I have chronic pain at T8 area which never moves and wraps around to the end of the rib on the right side. i have had MRI/CT scans, which shows a disc bulge at T2 and a hemangioma at T8. I have had 2 injections, one in the fascia around the vertebrae at T8 and another one at T5 in the nerve itself to deaden the nerve, neither one has worked. i have another followup appointment and have a feeling we are going to be doing a guessing game in which we just inject each nerve in the area until we get the right one. i would like to know the chances of the hemangioma causing the pain. i am 41, female and this started after giving birth 3 years ago. the only way the pain goes away is if i am lying flat or narcotics to function daily. if i bend over as in an L shape the pain subsides, it seems prolonged standing, lifting or too much activity aggravates it and it just intensifies throughout the day, or just daily living.

Dr. Joshua’s Answer

In the treatment of chronic pain, the first step is to make an accurate diagnosis. First, it must be determined whether the pain is nociceptive (normal pain signal due to tissue damage) or neuropathic (due to chronic nerve damage) in nature. Next, regardless of which of the former it is, the cause must must be determined. Only after these steps, meaningful treatment can be initiated.

Vertebral hemangiomas as a rule do not cause radicular (nerve root) pain. A bulging disc at T2 would not explain T8 region pain. The level of the pain in the thoracic/abdominal region is not always easy to determine, so attention should be paid to the adjacent levels on the MRI. The MRI report should answer the following question: Is there such compression of neural structures that would explain your symptoms? Reporting a hemangioma or a bulging disc is meaningless when the clinical problem is radicular (nerve root) pain.

It needs to be determined if there is a treatable cause for the pain, and if so, treat the cause. Since you’ve suffered from the pain for several years, it’s possible that the pain is neuropathic in nature, in which case treatment of the original cause will not help unless there is a nociceptive component also. Often (but not always), neuropathic pain presents as a burning pain, and the area may be tender to the touch. In the case of neuropathic pain, anesthetic injections are unlikely to help, and drugs are the first line of treatment. Lyrica (pregabalin) or Neurontin (gabapentin) are the most commonly used effective drugs for neuropathic pain. Other treatment modalities exist, and should be discussed with a doctor specializing in pain treatment. If drug treatment fails, spinal cord stimulation may be considered.

I’ve presented here some talking points for your next visit to the doctor’s. I cannot give any specific diagnosis or treatment suggestions over the Internet, so please discuss everything with your doctor. Please keep us posted on the Forum!