Paincyclopedia
  • Pain recognition
  • Neck pain
    • Neck pain without arm pain
  • Shoulder pain
    • Shoulder infection, cancer
    • Shoulder muscle pain to arm
    • Local shoulder muscle pain
    • Shoulder muscle pain - back side
    • Frontal shoulder/arm muscle pain
    • Shoulder impinged nerve pain
    • Posterior shoulder pain
    • Shoulder and arm pain - Thoracic outlet syndrome
    • Shoulder neck pain from torticollis
    • Shoulder/ upper back pain from liver gallbladder
    • Shoulder/upper back pain from abscess of the liver
  • Arm pain
    • Arm pain from posture
  • Abdominal pain
    • Abdominal pain from nerve
    • Abdominal pain from Appendicitis
    • Abdominal pain from colon
    • Abdominal pain from lactose intolerance
    • Abdominal pain from adrenal failure
    • Abdominal pain from porphyria
    • Abdominal pain: liver gallbladder
    • Abdominal pain from air in the abdomen
    • Abdominal pain/kidney, urinary bladder
    • Abdominal pain/DKA
    • Abdominal pain after food postprandial
    • Abdominal pain omental infarction
    • Abdominal pain/blocked artery or vein
    • Abdominal pain/mesenteric panniculitis, Abdominal pain
    • Abdominal pain: ovarian torsion
    • Abdominal pain/bowel obstruction
    • Abdominal pain/ volvulus
    • Abdominal pain-aorta dissection
    • Abdominal pain/Belly dancer syndrome
    • Abdominal pain/Spleen infarction
    • Abdominal pain/Herlyn-Werner-Wunderlich Syndrome
    • Abdominal pain/liver abscess
    • Abdominal pain: Gallbladder diseases
    • Abdominal pain: pancreatic cancer
    • Abdominal pain: pancreas
    • Abdominal pain: lymph node cancer
    • Abdominal pain: Tabes crisis
  • Hip, thigh, calf pain
    • Buttock pain
    • Piriformis syndrome-a sciatica pain from buttock shooting to leg
    • Frontal hip and thigh pain
    • Posterior thigh and calf pain
    • Thigh pain and groin pain
    • Back and leg pain: Tabes dorsalis
  • Back pain that stays local
    • Mechanical back pain 1
    • Mechanical back pain 2
    • Mechanical back pain from fracture
    • Back pain flank pain to groin
    • from ruptured artery
  • Headache
  • Chest Pain
    • Chest pain: aorta arch aneurysm
    • Chest Pain from cancer
    • Chest pain with position and movement
    • Chest pain with skin rash
    • Chest pain with skin cord
    • Chest pain with short of breath
    • Chest pain with difficulty breathing
    • Chest pain with pneumomediastinum
    • Chest pain with lung infection
    • in children adolescent
    • from heart attack
    • from over eating and spicy food
    • Chest muscle pain 1
    • Chest muscle pain
    • from abdominal organ
    • from the back
    • from epipericardial fat pad necrosis
  • Foot pain
  • Knee pain
  • Flank pain
  • PMH
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36 year-old lady 2 year of left mid to lower back pain without leg pain. The pain is worse when she trying to sit up or laying down.
She noticed this pain after she started a vigorous exercise routine.

Her pain was reproduced with her lying down and forced left hip flexion.


Diagnosis: psoas muscle strain. Easy on her exercise.

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81 year-old man 3 months of right far lateral lower back pain worse and catches when he gets in or out of his bed. The pain is static and it does not radiate.

He had severe tenderness over right quadratus lumborum.

Diagnosis: quadratus lumborum. muscle pain

MRI: L-IDDD and L-spondylosis

Management: trigger muscle injection rid him his pain.


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After a trigger point injection
68 year young man 3 weeks right lateral paraspinal muscle pain  -- worse with sitting up from a lying down position or lying down in bed..He described it as jabbing and knife stabbing in quality. HE denies trauma, injury or fall, skin rash, weakness or numbness. He developed this pain after a long lawn mower ride. 

He has left quadratus lumborum tenderness.

Diagnosis: quadratus lumborum strain

Treatment: muscle injection relieved pain immeiately

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After trigger muscle injection
79 year young lady lateral paraspinal muscle pain  -- worse while sitting up from a lying down position. 

She denies shooting pain to her leg. She denies weakness or parapinal pain. 


