. Now it seems my back is very sensitive like it has sunburn but with no physical irritation.
I am back on Lexapro 5mg and Gabapentin 1,000mg and while my chest burning pain is 95% better, my back is almost constant. I’m afraid to discontinue my current meds, but I have no idea how to address this latest problem. On one hand, the relief in my chest is evidence that the Lexapro is doing something positive. However, I’m perplexed why the pain has so recently become excruciating elsewhere. My problems do not present in a manner common to most ailments associated with burning pain.

So again to focus on my issue at hand burning pain began in my back but so slightly. It began between my shoulder blades and could radiate to the back base of my neck where it connects to my back and also at times to my triceps. I don’t have any weakness, difficulty breathing, or pins and needles. As weeks went by it got gradually worse.

Since the burning moved to my back I went for a thoracic, and lumbar back and got an EMG. The lumbar was normal, The thoracic was abnormal.

At T6-7 moderate sized left paracentral disc herniation which moderately idenents the left ventral hemicord causing mile to moderate focal cord compression but without significant central spinal canal stenosis. There is no abnormal sinal with cord

At T7-8 a small left paracentral disc herniation contacting and only slightly impinging the left ventral cord without central spinal canal stenosis.



The pain management doctor said that the pain is not coming from there as its too low on your back for the pain to radiate that high off the Dermatame Pain sensory chart. My neurologist says it’s possible it could radiate and wants me to get shot. I got an Epidural shot in T6 area but I didn’t seem to really help.
I saw a back surgeon and he said to get an Epidural in the C5-C6 area to see if it relives that burning pain.

When the burning was in my chest I could at least rub a biofreeze type cream on it which would help block the burning feeling but now that it’s on my back I can’t believe it as my back feels so sensitive like its sunburned, so putting any cream, ice or heat only makes it feel worse. It’s very sensitive to the touch. If I sit down too long it burns more. The only thing the helps are going for walks. I can sleep at night but as soon as I wake up my back is burning. I sleep on my back and I tried to sleep on my side but burning is either the same or worse. Seems like anything that rubs my skin makes it burn more. I went to a dermatologist and they said skin looks fine. They gave me a steroid cream to try. I didn’t help.

I am so lost. Is this drug induced skin sensitivity, Back problem, or a neuropathy? Ive seen three different Neurologist and they all can’t give me any answers. Most say I don’t have nerve damage and where I am describing the burning pain it does not follow any type of nerve pattern and since EMG looked good, I don’t have any weakness, burning in my hands or feet, or numbness/pins and needles they doubt its nerve damage. But I am burning so what else could it be but a nerve? Unless one of my organs are referring the pain but its bilateral and not isolate to one side of my body.

[GaryA]

Originally Posted by bent98

Here is my Story so please read through hold thing as will get to the part that’s troubling me right now. I tried to make it as brief as possible and there is a lot of test I am leaving out.
This is going to start out as a GI/ENT issue but its not.


