### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I have ongoing pretty severe pain that began in center of back between shoulder blades several times a day as we ll and waking me up almost very night, this is also causing pain toward front into abdominal area and to lower right. This is ongoing for roughly 2 months, 3 dr. And only one has has done basically a 1 finger exam on back and determined epidural injections prior to ant test along with an anti inflammatory that has not provided any relieve. I m scheduled for injections but have not been given a single other options or answer to what this could be.this has become so intense that it s become very hard to function thru day and sleeping has suffered as well. I feel like I m at my wits ends with frustration and desperate to finds answers and relieve. The MRI has shown nothing but this much pain has to be associated with something and the time between test and appointments it s getting very difficult to function, any advice would be helpful

### output:

Hithanks for the brief history of you. Since you mentioned you had visited the physician, and he has advised an epidural injection as well which you feel it didn't work. If the MRI has shown nothing then it is good to hear that your spine is intact. Now coming to the chief complaint what you mentioned - pain in the upper back in between the shoulder blades? Am I right?if the pain is in between the shoulder blades it will be interscapular muscle spasm. For which you may need some posture correction and post that a physical therapy sessions. The use of the therapeutic ultrasound and TENS will help you get relief of pain. Also on the later stages strengthening the interscapular muscles as to avoid any future pains. Also to note that you can discuss the same with the physician you have been seeing you currently.a lot of the people face this issue of interscapular muscle spasm and are getting helped without the epidural injection. Just a physical therapy. Even you added you have a dull ache on the left side abdominal area, for which I will advise you to meet an internal medicine specialist and get checked once. He might ask for the Ultrasound scan of the abdomen which can help us to rule out the systemic issues.It's always better to rule out the factors and possible cause will be reachable. With the grace of God I wish you a speedy recovery