She has left quadratus lumborum tenderness. She has scoliosis and kyphosis.


Diagnosis: quadratus lumborum strain

Treatment: Trigger muscle injection relieved pain right away

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58 year young lady bended forward to reach a drawer and had a sudden sharp pain in her back. The pain is quite severe and any movement seems to hurt a lot. She is afraid of moving. But she denies leg pain. Cough sneeze or defecation did not make it worse. Lying flat and not moving is better.

She has focal paraspinal muscle pain, spasm, and tenderness on examination.

Diagnosis: back muscle strain

Management: Steroid pack taper and muscle relaxer. This relieved her pain.





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After trigger point injection
58 year young lady 2 weeks of right upper back pain.
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left shoulder pain just below shoulder blade
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After left serratus anterior injection
73 year young lady years of left shoulder blade pain to her left chest wall.




She had pain with pressure at the same location.




Diagnosis: serratus anterior muscle strain and pain.



Treatment: local muscle trigger point injection resolved her pain for three months.
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Left lateral paraspinal pain
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After left quadratus lumborum injection
39 year young lady lateral paraspinal muscle pain  -- worse with sitting up from a lying down position.

She denies shooting pain to her left leg. She denies weakness.


She has left quadratus lumborum tenderness.


Diagnosis: quadratus lumborum strain


Treatment: muscle injection relieved pain

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right local lateral back pain only when he sits up from sleep
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After right quadratus lumborum injection
60 year young man 6 months history of right local lateral back pain only when he sits up from sleep or lying flat. Cough or sneeze does not worsen the pain. He denies leg pain.

He has right lateral lumbar area muscle pain in the location of right quadratus lumborum. Lifting his right leg makes the pain worse.  

Diagnosis:  right quadratus lumborum strain

Treatment: Pain is down to 3/10 from above 10/10 after muscle injection. A second injection one week later resolved his pain.

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After muscle injection
82 year young man 2 weeks history of right local lateral back pain only when he sits up from sleep or lying flat. Cough or sneeze does not worsen the pain. Lifting his right leg makes the pain worse. He denies leg pain.

He has right lateral lumbar area muscle pain in the location of right quadratus lumborum.  

Diagnosis:  right quadratus lumborum strain

Treatment: Pain is down to 2/10 from above 8/10 immediately after muscle injection.


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back pain worse with any movement
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Back pain after rest
72 year young lady 2 week history of severe local back pain. Cough sneeze or sudden laugh does not make the pain worse. Any movement makes the pain worse. She can not sit up without a lot of pain.

A CT scan did not reveal vertebral fracture or kidney stone.

She has severe left more than right local lower back tenderness with muscle strain. This reproduced her typical pain.

Diagnosis: muscle strain

Treatment: steroid pack taper; bedrest. heating pad.

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After trigger muscle injection
66 year young morbidly obese lady lifted 10 lbs of weight and developed severe back strain. She can not move in any way due to her severe back pain. She denies leg pain or weakness/numbness.

She has severe bilateral lower back paraspinal pain.

Diagnosis: back muscle strain

Treatment: Trigger point injection done; Pain medication, heating pad. bed-rest. Pain  nearly resolved.

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Local lower back pain that catches
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At rest
45 year young man acute onset local lower back pain when he picked up a towel on the floor. The pain is sharp, non- radiating, worse with standing straight up and better with sitting down and lying down flat. No weakness/numbness.The local lower back pain is at worst in the morning when he sits or stands up from a lying flat position from sleep. He finds he can not sit up without using his arms to support himself. Bed-rest helped the pain the most. Heating pad helped. 

The pain responded to Ibuprofen 600mg-800mg every 12 hrs. 


He gets better within two weeks.

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Pain at rest
55 year young man with  five month of local back pain. Sitting in a chair with his back leaning against a support is a relatively comfortable position.
The most severe back pain happens when he turns in bed or sits up or gets up from his bed. He is dreadful for this moment. The most reliable test for his back pain is the process of sitting up from a lying flat position, such as when he gets up from sleep in the morning.This position change would provoke intense local bilateral middle to lower back pain as showed in the picture.

A lumbar spine MRI showed minor degenerative change.

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Disclaimer: This site and its entire content are for informational purpose only. It is not for diagnosis and management of diseases. It is not a substitute for a medical professional. Nothing is. Seek immediate medical assistance if you feel any pain or weakness or numbness.

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