I am healthy 39 year old male 5’ 10” 163lbs. I don’t have any issues with my voice, heart, lungs, or sinuses. I don’t have asthma or allergies to food or the environment. I don’t have a cough. I had a history of LPR reflux 2.5 years ago where I developed substantial mucus in my throat. There was so much mucus I had to continually clear my throat and spit mucus out. I saw a local ENT; he ruled out allergies, post nasal drip, and gave me a FEESST Test, which the SLP told me, “The green liquid came back up” and was put on Nexium 40mg once a day for LPR reflux. After 2 months on Nexium, the mucus went away but I never stopped taking Nexium and continued to have a poor diet. Fast forward 18 months (still on Nexium), I started to get intense globus in my throat and some throat clearing and mucus (Not nearly as bad as 18 months ago. The tightness was so intense; I thought my throat was closing up. It didn’t happen all the time; it just came and went sometimes 5-6 times a week. After a lot of research on LPR, I realized I needed to change my lifestyle. I followed everything by the book. Low fat/acid diet, bed elevated when sleeping, and no eating 3 hours before bed.
After doing that a few months, I eliminated mucus but my throat was still tight. In fact, it was tight all the time, just not as intense as before. Had an endoscope and Esophogram which were normal with no signs of EOE, Celiac or Esophageal erosion. They said I was stressed out and I need to relax. Stress was not the cause in my case.
I finally saw and ENT who properly diagnosed me through high resolution videostoboscopy and HD manometry.
Primary Diagnosis: LPR
Secondary Diagnosis: Right Vocal fold paresis
Tertiary Diagnosis: MTD/Cricopharyngeal Achalasia.
The first manometry showed UES dyssynchrony with the pharynx and closed prematurely. Also my overall motility was out of whack. Only 2 of 10 swallows were normal. It was hypothesized that reflux could have been causing the UES to misbehave. I took 10mg Domperidone 3 times a day and 15mg Prevacid twice a day.
By now my tightness went away and was replaced by trapped gas or pressure feeling between my upper middle chest to my throat. It continued for a month. The doctor put me on 10mg of amitriptyline and slowly raised 5 mg a week until I reached 25mg a day. Trapped air went away, swallowing felt better but started to develop burning pain in the middle of my chest shortly after I ate or drank. I initially thought amitriptyline was relaxing LES causing small acid exposure causing the burning sensations. My doctor did a transnasal scope into my stomach and everything looked normal. The doctor said it had to be nerve related because of my vocal fold paresis. I decided to wean off amitriptyline and chest pains mostly went away but tightness in throat came back with a vengeance. It felt like someone was strangling me. I had to go back on 10mg amitriptyline which helped relieved some of the globus but at that dosage the chest burning pains were tolerable but still uncomfortable. It was decided to do another manometry to see the status of my esophageal motility.
This second manometry was performed, and it showed a substantial improvement of my overall swallowing motility except for my UES. One thing that stood out was that I still had UES dyssynchrony and rebound pressures that were high. I was told the best option is to get Botox injection in my UES and to stay on 10mg Amitriptlyne for the time being.
I got 10 units of Botox on each side of my UES for a total of 20 units in office through the neck. The doctor did follow up Manometry which showed my swallowing was completely normal and the injection was successful.
A month went by and while I didn’t feel like someone was strangling me, I still had tightness sensation in my throat. The doctor felt this was nerve related and added Gabapentin to meds. I went up to 300mg 4 times a day and between 10-20mg of Amitriptlyne. I still had some burning and throat sensations and had an extremely dry mouth with the combination of those two meds. I switched to Lyrica 50mg twice a day but taking the second dosage in combination with Amitriptlyine gave me caffeine like jittery feeling and was not able to sleep.
Weaned of lyrica and went on Klonpin .5 mg one a day. Made me feel drowsy. I weaned off Amitriptlyne and Klonopin and then my chest burning pain was excruciating. It was burning for most of the day.
The only thing that helped the burning was rubbing my chest or a hot bath but as soon as I stopped rubbing it or got out of bath burning came back.


I feel the amitriyline triggered this burning in my chest somehow.
I had CT Scan of Chest and Neck, MRI of brain and MRI cervical Spine. C spine showed herniation in c5-c5-6 but very minor and was not pinching a nerve. All normal. Took several blood tests to rule out auto immune diseases, MS, etc. All normal.
I was told to wean off PPI to see if it was causing the burning pain which didn’t help.
Started back on Gabapentin 1,000 mg a day and it helped slightly with the burning pain. I cannot tolerate more medication since it dries out my throat. Over the next few weeks, burning was getting worse. I also occurring in my upper back,lower part of back of neck, shoulder and tricep which I am not sure if it started before or after I started taking the SSRI’s.
The only thing I could come up with symptom wise that matched was functional heartburn, so I worked with GI doctor and tried Lexapro, Zoloft for a week which gave some relief to burning in chest but caused nausea and my upper back burning pain was getting worse . Effexor seemed to make the burning worse. Celexa made burning in chest almost disappear but seemed to make the burning in my back and triceps worse. Now it seems my back is very sensitive like it has sunburn but with no physical irritation.
I am back on Lexapro 5mg and Gabapentin 1,000mg and while my chest burning pain is 95% better, my back is almost constant. I’m afraid to discontinue my current meds, but I have no idea how to address this latest problem. On one hand, the relief in my chest is evidence that the Lexapro is doing something positive. However, I’m perplexed why the pain has so recently become excruciating elsewhere. My problems do not present in a manner common to most ailments associated with burning pain.

So again to focus on my issue at hand burning pain began in my back but so slightly. It began between my shoulder blades and could radiate to the back base of my neck where it connects to my back and also at times to my triceps. I don’t have any weakness, difficulty breathing, or pins and needles. As weeks went by it got gradually worse.

Since the burning moved to my back I went for a thoracic, and lumbar back and got an EMG. The lumbar was normal, The thoracic was abnormal.

