37f — severe progressive burning/gripping right thoracic and rib pain with 45–60 minute attacks, multiple er visits, unclear cause
37f, approximately 5’2” and 105–110 lbs.
i’m looking for guidance on what could reasonably be considered next and what type of specialist would be most appropriate. i understand no one can diagnose me online.
several weeks ago, i developed a constant burning and pinching pain under and around my right shoulder blade that wrapped around my ribs. initially it was persistent but manageable. it gradually became more severe and spread across a broader area of my upper/mid back and right rib cage.
more recently, i started having severe episodes or “attacks” on top of the constant pain. these last approximately 45–60 minutes and feel like a combination of deep stabbing, burning, gripping, tearing, and cramping pain. they then partially subside before returning again, sometimes with only about an hour between episodes.
my baseline pain between attacks is often around 8/10, with attacks reaching 10/10. deep breathing and some movements worsen the pain. during severe episodes, i’m unable to sit still and find myself rocking back and forth. very hot baths temporarily reduce the pain but do not eliminate it.
i have been to the er four times in the past week due to uncontrolled pain and inability to sleep. i’ve had blood work and imaging, including an mri, but so far i’ve been told nothing clearly explains the severity of the pain. intercostal nerve irritation/neuralgia and severe muscle spasm irritating a nerve have been mentioned as possibilities.
medications/treatments i have tried include:
• gabapentin
• prednisone taper
• prescription anti-inflammatories
• cyclobenzaprine
• norco
• dilaudid injections in the er
• heat/hot baths
• tens unit
opioids have surprisingly had very little effect on the pain. even dilaudid only reduced the severity somewhat and temporarily.
relevant history: i had shingles when i was 18. i currently do not have a rash, but because of the burning and wrapping nature of the pain, i have wondered whether zoster sine herpete or another neuropathic process could be considered.
my main questions are:
what conditions can cause this pattern of constant unilateral thoracic/rib pain with severe 45–60 minute exacerbations?
are there diagnoses that may not appear on routine imaging or a standard mri that would be reasonable to investigate?
would pain management, neurology, pm&r, sports medicine, or another specialty be the most appropriate next step?
would something diagnostic such as an intercostal nerve block be reasonable to discuss with my doctors?
are there any specific symptoms, tests, or physical exam findings that would help distinguish intercostal neuralgia from thoracic radiculopathy, muscle spasm/myofascial pain, slipping rib syndrome, or another cause?
i’m barely sleeping and struggling to function because of the severity of the pain. i’m not seeking medication recommendations or a diagnosis from reddit — i’m mainly trying to understand what questions to ask and what direction of evaluation might be appropriate next.
thank you for any guidance.