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Dr. Chip
Dr. Chip, Board Certified Physician
Category: Medical
Satisfied Customers: 36076
Experience:  20 yrs. in practice, includinge surgery, general medicine, addiction medicine and pain.
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Hi again, I took your advice from my previous question but

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Hi again, I took your advice from my previous question but the symptoms are progressing, with the pain in my upper/mid back now becoming unbearable. I take fentanyl for CRPS and have breakthrough medication (oxycodone) but am now using that breakthrough medication just to manage/lessen the pain in my upper/mid back. Shortness of breath is becoming constant, making it hard to do anything without having to stop. Neti pot has helped a little with the sinuses but now more concerned by pain/breathing
Sorry for the delay. Tell me more about your upper back pain
Customer: replied 3 years ago.

It has a few qualities: it feels like a lot of pressure, as if I'm being pushed all the time and a great weight upon me. It also feels very tight, like perhaps the muscles are in spasm but unsure if that is related. I do have a lot of pain obviously from CRPS but am concerned as this is of a different type of pain. There is also a sharpness to the pain, a little like broken glass that keeps moving around the upper back, sometimes as shooting pains but overall is it a constant dull pain. It's recently become bad enough to warrant needing the breakthrough medication just to function but even with that, always aware of it. Compared to CRPS I would say it isn't the burning 'liveness' of CRPS but more of a sharp pain with a lot of pressure. Hope that makes some kind of sense! I have tried holding by breath to see if it is a lung pain but though talking does make it worse, the sharp exhale or holding it doesn't really alter it (hoping that is a good sign). I once had pneumonia and remember the dull ache of the lungs after that but it's tricky to tell. This is a lot worse (which I hope isn't a bad sign) than that pain but is in the same area. I could of course have spreading from the CRPS but my specialist for CRPS said it was unlikely. Also it being different in style, more likely to be unrelated to the CRPS (which started in my ankle in 1999). Thanks ever so much.

Joa have you had an MRI of your spine?
Customer: replied 3 years ago.

I've had a few MRI's of my spine but not recently. This pain has worsened in line with the other respiratory/ENT symptoms, which is why I think it may be related. I'm obviously used to a lot of pain but this seems far too severe for it to be mucus, however, I have considered that because of my CRPS, the pain may be being exaggerated by my hypersensitive and dysfunctional nervous system. Would you think that feasible? The grander concern however, is that in my 20s I used to smoke heavily and quit then started again, quit again in a bit of a yoyo style and heard that that is worse for the lungs than smoking the whole time and simply quitting (the once) because of they way the lungs repair, is that true? I know you suggested prednisone last time and have now a prescription for that too, so will try that. For now, getting worried because of the wheezing and shortness of breath combined with the worsening pain. What are your thoughts? Thank you very much.

No, there's no difference in lung damage between constantly smoking or doing it off and on. Just for clarification here Joa--the wheezing and shortness of breath are new?
Customer: replied 3 years ago.

Everything started last October but my doctors have not been helpful. The wheezing and shortness of breath is far worse now as are the other symptoms, with the mucus appearing thicker. The doctor I saw seemed to think it was Allergy but it seems too severe, I'm also in a completely different environment. Thanks v much.

Have you had a recent chest x-ray?
Customer: replied 3 years ago.

Hi apologies for the delay. No, my doctor thinks it's allergy but that doesn't make sense. Without being referred, I cannot have a chest x-ray unless it's an emergency. The symptoms do fluctuate and although the Neti pot has helped a little, there seems to be too much mucous. One side question, would opioid medication make respiratory symptoms worse? The CRPS means high doses. Do you do think I should take a steroid to clear things? Thanks again.

The idea of a short course of prednisone is a very good idea Joa. And, no, your opiate medications wouldn't be contributing to this
Customer: replied 3 years ago.

Thanks ever so much. I'll start the prednisone right away. Just to confirm, how many days do I take it for and what dose? Thanks so much again, you've been so helpful.

20 mg twice a day for three days, then once a day for three days would be my recommendation
Customer: replied 3 years ago.

Unfortunately my friend has come back with 30mg. Shall I still take but twice a day or what do you suggest? I'm housebound so have to rely on help from friends. Really need to sort this out though as so bad. Thanks so much.

That's fine--just take one tablet each day for five days, then one every other day for another week
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