At T6-7 moderate sized left paracentral disc herniation which moderately idenents the left ventral hemicord causing mile to moderate focal cord compression but without significant central spinal canal stenosis. There is no abnormal sinal with cord

At T7-8 a small left paracentral disc herniation contacting and only slightly impinging the left ventral cord without central spinal canal stenosis.



The pain management doctor said that the pain is not coming from there as its too low on your back for the pain to radiate that high off the Dermatame Pain sensory chart. My neurologist says it’s possible it could radiate and wants me to get shot. I got an Epidural shot in T6 area but I didn’t seem to really help.
I saw a back surgeon and he said to get an Epidural in the C5-C6 area to see if it relives that burning pain.

When the burning was in my chest I could at least rub a biofreeze type cream on it which would help block the burning feeling but now that it’s on my back I can’t believe it as my back feels so sensitive like its sunburned, so putting any cream, ice or heat only makes it feel worse. It’s very sensitive to the touch. If I sit down too long it burns more. The only thing the helps are going for walks. I can sleep at night but as soon as I wake up my back is burning. I sleep on my back and I tried to sleep on my side but burning is either the same or worse. Seems like anything that rubs my skin makes it burn more. I went to a dermatologist and they said skin looks fine. They gave me a steroid cream to try. I didn’t help.

I am so lost. Is this drug induced skin sensitivity, Back problem, or a neuropathy? Ive seen three different Neurologist and they all can’t give me any answers. Most say I don’t have nerve damage and where I am describing the burning pain it does not follow any type of nerve pattern and since EMG looked good, I don’t have any weakness, burning in my hands or feet, or numbness/pins and needles they doubt its nerve damage. But I am burning so what else could it be but a nerve? Unless one of my organs are referring the pain but its bilateral and not isolate to one side of my body.

First, a general question: if the problem is internal, why would rubbing the OUTSIDE of your chest provide some relief? The hot bath might, yes. But rubbing the skin and muscles of the chest... I just can't see how that could affect anything on the other side of your ribs.

[GaryA]

Originally Posted by bent98

Here is my Story so please read through hold thing as will get to the part that’s troubling me right now. I tried to make it as brief as possible and there is a lot of test I am leaving out.
This is going to start out as a GI/ENT issue but its not.


I am healthy 39 year old male 5’ 10” 163lbs. I don’t have any issues with my voice, heart, lungs, or sinuses. I don’t have asthma or allergies to food or the environment. I don’t have a cough. I had a history of LPR reflux 2.5 years ago where I developed substantial mucus in my throat. There was so much mucus I had to continually clear my throat and spit mucus out. I saw a local ENT; he ruled out allergies, post nasal drip, and gave me a FEESST Test, which the SLP told me, “The green liquid came back up” and was put on Nexium 40mg once a day for LPR reflux. After 2 months on Nexium, the mucus went away but I never stopped taking Nexium and continued to have a poor diet. Fast forward 18 months (still on Nexium), I started to get intense globus in my throat and some throat clearing and mucus (Not nearly as bad as 18 months ago. The tightness was so intense; I thought my throat was closing up. It didn’t happen all the time; it just came and went sometimes 5-6 times a week. After a lot of research on LPR, I realized I needed to change my lifestyle. I followed everything by the book. Low fat/acid diet, bed elevated when sleeping, and no eating 3 hours before bed.
After doing that a few months, I eliminated mucus but my throat was still tight. In fact, it was tight all the time, just not as intense as before. Had an endoscope and Esophogram which were normal with no signs of EOE, Celiac or Esophageal erosion. They said I was stressed out and I need to relax. Stress was not the cause in my case.
I finally saw and ENT who properly diagnosed me through high resolution videostoboscopy and HD manometry.
Primary Diagnosis: LPR
Secondary Diagnosis: Right Vocal fold paresis
Tertiary Diagnosis: MTD/Cricopharyngeal Achalasia.
The first manometry showed UES dyssynchrony with the pharynx and closed prematurely. Also my overall motility was out of whack. Only 2 of 10 swallows were normal. It was hypothesized that reflux could have been causing the UES to misbehave. I took 10mg Domperidone 3 times a day and 15mg Prevacid twice a day.
By now my tightness went away and was replaced by trapped gas or pressure feeling between my upper middle chest to my throat. It continued for a month. The doctor put me on 10mg of amitriptyline and slowly raised 5 mg a week until I reached 25mg a day. Trapped air went away, swallowing felt better but started to develop burning pain in the middle of my chest shortly after I ate or drank. I initially thought amitriptyline was relaxing LES causing small acid exposure causing the burning sensations. My doctor did a transnasal scope into my stomach and everything looked normal. The doctor said it had to be nerve related because of my vocal fold paresis. I decided to wean off amitriptyline and chest pains mostly went away but tightness in throat came back with a vengeance. It felt like someone was strangling me. I had to go back on 10mg amitriptyline which helped relieved some of the globus but at that dosage the chest burning pains were tolerable but still uncomfortable. It was decided to do another manometry to see the status of my esophageal motility.
This second manometry was performed, and it showed a substantial improvement of my overall swallowing motility except for my UES. One thing that stood out was that I still had UES dyssynchrony and rebound pressures that were high. I was told the best option is to get Botox injection in my UES and to stay on 10mg Amitriptlyne for the time being.
I got 10 units of Botox on each side of my UES for a total of 20 units in office through the neck. The doctor did follow up Manometry which showed my swallowing was completely normal and the injection was successful.
A month went by and while I didn’t feel like someone was strangling me, I still had tightness sensation in my throat. The doctor felt this was nerve related and added Gabapentin to meds. I went up to 300mg 4 times a day and between 10-20mg of Amitriptlyne. I still had some burning and throat sensations and had an extremely dry mouth with the combination of those two meds. I switched to Lyrica 50mg twice a day but taking the second dosage in combination with Amitriptlyine gave me caffeine like jittery feeling and was not able to sleep.
Weaned of lyrica and went on Klonpin .5 mg one a day. Made me feel drowsy. I weaned off Amitriptlyne and Klonopin and then my chest burning pain was excruciating. It was burning for most of the day.
The only thing that helped the burning was rubbing my chest or a hot bath but as soon as I stopped rubbing it or got out of bath burning came back.


