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Have Costochondritis. Pain Lifting Weights. Pain Radiating To Jaw. Feel Shortness Of Breath. Get Headache. What Can Be Done?

Posted on Fri, 18 Oct 2013

Question: hi there I have had costochondritis for about 3 years now. I got this pain from lifting weights. But more recently it feels like a pain that I have never experienced before. Its mostly on the left side on my 3rd and 4th rib. About 2 months ago, my chest was in so much pain I decided to rub my chest with ruba535 on the left side. I was rubbing it really hard to let my chest absorb the cream. About half an hour later, I experienced this really sharp tearing pain in that area that lasts about 5 seconds. That pain is so severe it really feels like it takes the life out of me. I got that same severe tearing pain once a day, everyday for the next 2 weeks. It happens once a day and normally at night time. The pain also radiated to the jaw. I haven't gotten that severe tearing pain for the last month and a half but other symptoms are apparent. I still feel pain in the same chest area and my jaw, my whole face including the the cheek bone, the bone on my nose, the bone under my eyes and even my ear hurts. The facial pain feels like a burning, numbing and sharp pain. I am also getting frequent headaches. I feel shortness of breathe especially with simple things such as walking and at times even at rest. Talking is the worst. I get shortness of breathe when i talk and my chest and jaw hurts a lot. I told my GP about this and hes prescribed me with NSAIDS that only gives short term relief for about a few hours, but it really upsets my stomach. MY GP has also done an echo-cardiogram, and ECG, a chest CT scan and done a halter monitor test to rule out heart related problems and has found everything to be negative. My GP says he doesn't know what I have and has basically given up on me. Any help or advice would be strongly appreciated.

Answered by Dr. Lohit K (3 hours later)

Brief Answer:
Monitor BP,Pulse.Have NSAID & muscle relaxant.Eval

Detailed Answer:
Hi Thanks for using XXXXXXX
I went through your history and understand your concern. Since no cardiac signs are present you need to relax now.

1. With the presenting illness I would have excluded myocardial infarction (MI) as initial differential diagnosis. Considering history of costochondritis, your age and negative reports of echo-cardiogram, ECG, chest CT scan and holter monitoring you may not be suffering from MI. Get done cardiac enzymes and complete haemogram once. This may help us to diagnose your problem.

2. Vascular problem. The similar type of presentation will also be there in vascular tearing (Aortic dissection) due to any congenital cause or secondary to very high blood pressure.
It usually presents with sudden severe chest or upper back pain (like tearing, or shearing sensation) that radiates to the neck or down the back, may have loss of consciousness (fainting), shortness of breath, sudden difficulty in speaking, sweating and weak pulse in one arm compared to the other or difference in arms and legs.
So I advice you to monitor your BP, pulse and cholesterol levels on regular basis and if the symptoms still persists you can get done angiography(aortic angiography) to know if any problem in blood vessels.

3. musculoskeletal pain: This is more localized severe pain but usually breathlessness wont be there. By applying local analgesic and with NSAIDs and muscle relaxants like chlorzoxazone the pain will disappears.

So in nutshell I advice you to monitor your BP, Pulse (both arms and legs), cholesterol levels and quit smoking (If smoker). Get done cardiac enzymes and carotid angiography if the symptom persists after your doctor's opinion. Apply topical analgesic and continue NSAID and muscle relaxant.

Hope this helps you. Feel free to ask if any relater query and I will be glad to answer them. Wish you faster recovery and good health.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Lohit K (31 minutes later)

thanks for the answer. I have a question about the facial pain because you didn't cover that. What would be causing the facial pain, like an inflammation of the nerve in my face? Im really concerned about the facial pain because the pain is like a 6 or 7 out of 10. Ive noticed that the severe tearing pain is experienced when I touch the chest area, which is what started this severe pain. and thanks for the suggestion of the aortic angiography. I just want to know, how likely can it be an aortic dissection based on my story, my blood pressure and cholesterol levels are fine and I've read that an aortic dissection almost always causes immediate death if not within 30 days. I think I should still get a test done for the aorta but I just want to know how likely is it that I have an aortic dissection.

Thanks

Answered by Dr. Lohit K (14 hours later)

Brief Answer:
Referred pain.May be only intimal damage.

Detailed Answer:
Hi Thanks for writing back.

1. According to the presentation the severe tearing pain experienced when you touch the chest area, suggests that the pain is originating in chest and is referred to the face. We call this as referred pain. So the problem lies in chest area.

2. Aortic dissection if complete then it causes immediate death but if the intima (only the inner layer of blood vessel) is getting affected then there wont be collapse, no rise in cardiac enzymes and also no change in ECG and echo cardiography, but will be only few symptoms as discussed before. The pain will be referred to other places. So I suspected this. Since your BP & lipid profile are normal this may not be the problem.

If you find normal angiography then the symptoms may be due to costochondritis. You need to take NSAIDs fo this. For neuropathy you can take Tab Pregabalin 75mg with methyl cobalamine. This may help you pain management.

Hope this answered your query. Feel free to ask if any related questions.
Wish you good health.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Lohit K (36 minutes later)

Ok thanks for the answer. So the only real life threatening concern I should is regarding the Aorta. If the Intima is being affected as you might suspect, how is this often treated and whats the prognosis of this. A normal angiography, does that just involve an Xray and a XXXXXXX injected into the vein?

Thanks

Answered by Dr. Lohit K (22 hours later)

Brief Answer:
Maintain BP.Contrast angiography/MRI.ContinueDrugs

Detailed Answer:
Hi thanks for writing back.

This can be treated by decreasing the blood pressure in order to decrease the intimal tear and propagation of the complete dissection. Treatment with beta-blockers to maintain BP by reducing the pressure from heart is the treatment of choice and also need to manage the cholesterol levels. Prognosis is good if detected and managed in initial stage.

Angiography (CT) with contrast agent is required or else even Magnetic resonance imaging (MRI) can be used. MRI will also help us to know if any other cause for your symptoms.

Hope this answered your questions. I hope your pain has reduced by using NSAID with muscle relaxant and Pregabalin. IF not controlled, then get evaluated as explained above and also continue the same drugs.

Wish you faster recovery and good health. Feel free to ask if any queries.

Regards

Note: For further follow-up it is advisable to consult an emergency medicine specialist. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar