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.

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.