I feel the amitriyline triggered this burning in my chest somehow.
I had CT Scan of Chest and Neck, MRI of brain and MRI cervical Spine. C spine showed herniation in c5-c5-6 but very minor and was not pinching a nerve. All normal. Took several blood tests to rule out auto immune diseases, MS, etc. All normal.
I was told to wean off PPI to see if it was causing the burning pain which didn’t help.
Started back on Gabapentin 1,000 mg a day and it helped slightly with the burning pain. I cannot tolerate more medication since it dries out my throat. Over the next few weeks, burning was getting worse. I also occurring in my upper back,lower part of back of neck, shoulder and tricep which I am not sure if it started before or after I started taking the SSRI’s.
The only thing I could come up with symptom wise that matched was functional heartburn, so I worked with GI doctor and tried Lexapro, Zoloft for a week which gave some relief to burning in chest but caused nausea and my upper back burning pain was getting worse . Effexor seemed to make the burning worse. Celexa made burning in chest almost disappear but seemed to make the burning in my back and triceps worse. Now it seems my back is very sensitive like it has sunburn but with no physical irritation.
I am back on Lexapro 5mg and Gabapentin 1,000mg and while my chest burning pain is 95% better, my back is almost constant. I’m afraid to discontinue my current meds, but I have no idea how to address this latest problem. On one hand, the relief in my chest is evidence that the Lexapro is doing something positive. However, I’m perplexed why the pain has so recently become excruciating elsewhere. My problems do not present in a manner common to most ailments associated with burning pain.

So again to focus on my issue at hand burning pain began in my back but so slightly. It began between my shoulder blades and could radiate to the back base of my neck where it connects to my back and also at times to my triceps. I don’t have any weakness, difficulty breathing, or pins and needles. As weeks went by it got gradually worse.

Since the burning moved to my back I went for a thoracic, and lumbar back and got an EMG. The lumbar was normal, The thoracic was abnormal.

At T6-7 moderate sized left paracentral disc herniation which moderately idenents the left ventral hemicord causing mile to moderate focal cord compression but without significant central spinal canal stenosis. There is no abnormal sinal with cord

At T7-8 a small left paracentral disc herniation contacting and only slightly impinging the left ventral cord without central spinal canal stenosis.



The pain management doctor said that the pain is not coming from there as its too low on your back for the pain to radiate that high off the Dermatame Pain sensory chart. My neurologist says it’s possible it could radiate and wants me to get shot. I got an Epidural shot in T6 area but I didn’t seem to really help.
I saw a back surgeon and he said to get an Epidural in the C5-C6 area to see if it relives that burning pain.

