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.


I would love to hear so people who have had Thoracic herniations like mine and get the impression on if the burning in my back is related to my spine? I feel completly fine other then the burning and again if you rub or touch my back it gets the burning sensation.

Hello,

It is frustrating to go through so much and know so little about what we have. I have a large central herniation t6/t7 with spinal fluid efacement and mild cord indentation. I have never had arm involvement, but I do have chest burning and pain that mimics gall bladder. Mine complicates a lumbar sacral axon pathology that is progressing me into a wheel chair. I am told the pressure on my cord is a contributing factor, but my neuomuscular doc does nothing about it. I am in agonizing pain which the Lyrica has done nothing to to relieve. She insists that it will relieve the pain.

I get what feels like my midsection is burning, heartburn like, but it is from the herniation. It wraps around me like a band at the level of my diaphragm
and I feel like I am being cut in half. I have bilateral foot drop, leg weakness, and atrophy. No fun. This is part of my experience.

Perhaps the cervical area is causing the arm problems. Thoracic is kind of low for your symptoms, but I guess there could be refered pain and burning.

When you say it mimics a gallballder what do you mean exactly?

Alsto the chest pain in midsection can you be specific as to where? Is the butning isolated to one spot on your chest or does it wrap around from your back?

MY chest pain was specific to my sternum to my nipples slap dab in the middle.

I have lateral and far lateral herniation from T5 through T9 with exiting root compression documented with MRI since 2003 for no particualr reason. They cause(d) recurring pain of the midback at those levels, occasional burning radiating around the ribs of those levels and occasional anterior costal-sternal pain when aggravated. Nothing else that I know of.

Can you explain the burning in more detail? Is it like sunburn or sensitive to touch. You mentioned exiting root compression, what does that mean? Are there differences in root compression?

When flared up, it feels like a sunburn and much like that, is sensitive to the touch too. Root compression is the same as "pinched nerve," loosely stated.

So what do you do for flair up?

I am dying. I cant touch my back

I'm probably not the best one to answer that. The thoracic pain is now trivial in comparison to the CRPS (last 3 years) in my right shoulder, arm and hand, so now I really don't even pay attention to it.

In better days (pre-CRPS), a combination of therapies noticably helped. Spinal manipulation of my midback (crossed-arm face up manouver) did wonders. For really obnoxious flares, Bextra (no longer available) and when really annoying, medrol dose pak were the way to go. I did consult a neurosurgeon once who said the cure was worse than the condition (for me).

Time ultimately was therapeutic as it has been 8 years now and flare ups are less often and less intense, although I may have just become used to it now. Also, avoiding aggravating postions like sustained bending, made a huge difference.

How did you CRPS develop and what are your symptoms?

Started when a surgeon permanently damaged my brachial plexus during a Bankart/SLAP repair. I have all of the "classical" symptoms.