Thoracic spine pain in reflux with heartburn

I would like to tell you about one of my patients who has appeared in my practice at irregular intervals for treatment since January 2015. As is customary for me, I have created a medical history on which I have based the following treatments. In the organic field, and this is what is supposed to be important here, the 65-year-old lady did not state any pre-existing conditions or acute illnesses in January 2015. Her reason for consultation for the first visit was of a parietal nature, the treatments in a first series also extended to the musculoskeletal system. In October 2016, she asked for another appointment. Their acute complaints at that time related to the thoracic spine. She has had "deep inside" pain lying on the left side paravertrebral in the area of the spine at height BWK 5-7 for a few weeks. Their detailed description is typical of this type of pain. She said it feels like it had to crack properly and then everything was fine again...but it didn't. She also described that she herself firmly presses into the door frame at the said height, then the pain subsided...but did not disappear completely and came back to old strength after a short time.

This type of pain, and as described by many patients, is not pain that emanates from the musculoskeletal system. Although it is reflected there, it also reacts well to parietal treatments in the current treatment situation, so that patients can be discharged home with a sense of success, but the pain recurs quickly and persists for weeks and months without changing much. However, they do not deteriorate either. The described type of pain is typical of viscero-somatic reflex pain, i.e. an organ is the cause of this pain. Reflectively, visceral afferences are processed at the spinal cord level and a hypertension of the segmental muscles is generated. Or these pains are an expression of a Headian zone, as known from different organs. The keyword here would be "continued pain."

The physical examination revealed no further findings in the musculoskeletal system apart from a painful circumscribed area of about 8x8cm at height BWK 5-7 paravertebral left. Apart from different age-appropriate movement restrictions in various sections of the musculoskeletal system, but all of which were compensated and did not cause any complaints. And I'll leave it at that. If the body is in compensation, there is extensive freedom from complaint. Now to insist that, for example, a cervical spine is helped to regain mobility like at 20, because this could possibly trigger the BWS pain is not my approach.

From experience, I now knew that if a parietal cause, such as an acute spinal blockade, the described pain in the visceral could find its cause. The level of pain on BWK 5-7 allows conclusions to be drawn about the organs. Assuming a viscero-somatic reflex, one wonders which organs are sympathetically supplied from segments BWK 5-7, because this part of the nervous system is connected to the somatic nervous system at the spinal cord level and then leads segmentally to the hypertension explained above. The ones in question in the case of my patient were therefore the heart, lungs, chatter, stomach, gallbladder. In order to narrow the selection, I first focused on the thorax. Fascial organ tests did not lead to any finding that could be associated with the pain. In the abdomen, the liver showed a subtle osteopathic congestion, the stomach a viscoelastic disorder. Nothing serious, but at least with a possible connection to the complaints. I provoked myself and had my patient provoke the pain through pressure even at the pain site. Declared this as a control result, I first treated the liver decongestantly and then checked the stomach to see if the viscoelastic disorder had improved. Didn't have it. Then I treated the stomach viscoelastically. It took about 10 minutes. After that, the control result was significantly better, only about 20% of the initial pain was noticeable. This made me surprised and I inquired if she had problems with her stomach. She said no. After a short time, however, she said that she had a hard time dealing with heartburn years ago. So bad that she did not calm down sensibly at night because the reflux and burning in the chest were so pronounced. She had to take an acid blocker for a few months, which, by the way, she now only takes when necessary, often on weekends. She still does not tolerate alcohol, spicy food, ginger well. A gastroscopy of his time has not been carried out because heartburn and retrossternal burning have developed declining under medication until almost complete disappearance. It was all new to me. In my initial anamnesis in January 2015, she did not indicate any organic pre-existing conditions or any food intolerances. At the time of treatment, she had not had reflux for a long time.

I would like to say two things about this. Could I have asked in more detail in the initial history? Sure, you can always. Maybe she would have told me about her past reflux. However, I have not lost much, because the experience has led me to the upper abdomen and finally to the stomach. Despite everything, I experience this more often that patients cannot remember their entire medical history, nor can I either. Whatever, everything went well. Memory only comes back in clear associative situations.

So I once had a patient (late 40s) who had a shooting bright pain in the area of the lower rib arch on the right, which clearly seemed to come out of the abdomen, but which could not be tied to an organ. When asked whether there had once been something pathological in this region, he first denies, but after quite a while he remembered that For fear of his parents, he didn't tell anything at home. In the end, it was scarring in the abdominal area that could be attributed to this trauma. At that time, treatment was sufficient for a restitutio ad integrum.

I continued the stomach treatment even further, took care of the circulation and carried out a stretch treatment of the esophagus. 95% of the original pain disappeared during treatment. As a "homework" it should carry out a self-stretching of the esophagus on a daily basis. For the second treatment, 3 weeks later, about 10% of the initial pain was still present in the cerg. A third treatment was no longer agreed, it should contact you if necessary.

Why did the pain occur without any apparent external reason? It is known that stomach symptoms occur more frequently in autumn and spring. There are no conclusive reasons for this so far, nor will I start speculating about it. The stomach was a weak point in my patient due to previous illness, almost a predetermined breaking point. Even if she had no acute stomach problems, the viscerosomatic reflex in the BWS was shown at the altitude assigned to the stomach. This is always the experience I have in practice. You can rely on the neuroanatomical compounds. You know an extremely helpful matter.