When the burning was in my chest I could at least rub a biofreeze type cream on it which would help block the burning feeling but now that it’s on my back I can’t believe it as my back feels so sensitive like its sunburned, so putting any cream, ice or heat only makes it feel worse. It’s very sensitive to the touch. If I sit down too long it burns more. The only thing the helps are going for walks. I can sleep at night but as soon as I wake up my back is burning. I sleep on my back and I tried to sleep on my side but burning is either the same or worse. Seems like anything that rubs my skin makes it burn more. I went to a dermatologist and they said skin looks fine. They gave me a steroid cream to try. I didn’t help.

I am so lost. Is this drug induced skin sensitivity, Back problem, or a neuropathy? Ive seen three different Neurologist and they all can’t give me any answers. Most say I don’t have nerve damage and where I am describing the burning pain it does not follow any type of nerve pattern and since EMG looked good, I don’t have any weakness, burning in my hands or feet, or numbness/pins and needles they doubt its nerve damage. But I am burning so what else could it be but a nerve? Unless one of my organs are referring the pain but its bilateral and not isolate to one side of my body.

You know, I think burning sensation might be due to muscle tightness. Because it varies from posterior trunk to anterior trunk, I have to question any nerve damage in either cervical or thoracic spine-- they are served by different nerves.

You've tried everything else, why not try therapeutic massage for the soft tissue sensations? Trigger points in the scalenes of the neck can refer pain to all sorts of places--into the arm or, conversely, down the back.

However, the burning sensation may be caused by sensory nerves and not motor nerves (muscles have both). The burning can also be ischemia (muscles and skin not getting enough oxygen).

For whatever it is worth, IMO you should book a session with a massage therapist. It won't cause you any more harm, and it may eliminate some of your problems.

[bent98]

Originally Posted by GaryA

You know, I think burning sensation might be due to muscle tightness. Because it varies from posterior trunk to anterior trunk, I have to question any nerve damage in either cervical or thoracic spine-- they are served by different nerves.

You've tried everything else, why not try therapeutic massage for the soft tissue sensations? Trigger points in the scalenes of the neck can refer pain to all sorts of places--into the arm or, conversely, down the back.

However, the burning sensation may be caused by sensory nerves and not motor nerves (muscles have both). The burning can also be ischemia (muscles and skin not getting enough oxygen).

For whatever it is worth, IMO you should book a session with a massage therapist. It won't cause you any more harm, and it may eliminate some of your problems.

If you touch my skin it its not soar to the touch but it will make the burning pain worse. God forbid you rub or message it I would be in a lot of burning pain.

The funney thing is that when I had the burning in my chest and tightness in my throat I went for myofacial message therapy. It helped lossen my neck muscles and helped tightness in throat but did notthing for mychest. At the time my back had no issues or burning.

Over next 2 months around the time I started on SSRI's my back started to burn and my chest buring went away. I was still going for messages and wife was rubbing me at home too. It helped the back burnin a little while rubbing but once stopped it would come back. Now back then you could touch or rub my back but now its just got so senstive you can't I havent had anyone rub my back in over a month.

Could a pinched nerve in my back even cause this? Its defenitily a sensory issue here. I am at a loss. I am thinking about stopping Lexapro but not sure.

Is there any other tests I can go for? Does this sound like nerve problem?

[mrsD]

Welcome to NeuroTalk:

I see you have been thru a diagnostic wringer of sorts.

And I get the impression that the tests themselves, the scoping etc may have made you worse or created a secondary problem!

I wonder if you smoke, or smoke MJ?

Can you tell us what drugs you use besides the Nexium or other acid blocking ones? All the acid blocking drugs block absorption of B12, folate, calcium, iron, zinc and magnesium from normal absorption in the GI tract.

Many people become low in B12 as a result. When calcium gets low, there can be many abberant nerve reactions in the body. Paresthesias, etc. Low Vit D which is very common today, leads to poor calcium absorption, too, which when added to things like Nexium etc, means you can have serious issues there.

You can get serum tests for B12 and D, but be aware that doctors do not use current lab ranges...and may give "normal" answers and you then need to get the actual numbers and come back here to find out further if you are indeed in trouble with them.

