Q: My 54 years old husband had a coronary artery bypass graft (CABG) done last month to treat blocked arteries. He is a diabetic too. Even after 5 weeks of the surgery, his back and shoulder pain has not reduced. He takes Tylenol every 6 hours but that does not seem to help much. I massage his back with balm and give hot pack fomentation but all this only provides temporary relief. How can this be treated?

A:Unfortunately the information given by you is not sufficient to make a diagnosis. The shoulder pain could be part of a symptom, which is common in diabetics. This is called periarthritis shoulder. For some reason this condition is common among the diabetics and can be very painful especially at night. The patient prefers to keep his arm by his side as any movement causes him pain. As times goes by shoulder becomes more and more stiff. Initially simple analgesics like Tylenol work later you may need to add muscle relaxant and other pure painkillers. One way to reduce the stiffness in the shoulder is to do daily passive range-of-movement-exercises and once the acute pain subsides you go on to active range-of-movement-exercises. The resolution of symptoms may take three to four months to resolve. Some residual stiffness may persist. The backache does not seem fitting. Where exactly it is? Is it in an area between his shoulder blades or is it right in the middle? Is it in the upper back, middle back or lower back? Is there any deformity in the back (spine)? If it is between the shoulder blades and on the muscles it is possible he may have what is called fibrofascitis, in which there is inflammation between muscle planes causing pain. He may need to have an anti-inflammatory drug in consultation with his physician. If it is still persistent and disturbs sleep, he needs to have a review with a physician or an orthopaedic surgeon and if necessary get fully investigated for his symptoms.