Dr. Hitesh Kumar
Neurology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have a tight banding sensation around my upper torso, chest, and neck, that came on suddenly 24 years ago and has never gone away. The intensity rises and falls, but the sensation itself never goes away. It is always there whether I am active or at rest, asleep or awake.
I have had x-rays or the chest that appear normal. Also, I have undergone standard neurological tests that appear normal as well. I have been prescribed medications for neuropathic pain, including Amitriptyline and Gabapentin. Amitriptyline has worked irregularly to relieve some of the intensity. A few years ago, I had physiotherapy and coaxed greater relief levels through a good neck massage, but even that would only prove temporary (weeks at most). I have tried many other types of physical therapy and exercise, but I have not been able to find anything that properly subdues the pain.
At this point, I am wondering if there is anything worth doing to find the root cause of the problem? I have read about transverse myelitis and multiple sclerosis and how they can cause banding across the chest. I do not have any other noticeable symptoms that I would associate with these disorders, but I wondered if it might be worth me getting it looked into all the same?
Hello,
Welcome to icliniq.com.
I would like to know some further details about your symptoms:
Does this banding sensation happens in the whole chest, or only in the upper part of the chest, or only in the lower part of the chest? Do you have any neck pain or upper back pain also? Do you have associated burning, pinprick, tingling, electric currents like sensation over the neck, arm, and chest? As you mentioned that banding sensation intensity rise and falls, have you been able to conclude the situations in which this banding sensation rises? And in which situations it falls?
Once that chest tightness rises, then for how long time duration it persist for the high intensity? Do you also have a fast heart beat or breathing difficulty at the time of risen chest tightness? Do you have any other significant medical history also? If yes, please tell in detail and also about other medications you are taking (apart from Amitriptyline and Gabapentin). What investigations did you undergo for this symptom (apart from x-ray chest)? Please send the reports here as an attachment. In what doses and how many times are you taking Amitriptyline and Gabapentin? Do you have any weakness (weakness of power) in hands or legs or any urine control difficulty?
How is your sleep routine? Do you sleep soon after lying in bed? Or it takes a long time? Once you fall asleep, do you have frequent awakenings during sleep? Do you feel fresh on awakening from sleep in the morning? How is your usual mood in day-today activities? Happy toward the sad side (thinking about past events), toward the worried side (thinking about future things, irritable, something else)? How is your appetite?
Getting relief with a neck massage may indicate that some muscular component also is associated with your symptoms. Your symptoms will need further evaluation to find out and rule out the possible etiologies pertaining to it.
Regarding follow up
Patient's Query
Thank you doctor,
The sensation is in the upper chest and feels tighter on the left side than the right. The sensation can also be felt up in the neck and throat when it is at its worst. I have a tight feeling in the back of the neck, worse on the right, which can sometimes feel like a squeezing or narrowing of the throat. No upper back pain. Though my physio was able to produce a current sensation in my right arm (but not the left) by extending the arm outside of its normal range. It feels very arbitrary. I have never been able to relate my pain to any cause, such as a change in mood, a change in exercise, etc. The sensation is always there, but it just gets worse for short periods.
I do not have a fast heartbeat or breathing difficulties. I have no other significant medical history apart from urinary issues, and my blood test was normal. My physio has carried out some general neurological checks on me, which seemed fine. I have discussed the issue with family GPs, who prescribed the medication, but they have not referred me for any deeper testing.
Currently, I am taking 25 mg Amitriptyline daily. I do get numbness in my right arm and right leg (but never the left) from time to time. Around four years ago, I started to have difficulty urinating with intense discomfort in my groin. I was diagnosed with a moderately enlarged prostate and recommended to have prostate reduction surgery. Although symptoms improved, with less pain, I continue to have issues with urinary retention. Currently, I have been recommended to have further surgery to widen the bladder neck due to a build-up of scar tissue.
My sleep is generally fine, and I sleep well most nights. The urinary issues have upset my sleep more in recent years. My mood is usually fine and remains quiet even. Thinking about or focusing on the discomfort can put me in a low mood, especially if the sensation intensity is bad. My appetite is good, and I eat normally.
Hello,
Welcome back to icliniq.com.
There is no direct clue with your description and details that can point toward any specific etiology for your symptoms. Also, I speculate that in 24 years, with an untreated problem, there might be some newer symptoms or progression in symptoms, but such a scenario not happened.
To rule out some etiologies, I recommend some evaluation, mainly related to the heart, chest, and spinal cord.
Sometimes, such tightness in the chest can also happen in anxiety states, particularly severe anxiety and panic attacks. As you mentioned that you are a worrier, but you deny any specific mood disturbances in you. But before thinking about that, we must rule out other organic causes.
Investigations to be done
Treatment plan
Regarding follow up
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Neurology
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