We had a poster here Mark... who had alot strange pain in his chest and found he was really low in Vit D. Fixing that fixed his issues and he posted about it here.

http://neurotalk.psychcentral.com/post283969-33.html

B12 information here:
http://neurotalk.psychcentral.com/thread85103.html


Vit D information here:
http://neurotalk.psychcentral.com/thread92116.html

Be aware that certain RX drugs cause PN...
statins and some common antibiotics like Cipro, Avelox,Levaquin, Flagyl, and many others. Doctors WILL NOT address this issue. You have to do it. Damage from Cipro, Levaquin etc may not be evident for months after you stop these drugs. Therefore, they are confusing triggers and often ignored.

Here is the drug thread:
http://neurotalk.psychcentral.com/thread122889.html

It seems to me you started off with just an annoying symptom and now you are in much more discomfort. I suspect this may be iatrogenic (doctor caused) for you. I certainly hope not.

There is alot of information here we have all gathered, and you need to start taking advantage of it, to see if anything pops out at you so you can begin to get some relief.

[bent98]

I am currently on 1000mg Gabapetin, 5mg of Lexapro, and 40mg Zegerid. I also take 2000IU of Vitamin D and 300mg ALA twice a day.

I have had several blood tests and Vitamin test.

Ill give you the latest result.

My Vitamin B12 644 Range 211-911
Folate Serum 9.6 Range >5.4
MAgnesium 2.0 Range 1.5-2.5
Iron Serum 130 Range 50-212
Vitamin B1 Plasma 6 Range 8-30
ITs low. I did fast night before so not sure if that threw anything off. They make a disclaimer on this test saying the total thiamine measured is reported however the biologically active form of the vitamin, thiamine diphosphate (TDP) is best measured in whole blood and is not found in measureable concentration of plasma. Plasma reflects recent intake rather then body stores.
Vitamin B2 9 Range 5-50
Vitamin B6 35 Range 20-125
Vitamin D 24 Range 30-100
Zinc Serum/Plasm 84 Range 80-120
Hematology all normal
Auto Diff all normal
Glucose 75 Range 70-118
BUN 23 Range 8-26
Creatinine 1.1 Range .6-1.3
Bun/Creatine Ratio 21 Range 8-36
Sodium 141 Range 134-149
Potassium 4.3 Range 3.6-5.5
Cholride 103 Range 94-112
Carbon Dioxide 26 Range 21-32
Calcium 8.7 Range 8-10.4
Total Protein 7.7 Range 6.3-8.1
Albumin 4.2 Range 3.5-5.2
globulin 3.6 Range 2.0-4.8
a/g Ratio 1.2 Range .6-2.2
ALK phos 73 Range 40-128
ALT 35 Range 10-40
AST 24 Range 5-34
Bilirubin 1.6 .2-1.3

C Reactive PRotien .36 Range .1-.6
Anti -CCP 2.9 Rance 0-20
Urine

Ph 5 Range 5-7.5
Glucose Neagtive
Bilirubin Negative
Blood Negative
Portien Negative
Urobilinogen .2 Range 0-2.0
Nitrite Neagative
Leukocytes Negative
SQ Eithelial cells negative
Ketone Negative


So my Vitamin B1 is slighly low but I am not sure how accurate plasma measured is. My vitamin D is low but not grossly low. I am taking Vitamin D 2000iu for last 2 months but Dr. Has written a script to take 50,000 IU for 6 weeks. My Bilirubin is high but its been high my whole life my brother has the same ever since I was a child.

I have a bunch of other blood work done by the Rheumatologist to rule out lyme dieases, Lupus, and a bunch of other autoimmune diseases. I am in good health otherwise and eat a low fat low acid diet. I am normal body weight. Have normal blood pressure.

This burning has consumed my life. I talked to 3 different Neurologist. One tells me get the epidural in my t spine, another tells me there’s nothing wrong with you because I don’t have numbness, pins and needsle or symptoms anywhere else on my body except upper back, sholders, and bottom of neck, and can’t explain my symptoms, and another says take more drugs Back surgeon say to get an epidural in my C6 cervical area.

Maybe I have a visceral hypersensitivity in my esophagus and lexparo helped but why the burning in my back? And having that herniation in my Tspine leaves me with another question mark as most of my tests are all normal. Why is my back so damn sensitive? I also went to a dermatologist said my skin is fine, and game me a steroid cream to try for a week which did nothing.
I am trying to make sense of all this for so long now. I just cant get an answer that makes sense.

Please help me rule out neurological cause or pursue an area that makes sense.

