Chest pain: One of the most commonly misdiagnosed and mistreated causes

February 19, 2013

Mitchell A. Cohn

Chest pain, especially acute (meaning "new onset") or severe, frequently elicits a workup for heart disease. When no cardiac or lung problems are found, however, the treatment is often to ignore the problem and hope it goes away. If it lasts long enough to become chronic pain -- meaning that it is consistently present and lasts for 6 to 12 weeks -- the patient is frequently started on pain medications or treatments ranging from the mild, such as ibuprofen or chiropractic, to the more significant, such as narcotic pain relievers, injections, or nerve blocks.

Characteristics of cardiac pain: Usually (though not always) crushing, deep pressure associated with shortness of breath, nausea, and/or profuse sweating. It may radiate up into the neck, to the back, or into either arm. Sometimes it presents with a pain similar to heartburn. Touching or pushing on the chest usually has no significant effect on the intensity or character of the pain. When a person is asked to show where the pain is, they will often open up their hand and place the whole hand over an area, indicating that the pain is diffuse and not particularly well localized.

Characteristics of rib pain: Often sharp. Not usually associated with other symptoms. When indicating where the pain is, the patient will most often do so by pointing to the spot with one finger, indicating that the pain is well localized and not diffuse. The pain is usually in the front of the chest, near the sternum (breast bone) or in the back within one to three inches of the spine. Touching the chest wall often aggravates or relieves the pain. When the patient moves his or her arm(s) or changes position, the pain may be aggravated or relieved. Inhaling deeply or exhaling very completely often aggravates the pain.

Understanding the cause of the pain: Ribs move up and down with inspiration and expiration. Sometimes, due to a slight dislocation of the rib or due to the rib "getting stuck," the rib stops moving in concert with the rest of the rib cage. In other words, the rib stays down when the rest of the ribs rise during inhalation or the rib stays up when the rest of the ribs fall during exhalation. The pain can be very severe and can cause a person to take only shallow breaths due to the increase in pain with deep breathing or complete exhalation.

Treatment: No medications are necessary and no amount of high tech treatment or physical therapy will necessarily help. The problem can usually be corrected easily, however, by hands-on techniques, such as osteopathic manipulation, directed at the rib and its attachments. Properly employed manipulation techniques tend to help free up the rib's attachments, allowing the rib to move normally and rejoin the normal inspiratory / expiratory motion of the rib cage as a whole.

Pain resolved.

Note: Chest pain has many more potential causes, some of which can present with symptoms quite similar to rib / chest wall pain, many of which are lethal if not properly diagnosed and treated as quickly as possible. When significant chest pain is present, you should always see a doctor for proper diagnosis and not engage in self-diagnosis or treatment.

Dr. Cohn is employed at the Born Preventive Health Clinic in Grand Rapids, Michigan, where he is focused on treating acute/chronic pain and injury via osteopathic manipulation and prolotherapy. Dr. Cohn regularly blogs on medical issues and other issues of global and personal interest.

Originally published Feb 19, 2013 10:00:18 AM.