I know this may be a bit longwinded, but I wanted to provide as many details as possible for others to help me understand if this is TMS or an actual nerve condition in my body. First, some details about me. I am a healthy, 5’9, 165lb, 49-year-old male with no major health issues. I am a very detailed oriented, type A personality, with a critical thinking and problem-solving mindset. These attributes are what made me successful in my career a but aren’t always good when dealing with stressful situations that are of unknown origin. The fact that I could never truly say with certainly the root cause of my pain was very frustrating for me. I spent many nights trying to figure it out root cause. In 2011, I had an issue with Reflux. I didn’t have the typical GERD where you would get heartburn in your chest. I had LPR reflux which was more difficult to treat. This repeated reflux that would go up to my larynx caused horrible tightness in my throat and a lot of phlegm which caused me to clear my throat a lot. I went from doctor to doctor and no one could help me. This caused me a lot of anxiety and stress which I am sure made the tightness in my Upper esophagus sphincter worse. I finally found a doctor who specialized in LPR Reflux. Through diet modification and reflux medication, the phlegm and throat c went away, and my upper esophagus swallowing motility was synchronized. However, my most distressing symptom, tightness in my throat, remained. The doctor felt administrating Botox in my Upper Esophagus sphincter would relax the muscle and when it wore off in a few days, I would feel normal. The weird thing was that after the Botox injection, I still felt my throat was somewhat tight even though the muscle was completely relaxed. In fact, we measure the pressure, and it was 0hg! The doctor concluded, it’s possible my Vagus nerve became hypersensitive from many months of repeated acid exposure to my Upper Esophagus sphincter. Her fix for this was to prescribe a dose of amitriptyline (5mg). It helped with the tightness but then I started to get a burning pain at the top of my chest a few inches down from my Adams Apple. We did a bunch of endoscopes tests which showed that my esophagus looked perfect and that the burning was not caused by acid. It had to be nerve related. The doctor said I can’t do anything else to help you. I was mortified. I went front this terrible tightness in my throat to this excruciating burning pain and you can’t do anything else to help me rid this pain? I was devastated. From there I went to some of the most respected GI and ENT doctors in NYC with no one having a clue what to do. I tried getting massage therapy and acupuncture where they rubbed and or stimulated that area. After about 2 months of doing this, with zero relief, the pain then moved from my upper chest to the exact spot location in my upper back lower neck areas. And then, I’d say a few days later, it spread to both shoulders. That’s where it stayed for good! I was in tremendous burning pain and developed allodynia. This is where your skin feels like sunburn and clothing or any contact can make the pain worse. It was uncomfortable to wear a shirt! I was devastated. How did I go from reflux to this????? It’s now 2012, I sent months going to over 30+ doctors ranging from neurologists, pain management, infectious disease, anesthesiologist, endocrinologists, immune doctors, etc. I tried so many different drugs, IV steroids, epidural Injections but nothing seemed to help. I was a crying every day and slipped into deep depression over my pain. Over the course seeing all these doctors, I was left with three diagnosis: Brachial Plexus Neuropathy, Small Fiber Neuropathy, Central pain/Chronic Regional Pain. Brachial Plexus Neuropathy – usually has motor issues with movement like frozen shoulder. All I had was burning. Small Fiber Neuropathy – usually in hands or feet. Because it was in my upper extremities, they couldn’t do a biopsy. Also, EMG won’t show anything. All blood tests were negative Central pain/Chronic Regional Pain – Didn’t have an injury. Very rare it happens bilaterally, but the allodynia was a symptom that matched up Some doctors hypothesized that I may have gotten a virus or damage from all the tubes they stuck down my throat, or possibly that my Epstein Barr virus was reactivated from the immense stress over the past 6 months which caused nerve damage or some type of central nervous system disorder. As mentioned, I love to troubleshoot and figure things out. I never felt good or got closure on the root cause. I eventually had to give up trying to figure out the etiology and focus what to do to get the pain under control. I went to a therapist, to help cope with the pain as my wife couldn’t do anything more to support me. He told me to stay in the now, make room for the pain, don’t fight it.The the pain was so bad, I just wound up crying for the entire session about the pain. I think it did about 10 sessions. It was a release