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What Causes Pain In Mid Back Radiating To Left Side?

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Posted on Mon, 26 May 2014
Question: I have had deep pain in my mid back radiating to my LEFT side and up to my shoulder and kind of wrapping around low under my arm kind of where an horizontal bra strap would sit. I do get some right side pain here and there. The left side pain has been somewhat chronic and getting worse. It gets worse with lying down, waking me 4 hours or so after lying down and there is NO going back to sleep. It does not ease with urinating. It eases when I am upright after a few hours. It is a strong pain with a bit of burning or stinging feeling. It does not feel muscular or structural. I get some relief leaning forward. I think digestive enzymes help if I take them when I eat anything with much fat content. I get some less pain if I don't eat or drink for hours before going to bed. It is much worse with any alcohol for days afterwards. I don't really drink at all but many years ago I did go through a stage of drinking too much when I experienced infertility issues. this was 9 years ago and lasted a year or two. Prior to this I did binge drink every now and then. I have hardly drank since then except for a couple of drinks occasionally socially (not at all anymore). I have had hashimoto's for 10 years which is managed reasonably well. I have also experienced gout in the same time frame as this problem. This is managed with Allopurinol. I had gestational diabetes with one pregnancy. In the past year my blood sugar is rising despite 5kg weight loss. This morning it was 121. I have to mention that in recent years I have taken doxylamine succinate and valerian to help with sleep, which I have struggled with since hypothyroid issues. I had become tolerant to the antihistamine and was taking more to get the same effect, up to 100mg a night. This continued for a couple of years. I no longer take it and with a lowering of thyroid meds I get off to sleep well now, but have this pain issue that means I get no more than 4 hours or so sleep before waking up in strong discomfort. I have had quite a few scans and blood tests and nothing very out of the ordinary showing. Had a HIDA scan which showed gallbladder is functioning fine. I do get the occasional gall bladder twinge but this pain radiating to my back is very different. I am wondering if it could be something like chronic pancreatitis? It is getting worse over time and am close to going to our Accident and Emergency when in the middle of the night it is just so painful.
doctor
Answered by Dr. Binu Parameswaran Pillai (45 minutes later)
Brief Answer:
Hello

Detailed Answer:
Hello
Good day.
It was a very good case history and thank you for that. ( many people would stop by writing just few lines of history and it is hard to fugure out the possible diagnosis).
Noted that you have well controlled Hashimtos Hypothyroidism and suffer from uncontrolled diabetes + sleep issues.
Going by the nature of the history, the pattern of pain, its radiation etc make me suspicious of a pain originating in your spine. Pain originting in pancreas would go to shoulders rather than sides.
However, the worsening of pain with alcohol is seen with pancreas pathologies and rare disorders like lymphoma. From the history these are my differential diagnosis. However, it is possinble to pinpoint the cause in most cases by doing a good physical examination and by doing an MRI/CT scan of the suspected area. Some blood works also may be required. I think you should request your GP to refer you to a public hospital Internal medicine specialist who can examine you and figure out the cause. Otherwise, you could walk in to an emergency room when you have the pain next time so that they would call in the physician on call who can help you out.
Your weight loss is worrying me and togther with unconrolled diabetes, you seriously need expert help.
I am more than happy to answer if you need more clarifications.
I wish you a speedy recovery.
Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai (9 hours later)
Thank you. Sorry the pain is in my mid back on the left side of my back and radiates up to my left shoulder. How I wrote it was a bit unclear. It does radiate a bit to the side but is mostly left side of back up to left shoulder. The pain is much less when I just do not eat. It does not feel spinal as it is a very deep internal feeling that is very impacted by what i eat.

I think I will go to Emergency and try to get the bottom of it as my GP is really not understanding how much it hurts and is not interested in my elevated blood sugar. I live in the country and medical facilities are a bit thin on the ground. Apparently my blood work was not out of the ordinary. The pain at night is excruciating.
doctor
Answered by Dr. Binu Parameswaran Pillai (18 hours later)
Brief Answer:
Hello

Detailed Answer:
Hello,
Good day.
Thank you for the clarification. From the symptom analysis, the most likely source of pain is pancreas / gastro intestinal tract. Have you ever noticed oily stools ( poo) after eating a fatty meal ? Do you think the pain get any worse after eating fatty food?
Please meet an Internal medicine specialist who can arrange for further check ups. Having worked in Australia before, I do realize the difficulty in getting specialist care in country side. However, I guess if you present yourself to an ER in one of those pain episodes, they may be able to help you out.
Please do not hesitate to contact me if you need more clarifications
Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai (4 hours later)
Thank you. Yes the pain is worse if I eat rich fatty food or drink ANY alcohol. I have not noticed oil in poo but have been sticking with a pretty low fat diet as it seems to result in less pain. It is much worse at night when lying down and eases during the day. If I just do not eat or drink ANYTHING for many hours before bed I have much less pain. This is what I am currently doing and am sleeping for maybe 4-5 hours before waking and having to get up. Could it be a blockage that happens when I lay down? If I eat anything at night the pain sets in about 3-4 hours after laying down and just gets worse until I stay upright then it eases over hours. The pain has eased off by mid morning and as long as I stay upright during the day the pain stays mild or non existant with just the occasional niggle. Then every night it is the same pattern, just getting more severe over time.
doctor
Answered by Dr. Binu Parameswaran Pillai (8 minutes later)
Brief Answer:
Hello

Detailed Answer:
Hi,
I was just about to sleep when i got your reply.
Good morning.
Yes, as i mentioned earlier, this pattern of pain generally originates from pancreas or gastrontestinal tract ( GI tract). The symptom of worsening pain when you lie down makes me suspicius of an acid reflux or GERD. That pain will originate from yur GI tract ( esophagus/stomach). Blockage usually doesnt present this way and may present with bloating and distension of your tummy
It can only be differentiated by doing an examination and few tests. An endoscopy or an imagiing may be necessary. Please dont panic. Stay calm.
Regards
B
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1439 Questions

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What Causes Pain In Mid Back Radiating To Left Side?

Brief Answer: Hello Detailed Answer: Hello Good day. It was a very good case history and thank you for that. ( many people would stop by writing just few lines of history and it is hard to fugure out the possible diagnosis). Noted that you have well controlled Hashimtos Hypothyroidism and suffer from uncontrolled diabetes + sleep issues. Going by the nature of the history, the pattern of pain, its radiation etc make me suspicious of a pain originating in your spine. Pain originting in pancreas would go to shoulders rather than sides. However, the worsening of pain with alcohol is seen with pancreas pathologies and rare disorders like lymphoma. From the history these are my differential diagnosis. However, it is possinble to pinpoint the cause in most cases by doing a good physical examination and by doing an MRI/CT scan of the suspected area. Some blood works also may be required. I think you should request your GP to refer you to a public hospital Internal medicine specialist who can examine you and figure out the cause. Otherwise, you could walk in to an emergency room when you have the pain next time so that they would call in the physician on call who can help you out. Your weight loss is worrying me and togther with unconrolled diabetes, you seriously need expert help. I am more than happy to answer if you need more clarifications. I wish you a speedy recovery. Regards Binu