[mrsD]

Based on your testing:

I'd start Benfotiamine (a better form of B1)... this may help.
This vitamin when low impacts carb metabolism, alcohol metabolism (not just ethanol) and nerve functions.
Start at 2 a day for a month, and see what happens. If you respond well, continue for 3 months and you may be able to reduce to 1 a day after that.
http://www.iherb.com/Doctor-s-Best-B...e-Caps/42?at=0

Do you drink alcohol alot? This can really irritate the throat in some people.

The RX 50,000 IU D2 does not work. There are studies showing it doesn't. I have that information on my D thread I gave you, near the end of the thread. (it is new information).

Purchase a D3 OTC of your choice and use that. Please read the D thread. Suggested doses daily are: 1000IU D3 for every 10 points you need to raise. Use the target of 50 for now, which is the new low normal level. That would be 3000 IU daily. I think the body handles daily use better than huge bolus doses infrequently. You can buy a 50,000 IU D3 if you want to use it weekly like the poor RX version.

You can test that herniation in the back with ICE treatment.
Put a Ice pack back there twice a day with a thin cloth to protect your skin. YOu know the location of the defect so that should help your placement. There are ganglia along the spine also and they can have virus or toxic damage to the cells, and send aberrant pain signals all over. Do the ice and see if those diminish. One virus that lives in those dorsal root ganglia is Herpes. Herpes Zoster especially. They can be active without progressing to full blown shingles. A blood test for both Herpes Simplex and Zoster can be done to show antibodies to them. High Zoster readings may indicate activity with this virus. Cold typically puts into sleep mode. Also high arginine intake can activate Zoster, so watch your food: The ratio of l-lysine to arginine is important for some people. If you eat high arginine content food, or take arginine in supplements, you may need l-lysine to balance it.

http://www.herpes.com/Nutrition.shtml

Your B2 is somewhat low... B2 is important for conversion of pyridoxine to active pyridoxal in the body, as it is a cofactor in that enzyme called pyridoxal kinase. The blood work for B6 does not separate this out ...so your B6 may be actually looking good, but be inactive. Taking a B-50 complex may help.
Or you can take this... active form of B6 with B2 added:
I'd suggest the P5P first.

http://www.iherb.com/Now-Foods-P-5-P...blets/740?at=0

I'd take a methylB12 anyway....perhaps you would only need 1mg a day...on an empty stomach. Having a lower reading, would suggest higher, but you don't have a really low one.

Did you have thyroid done? Thyroid issues, can press on nerves in the neck, and give all sorts of problems. I don't see thyroid panel in your list.

Concerning your antidepressant lexapro. SSRI's have been shown to affect dopamine levels, as a side effect, in some people. This manifests with mouth, tongue and throat spasms.
So watch for this effect. It typically can come on at 6mos or longer using the SSRI. And not everyone gets it.

The lining of the throat,lungs and stomach are maintained by PEG1 cytokines. These are favored by Omega-3 fatty acids, and inflamed when Omega-6 are too high in the diet compared the the -3's. Taking some fish oil, or krill oil, may help you in maintaining that mucosa so it does not seem inflamed. 3 fish oil a day or 2 Krill oil, may help heal you up and improve the functions of the throat, esophagus, and stomach. I got rid of all my GERD with fish oil 10 yrs ago!

Were you tested for H. pylori infection of the stomach? If not, I'd get that done. H.pylori can cause all sorts of grief/burning and PN symptoms.

These are just ideas to start with. I would really stop smoking anything, at this point. And stop all alcohol...both activities can irritate the areas you have affected.
I would also stop using all mouthwashes. Some contain triclosan, which can irritate people immensely! Same with toothpastes. NO triclosan... please read the labels carefully.

If all this fails, you will have to consider gluten as a possible culprit. Many people can have a gluten intolerance and have PN and burning symptoms. Going gluten free is the only way to test this, yourself.
There are blood tests, also, but you can see by going gluten free yourself.

[bent98]

Do you drink alcohol alot? This can really irritate the throat in some people.

I Don’t drink any coffee or alochol

You can test that herniation in the back with ICE treatment.
Put a Ice pack back there twice a day with a thin cloth to protect your skin. YOu know the location of the defect so that should help your placement. There are ganglia along the spine also and they can have virus or toxic damage to the cells, and send aberrant pain signals all over. Do the ice and see if those diminish. One virus that lives in those dorsal root ganglia is Herpes. Herpes Zoster especially. They can be active without progressing to full blown shingles. A blood test for both Herpes Simplex and Zoster can be done to show antibodies to them. High Zoster readings may indicate activity with this virus. Cold typically puts into sleep mode. Also high arginine intake can activate Zoster, so watch your food: The ratio of l-lysine to arginine is important for some people. If you eat high arginine content food, or take arginine in supplements, you may need l-lysine to balance it.

