A large percentage of patients being treated by general practitioners and being referred to various specialists suffer from back pain. Such patients constitute one-third of the total attendance in the orthopaedic out-patient departments, excluding accident cases. X-rays, electrocardiograms and other investigations are carried out and these patients are then informed that they do not have any serious problem. They are only able to give a vague description of their pain. Unable to find any abnormality in these conditions, the physician treats the problem as a psychological one and often refers them to a psychiatrist.
The pain is mostly in the upper back between the two shoulder blades. It is a postural problem: a wrong way of sitting, standing, or doing home or office work. A majority of sufferers are typists, secretaries and housewives, more commonly females than males. According to our own findings too, such problems occur almost four times more in females than in males. The pain is usually only on one side of the spine. In a few cases it may radiate to the lateral border of the shoulder blade or upwards to the neck.
The patient may feel a deep-seated chest pain. Sometimes the pain is excruciating as if somebody is piercing a nail in the back or an abscess is present in the back. At other times it is diffused and a certain heaviness is felt in the back. A few patients describe their pain as a burning sensation or painful tension. Sometimes they point to a specific point on their backs which hurts them the most.
The pain is common in people who use their hands at the level of the chest without providing any support to the elbows. A farm girl doing strenous work in the field may not get any pain, but when she starts knitting, she may develop a severe pain in the upper back. Among those who have to do work with a stooping posture or where the posture is not correct, the pain may start – as in the case of a typist sitting and stooping for hours over her typewriter.
Housewives who either have a low kitchen platform and have to stoop and work, or sit on the ground stooping and working for hours to cook food, complain that when they roll chapatis, they experience pain in the upper back. The pain may be absent while they are engaged in other activities. This pain is common among ladies who use a hand-operated sewing machine or those who iron clothes. Carrying a heavy shopping bag may increase pain. Sometimes the pain occur at night when the head is in an odd position or when using too high a pillow.
Even wearing a heavy overcoat for a long time may bring about pain. The pain is sometimes so severe that the patient cannot carry on with his work. Pain may also be felt after a sudden twist or turn. It can be severe and excruciating; a deep breath may hurt but coughing may not be painful. This is just the opposite of lumbago (lower back pain) where coughing hurts but deep breathing does not have any effect. A few days of rest may relieve it. While bending the trunk forward, it may recur due to compression on the intervertebral joints. The pain may be felt on one side of the upper back on one occasion, and on the other side on another occasion.
A clicking sound may be felt during manipulation and following this, the pain may change its side. This is a clear indication that thoracic pain is caused by a disc lesion. The pain often radiates to the front at the level of the lower ribs. Sometimes the whole chest may be involved and the pain may travel down to the upper part of the abdomen.
This when confusion starts. Since the pain starts suddenly, for example, while lying down, the symptom may suggest a heart problem like coronary thrombosis or even a myocardial infraction. In the case of a real heart attack occurring at middle age, the patient may have a similar history.
Differentiation between these two chest pains, namely, a prolapse of the intervertebral disc of the dorsal spine or a real heart attack may be made by asking the patient to take a deep breath. If there is pain during deep breathing, it is most likely that the heart is not involved and the cause of pain is the dorsal spine. An electrocardiogram should also be taken to exclude cardiac involvement. The slipped disc of the dorsal spine is self-curing It is common among patients like typists, who have to sit for long hours every day.
The patient feels comfortable when he wakes up from sleep and for a few hours thereafter; then after sitting for some hours, the pain starts playing up. It goes on increasing as the day wears on. Standing or lying removes the pain in a few minutes. The cause of the pain is the posterior bulging of the disc, which recedes as soon as the forward stoop is no longer there.
When the nerve roots are compressed, the pain may be felt in the lower part of the abdomen or may radiate to the testicles. Sometimes symptoms may appear as in cases of gastritis or cholecystitis, depending on the dorsal involvement. In such cases we should examine the chest and abdomen very thoroughly and any pathological disturbances involving the chest or abdominal organs must be excluded first.
Generally the chest and abdominal symptoms which arise due to pressure on the dorsal nerve root are forgotten while diagnosing different diseases of the chest and abdomen. Most chest or Abdominal pains are due to disease of the local organs, but when the pain is in front of the trunk, and gets aggravated by exertion and bad posture, then you may conclude that it is due to pressure on the dorsal nerve root.