Pain in the upper back after a long flight

Patient

Q: Hello, I am a 31 year old ex smoker (smoked for 12 years), about 2 weeks ago I had what felt like a pulled muscle in my shoulder blade after a long flight, the next day I had what felt like a very strong back spasm that moved across my back, i had to lie still for about an hour for it to pass, felt like i might be having a heart attack or even a panic attack. The following day I woke up with a dull pain in my upper right back , the pain has remained, somedays its worse and it is worse when i twist or bend to stretch and pick things up but doesnt feel like muscle pain. The pain goes away at night and does not stop me sleeping, for around the first hour when i am awake I have very little or no pain and then it comes on and stays all day. Feels like a dull ache, slightly pins n needles like and is just above the bottom of my ribcage, its mainly on the right but by end of the day pain feels like it is all across my back. I have no shortness of breath and am generally healthy and fit, cycling 150 kms per week, the pain is not worse when i breathe deeply. I have no cough and am not coughing up any blood or similar. Please can someone help as I am so worried it is lung cancer, could it be pleurisy, or anything else. Am I too young to have got cancer? In the last 24 hours I have started getting a similar pain in my left lower back just above my hip which comes and goes, could be completely unrelated. The pain in my back seems to be worse if I sit in a hard chair or lie on a hard surface. Please can someone shed some light. thankyou

Doctor

A:   The pain that you described is related to a physical factor, possibly a positional muscle contracture or strain after a long flight. Sometimes not only the muscles are affected when you have to keep a position for several hours, but the intercostals nerves located at several levels anterior and posterior of the rib cage. An Intercostal neuritis is not a serious condition but very annoying indeed and slow healing. The suggested strategy would be: please, try to be patient and do not expect an overnight improvement, take anti inflammatory medication and also Vitamin B12 supplement. Local moist heat helps to ease the pain. An again, try to avoid activities that worsen the pain. On the other hand, if you quit smoking, then your risk for lung cancer is decreased, besides the pain is not the only symptom of a lung tumor, it comes accompanied of some others manifestations. But if you are still worried I suggest that you visit your PCP and at least get a Chest X-rays done.

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