I have tried putting ice pack by my T-6-7 before and it feels good when its on there but when I take it off it seems to make me feel worse. Again I think my skin gets irrated and burns. I can have my doctor RX a blood test.


Did you have thyroid done? Thyroid issues, can press on nerves in the neck, and give all sorts of problems. I don't see thyroid panel in your list.


Yes I have had my thyroid check physically and with blood test and all is normal

Concerning your antidepressant lexapro. SSRI's have been shown to affect dopamine levels, as a side effect, in some people. This manifests with mouth, tongue and throat spasms.
So watch for this effect. It typically can come on at 6mos or longer using the SSRI. And not everyone gets it.

I have only been taking for 3 weeks now as I've been switching back and forth between them. I dnt have any throat spasms. Again main complaint is back burning pain and the sSRI seemed to make chest burning which I had for 9 months go away.


The lining of the throat,lungs and stomach are maintained by PEG1 cytokines. These are favored by Omega-3 fatty acids, and inflamed when Omega-6 are too high in the diet compared the the -3's. Taking some fish oil, or krill oil, may help you in maintaining that mucosa so it does not seem inflamed. 3 fish oil a day or 2 Krill oil, may help heal you up and improve the functions of the throat, esophagus, and stomach. I got rid of all my GERD with fish oil 10 yrs ago!

I have issues with Fish Oil making my burp. My brother recommend this one as its supposed to be easy to digest with no nasty taste.

drsearsfamilyessentials omega-3-dha-liquid

Were you tested for H. pylori infection of the stomach? If not, I'd get that done. H.pylori can cause all sorts of grief/burning and PN symptoms.

Yes, I had 2 full GI workups, Celiac, Stomach, Doludum, and Esphogus. Everything normal. I never have any issues with bowel movement or color/consistancy.

I also have went on gluten free for 2 week 7 months ago. Didnt help.

I also have had several food and enviromental allergy tests. All with no reaction to anything.

I dont smoke and never have.

I am going to get my aorta scanned today. Is there any other test for a possible vascular issue?
Maybe something in my back or chest that is being restricted causing this pain?

Thing is its on both sides of my body most of the time. ITs no specific to one part or side.

[mrsD]

Well, two weeks on gluten free is not nearly long enough.

Usually people see some improvement if it is going to happen at 3-6mos.

Many neuropathies can respond to supplements. So since you have no visible pathology with all those scopes, etc...you have to think on a cellular level.

Your symptoms have changed character. I think this is due to all the mechanical irritation you endured. We've had posters here and at our old site who posted throat problems after intubation during surgeries, for example.

Ganglionopathies at the dorsal root ganglia. This is a graph showing the distribution of a sensory issue:
http://neuromuscular.wustl.edu/antibody/sneuron.html
This list given is also helpful... of the various things that need to be ruled out.

These may respond to lidoderm patches, which were originally made for Zoster neuropathy which occurs in those ganglia along the spine. You could try asking for them, and place at various locations along your upper back and neck along the spine, in order to find the right location. Follow directions carefully when using these if you get them on RX. When shingles activates, it follows nerve pathways and often appears along a specific area. I have mine down my right arm. Hubby has his along his chest area and back. In spring and fall for some reason Zoster seems to activate and we both get pain sometimes, still. Your herniation in the back may be another thing separate from your original problem.

Try the supplements and see it they help. Krill oil has no aftertaste at all, the caps are much smaller, and is just like fish oil. The red color is a useful antioxidant. I use MegaRed.

Autoimmune and viral triggers may be your culprit. But you didn't have any of the burning did you before you had all those tests? This new symptom came after?

There are CNS problems that affect the neck. Most of them are dunning and frightening. Since you don't seem to have the dysphonia, or difficulty swallowing anymore, I don't think you have a major issue. You can always look at that later in time if you choose.

[bent98]

How about the Alpha Lipoic Acid 300mg twice a day I am taking. ITs not time released and its not the R form. Is that ok? Also, will any of these vitamins interfere with my current meds? That P5p has magniesum in it. Do I really need the extra?