What Else Is Back There

t e p t m a n p p m s t m c PRESENTATION Chronic back pain is a condition often seen by the internist and rarely requires further testing. When pain is intractable, however, other rare potential causes may need to be evaluated. A 47-year-old Caucasian man with history of chronic back pain presented to our facility for evaluation of suddenonset, severe, mid-thoracic back pain that radiated around to his chest and was worsened by any movement. No trauma was associated with the pain, which had started the previous day. He had experienced a similar pain episode 3 months previously and had been evaluated by a chiropractor, who determined the cause to be musculoskeletal. The pain had resolved with physical therapy. The patient denied any constitutional symptoms, chest pain, shortness of breath, limb weakness, paresthesias, numbness, or bowel or bladder dysfunction. No other significant past medical or family history was noted. He denied any alcohol, tobacco, or illicit drug use.