C-Spine: Tracking Down Pain

[biffnoble]

It is really been hard to nail down the relationship between Neck/Shoulder pain and C-Spine pathology.

Dermatome charts are great but pain cause and effect is complex, unless pain or function loss is found in limbs for example. ID'ing the pain source seems to be well-nigh impossible. For example: muscle spasm/recruitment of muscles due to chronic conditions: irritation of nerves/spinal cord versus: muscle spasm/recruitment of muscles due to trauma/splinting. Also pain versus function loss. This whole subject is in a sort of twilight zone. Diagnosis is (relatively) "easy" for patients that have been involved in an MVA's. They were ok, then they were not ok. Where does it hurt now that it didn't hurt before?

For chronic, degenerative conditions, diagnosis (in my case anyway) has been virtually impossible. The best I can do is look at the MRI and the adjacent (posterior) C-Spine structures and "reason" (palpate) out the pain patterns. No doc will provide this. Was examined by an eminent ortho surgeon who observed (and he did a thorough trunk anatomy exam) that there was shoulder girdle muscle atrophy which was indicative of C-spine disease, and that a (3) level fusion was the fix for "everything" including pain. No thanks.

Last DX: was myofascial pain syndrome, with chronic trigger points. TX: neurontin??!$!@! Is this a case of "immaculate perception" or is this pain being caused by some other generator? Logic would tell one that after many ineffective treatments for TRPS, sore muscles, etc., that maybe the pain is originating from the diseased C-Spine?

The point is: with one exception I have yet to nail down the pain origin(s).

What's your experience?