<s>[INST] Hi, I am a 37 year old female with chronic lower, thorasic and neck pain. I have been seeing a physical therapist and received a series of epideral injections over the last couple of years but nothing seems to help, I now have a new symptom a volar ganglion cyst on my left hand I am right handed and do not excessively use my left hand. What do you think could be wrong with me? [/INST] Hello, Such type of chronic pain can be due to following reasons:-Fibromyalgia-Calcium deficiency-Osteopenia or osteoporosis-Abnormal body posture-Spondylosis-Anaemia To rule out all these, I shall advise you to have routine blood investigation including CBC, ESR, serum vitamin D, liver and renal function tests, etc. At present you should do following to have relief:-You may have a mild analgesic like Advil or Aleve for relief-Start taking a multivitamin supplement-Start doing exercises to strengthen cervical muscles Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Mukesh Tiwari, Orthopedic Surgeon </s>