Severe Thoracic Nerve Damage

[roseybro]

My brother in law (Brendan, 49 years old) is suffering from very severe pain from what has been diagnosed as severe thoracic nerve damage, possibly as a result of various accidents he had over the last 40 years (car accidents where he had cracked and broken ribs and vertebrae). Over the years, the pain was manageable and he had what you might refer to as a bad back.

Two years ago (April 2011), he had a ‘karting accident’ and there was impact on his rib cage from the steering wheel of the kart. It was at this point that the severe pain began. It started with sharp darts of pain from around the rib cage area going towards his back – like an arrow shooting through. This was happening regularly but he wasn’t in pain all the time.

As he suffered from a severe stomach issues at the time, the focus initially was on getting that resolved. But subsequently, it took over a year to diagnose the rib pain, as the scans etc were focusing on his stomach. The stomach issue has since been resolved. However, the pain in the rib area since that time two years ago has gradually got worse and worse. In the last year, he has gone for multiple tests, scopes and scans – MRI’s and CT scans but with nothing showing up on any of these.

Earlier this year, he got this diagnosis called thoracic nerve damage. He has been on various types of pain management since then, but nothing has really worked.
He had his first epidural injection (which contained steroids) on 19th July (2013) which gave him very insignificant relief for about 3 days. He is on a long waiting list for the second injection which we have been told can take months to get. Seemingly they try 3 injections before giving up on this pain management route so then there would be a third injection.

In terms of other medication. He has used
1) All the standard pain killers - Tylenol etc etc
2) Tramadol
3) Steroids as part of the epidural injection 6 weeks ago on 19th July
4) Very high dosage of Amitriptylene
5) He has tried lyrica it didn’t work and had bad side effects
6) He is on Neurontin all the time
7) Diclac for pain
8) He is on morpine all the time, again something I am very worried about
9) He gets regular cranio-sacral which doesn’t help the pain much but at least relaxes his stress and his mind
10) He gets regular Accupuncture

Nerve Ablation (where they burn the nerve) was mentioned as an option at one stage but he was told the damaged area was too big to be treated using this.

Over the last 6 – 8 months the pain has spread. As mentioned it was originally in the rib area darting towards the back covering an area about the size of a hand. However, it is now in the whole upper back area, on his side area and all over his ribs. His upper back is hyper sensitive to the point that even touched by a feather causes unbearable pain.
Also any movement of his organs internally cause unbearable pain.

The pain has intensified even more (which he thought wasn’t possible) in recent weeks and is now affecting his breathing. So it just appears to be getting worse. He is at his wits end, unable to face each day and he is aging rapidy and fading before our eyes.

My questions are as follows:
What are the standard steps from here. I understand that they are going to give him 2 further epidural injections. Is that the standard process to treat thoracic nerve damage , is it worth waiting for or is it likely that the second and third will be as unsuccessful as the first?

With thoracic nerve damage is it normal that the pain might get worse and  spread and that his condition might deteriorate. We are worried that it is now affecting his organs as he is feeling pain in his organs now but it might be the effect of his body being scrunched up with pain. How does thoracic nerve damage affect the organs – what is the internal damage?

What is the long term alternative. He can’t stay on this heavy medication long term.

If the next 2 injections don’t work. What is the procedure from there?

Is surgery an option. There are mixed reactions from what I have read. Also I am not sure that they know the root of the nerve – to me it is probably around the rib area where the pain started. But is there surgery that can treat this?

What else can be done for him?
Have you treated other people with something like this?

[karryon55]

I had an accident 13 years or so ago & I had a couple of stress fractures in my thoracic spine. I lived with it for some time without the need for anything other than exercises & anti inflammatories. I had a bout of severe asthma shortly afterwards & I had to go onto oral steroids for this. When it came time to taper off the steroids I noticed more pain in my thoracic spine. When I had ceased them I was in acute pain & ended up having the steroid injections into the spine a few times & always without success.

They then decided to attempt denervation which was pointless also. I was so desperate for some relief & would have done almost anything the doctors offered. I guess for me I look back & would have probably done things differently given the chance. I would say "leave the area alone" & focus on good posture, gentle movements, hydrotherapy, massage, acupuncture & pain relief. I used to lean forward when sitting because I thought it was relieving the pain but it just caused further problems.

I tried many drugs for pain & Fentanyl patch was good but I was allergic to the patch itself. There are many options out there that you can try. I still have chronic pain there today but the severity is not impacting on me. I use meditation & relaxation as aids to help living with chronic pain. I also learnt to find something I love in life to distract me from pain. If you enjoy something & are happy then it is natural for you to not feel as much pain.

I guess I often feel that if they hadn't interfered with the area so much (on my request) & just left things to settle naturally I may not have had such a rough time. I have what is called mid thoracic chronic pain disorder. I also have rheumatoid arthritis & some other conditions. I feel that if I focus solely on my medical problems then my life would not have any happiness. Happiness is one of the ways to feeling better. The next best thing is a good pain clinic to aid in living with chronic pain.

Good Luck with it all. I hope this is helpful.

[Dr. Kokil Mathur]

Hi!
I am sorry to hear about your brother-in-law’s medical problems. It is very difficult to treat pain due to nerve damage. He can try Opana, which is an opioid just like morphine. If given as extended relief medication, it gives round the clock protection against pain. Hence, it will prevent break-through pain. Other drugs which can be tried are N-methyl-D-aspartate or NMDA antagonists and fentanyl patch or Butrans patch. Often changing the combination of drugs you are taking is helpful in preventing breakthrough pain. Spinal cord stimulator also helps control pain in some cases.
There are many other alternative or non-pharmacological pain management therapies which can be tried. These are: ice packs, heat pads, massage therapy, transcutaneous electrical nerve stimulation (TENS), aromatherapy, Reiki, acupressure and acupuncture, guided imagery and biofeedback.
If the nerve is permanently damaged then surgery may not help at all. Please discuss with your doctor. Take care!

The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.