Correctly interpreting the signals the human body sends is critical to relieving pain. Today, diagnostic tools are so sophisticated that what they uncover must be scrutinized ever more closely to determine if what is found is contributing to a chronic pain or is an unrelated situation.

A woman suffering from an intense pain on the lower lateral thoracic wall was referred to my office by her physician, after x-rays revealed a mild compression fracture in the lower thoracic spine. The woman, a registered nurse, could not remember any trauma having caused the pain, but first noticed the pain while lifting a patient. The pain was intense in the middle of her back and would radiate anteriorly along the lower intercostals spaces.

Between the time the x-ray had been taken and her scheduled appointment at my office, the woman noticed a rash with blisters along the area of the pain. This condition was still evident during her initial consultation in my office.

While the x-rays, ordered by the referring physician, did show a mild compression fracture in the lower thoracic spine that could have contributed to her pain, this did not point to the real cause of the pain, the rash, however, did.

Diagnosis: The rash was indicative of shingles or acute herpes zoster. Shingles is a viral infection of the nervous system caused by the same virus that causes chickenpox. After a person is exposed to chickenpox the virus remains dormant and for reasons not yet very clear it gets reactivated and spreads along the nerve tracks causing an inflammation of the nerve and the typical rash. It is extremely painful and very difficult to treat.

Early aggressive treatment is important to prevent the dreaded complication of having the pain persist for years even after the rash heals.

Treatment: I recommended an intense treatment with Antiviral medication along with Elavil, Neurontin®, an oral anti-inflammatory agent, analgesics, epidural steroid injection, intercostal nerves blocks, bioelectric therapy and topical agents.

Results: The rash healed and the pain was totally resolved with no post herpetic neuralgia remaining.