of anxiety and hopelessness that buildup over the week. Crying didn’t relieve that pain at all. All the test that I had performed never pointed to a 100% smoking gun diagnosis but unfortunately what I was told is that with some type of idiopathic nerve pain, your diagnosed is done by process of elimination. All I had left was figuring out who best to help me manage the pain By 2012-2013, I found a pain management doctor that worked with me. I wound up taking 500mg of Lyrica and 40mg of Nuedexta. It reduced the pain by 30%, but I was still suffering. The nights were always the worse. I believe by 2014, I began to make recovery. The crazy thing is I don’t really remember how long and when it took to get better. Looking back, I repressed this horrible experience in my life. I think over the next 3 years I began slowly feeling better. I would have one good day or week in the month and three bad ones. Then two good weeks and two bad ones, etc. until finally I felt good most of the time. I would have pain flairs for a few days. Stress and weather would also play a factor sometimes in the flairs but not always. By 2016 I was pain free. I had my life back! I got a new job, felt empowered and had purpose. By experiencing the pain, it made a more caring and compassionate person. I was so grateful to be alive again. By 2017, I slowly weaned off the Nudexta and Lyrica and by 2019, I was only on 100mg of Lyrica a day. I couldn’t seem to get completely off but Lyrica, but at a 100mg a day, there were zero side effects. I remember having small flairs that would last a few days every time. I went down on the Lyrica Fast forward to 2021. In May 2021, I began to get lightheaded (not dizzy) out of nowhere. Some days It would be all day, sometimes it just happened at different part of the day with not pattern, not known trigger. It was hard to concentrate. I went to a host of doctors. MRI/MRA of Brain, my vestibular system, my heart, my blood work. While getting various tests, I had a bad CT calcium score on two of my arteries in my heart. I was a bit stressed out that I had occlusions, so I got an angiogram. It turned out my arteries were only minimal blocked, and there wasn’t anything to worry about other than being preventative by going on a statin. As I continued check things off the list, I had a few blood tests that had elevated RBC. A hematologist diagnosed with Polycythemia Vera, a rare cancer of the blood. But wanted to confirm with more blood work. I was stressed out waiting for the blood results to come back. It turned out that’s everything was normal - I don’t have Poly Vera! Thank God, I am healthy but still lightheaded. Well, my neck is leaning forward as I have poor posture as I am in front of a computer all day. It was recommended to get massages to loosen up knots as well as do physical therapy. Back when I was in pain, you couldn’t touch my upper back area, but I was able to get massages and PT with zero pain. This went on for 3-4 weeks and I was still light head. We are now approaching the end of July and my doctor said the only thing that could be causing your lightheadedness is the Lyrica. I said, yes, it is the number one side effect, but I’ve been taking Lyrica for over 10 years and I am on a low dose and never had an that side effect. He said try the extended-release version. Its 82.5mg so its close to 100mg and it will possibly distribute the drug more evenly throughout the day. I took the drug for 3 days and felt very tired by the 3rd day. I started to burn in my neck and shoulders. I immediately switched back to my 100mg per day, but the burning persisted. I felt scared, OMG, the burning pain is back!!! This was the one thing in my life I never wanted to relive. Did the combination of massages, PT and switch the drug cause my pain to come back? My doctor told me we need to get this under control as quickly as possible. Over the next 2 weeks I went up to 250mg. I can’t seem to tolerate more. At first, I felt like it’s helped. I had a few parts of the day where I was light head with no or minimal burning, but most days were burning. Now I don’t have lightheadedness, just burning. It reminds me of when I had tightness in my throat and burning and then just burning back in 2011. Since the burning came back, I’ve been so depressed and anxious. I feel like I was teleported back to my past and I am back in this horrible pain cycle. Two weeks ago, I purchased The Way Out and went through the 28-day program on this site. At first it seems to help slightly. I felt empowered by the possibility, that there is nothing wrong with me and it’s just my brain sending out false alarm signals. I was in less pain for a day or two. Then I had a flair and have spent the last week in more pain. I have been practicing somatic tracking and trying to stay positive, but it hasn’t help reduce the pain thus far. I need help trying to understand if this is really nerve pain from nerve damage or Central nervous system issue or TNS pain??