Expert: J.R. Strecker, B.S., D.C. - 4/27/2008

Question
Hi,
My girlfriend has chronic back pain coming from two sources at pinpointed locations. We have had X-Rays, many tests and finally the last negative test was an MRI with no avial of what is causing the pain and all coming out normal. She has been on heavy pain medication using fentanyl patches at 50mg for about 3 months. On the side she is taking large doses of oxycontin and percocet for about 4 months. Basically enough that she has become very addicted and is taking enough to kill a horse and still has a large amount of pain. She has been on this routine for about 4 1/2 months. We have tried muscle relaxants and NSAIDS from weak to strong and nerve injections at a pain clinic. In her past she did have a pinpointed spot on her upper back at about the right mid shoulder blade level and very close to the spine if not right on it. Basically I give her deep massage at a location right beside her spine on the right side and pull away from directly at the spine towards the right. When I do this I feel a somewhat hard fiborous balllike structure which gives her relief. This spot has been bothering her for several years. I give her deep massage and have to almost pull a small like type fiborous ball away from the spineand even though it hurts she does get relief from it. More recently she has another similar pain spot to the right of her tail bone. It seems like a rounded area on her pelvic bone just beside the tail bone to the right and within a curvature within the pelvic bone. Again it is very close to the end of her tail bone and to the right and again deep penetrating massage seems to give her relief by basically pressing your thumb in those area or doing circular motions.

We are baffled and have had no answers what this might be...how to treat it and especially with the amount of pain killer she is taking which include a 50mg fentanyl skin patch and on the side taking about 10 perocet+/day with oxycontin as well each and every day. I can tell you how much this is costing and how debillitated she has become. I wasn't even sure if maybe the pain killers were the cause since she is a bit of a suck when it comes to pain.
Please help as I am at my wits end as is she and our family is falling apart very quickly because of this.

Answer
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Hello M.,

I appreciate your concern for your girlfriend's health.  It really does sound like you've tried almost everything in the allopathic book.  The thing is, some people swear by all the medications your girlfriend has taken and others have so much pain it does nothing for them.  There is no way I can know exactly what your girlfriend is suffering from without evaluating her myself.  But if all of her scans are normal, then it doesn't seem the treatment path you're headed on is going to magically work.  I would suggest trying alternative medicine.  It really sounds like something as simple as a trigger point, which can be very debilitating and painful if left untreated in some people.  Rather than massaging her yourself, take her to a really good massage therapist who really know what he/she is doing to do some deep tissue work.  I believe a combination of chiropractic, acupuncture, physiotherapy, and massage therapy would be very effective at helping the pain.  But you have to shop around and find someone who really knows what he/she is doing.  If there is not improvement of the pain after 2-4 sessions, then look for a new practitioner.  For example, I have a new patient that has been taking pain medication for several years.  She has been going to the same chiropractor for 7 years, nearly 3x/week and has spent THOUSANDS of dollars on chiropractic.  After four treatments with me, I had her off her pain medications.  Does this mean I'm especially good?  No!  But my point is that every patient responds differently with different doctors, especially when it comes to "physical medicine" and alternative medicine like chiropractic, massage, acupuncture, etc...  And like my patient, it can mean the difference of taking pain-killers the rest of your girlfriend's life or not.  Your girlfriend might also have myofascial pain secondary to a nutritional deficiency, so getting some blood work done by a naturopathic doctor may greatly assist her pain management as well.

I hope this helps give you a bit of guidance.

Best of luck!
Dr. J.R. Strecker, D.C.