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Suggest Treatment For Persistent Left-sided Pain In Chest And Arm

Posted on Wed, 6 Jan 2016

Question: I have been having pain on the left side of my chest and in my left arm for over a year. I am a 28 year old male, with no family history of heart issues. i have been to several doctors, none of which can tell me what is going on. I have had EKG's, Nuclear Stress test, blood work, ct scan; all of them came back good, and after nuclear stress test cardiologist said "well, we know its not your heart" Pain does not come on with exercise or anything in particular, i can just be sitting there and it starts, i am at a loss and I can't keep dealing with this! Please help!

Answered by Dr. Alexander H. Sheppe (13 minutes later)

Brief Answer:
Thorough work-up and further follow-up needed

Detailed Answer:
Hello, Welcome to HCM.
Thanks for your question.

I agree with your cardiologist. With a negative EKG, stress test, bloodwork, and CT scan, we have ruled out an issue with your heart. Especially given your age, a heart issue was exceedingly unlikely in the first place. This means the most likely cause of this pain is anxiety.

What all anxiety medications have you tried?

Standard treatment is an antidepressant + a Benzodiazepine + Cognitive Behavioral Therapy (CBT). If you have not tried this type of triple therapy, this is what needs to be started immediately.

I offer CBT therapy on this website. If you are interested in this type of therapy, or in talking about this issue in more detail, I encourage you to contact me at my private link below. After asking a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, or individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Alexander H. Sheppe (18 minutes later)

Thank you for your reply. I have been on everything from Paxil to Zoloft along with ativan. Currently im prescribed Mirtazapine 45 MG with 1.5 MG Ativan. It is not helping with the chest or arm Pain. The pain in the arm is upper backside of the arm and its like a dull ache. I also get pain in left shoulder blade/back and sometimes stiffness in my neck.. The Chest pain is always on the left side.. If anxiety related why is it I never feel anxious when this pain is occurring? None of the doctors who said anxiety could answer this, and those who say structural/musculoskelatal can't tell me what would cause all those symptoms together.

Answered by Dr. Alexander H. Sheppe (2 minutes later)

Brief Answer:
Followup

Detailed Answer:
Thanks for this additional information.

I would try an SNRI antidepressant for you. These work for anxiety as well as for muscular pain, and would therefore address both problems.

Examples of SNRIs include Effexor, Cymbalta, and Pristiq. Mirtazapine is a weak antidepressant at best and is probably not doing the job.

I would also switch the Ativan to a long-lasting form such as Klonopin that would last all day.

You can certainly have pain in the absence of anxiety. These are called Somatic symptoms and are common ways the body manifests anxiety without you realizing it. That's why your description is entirely consistent with an anxiety diagnosis.

Have you tried CBT? If you are interested in discussing this further, contact me at my private link:

tinyurl.com/DrSheppeAnswers

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Alexander H. Sheppe (35 minutes later)

Yes I am in therapy now as well... Effexor was actually the first thing they put me on, however i had a negative reaction to it. I have never been on Klonopin, the only other medicine like that I have been on was xanax but only .25 mg. Would the anxiety cause the muscles in my chest to be severely tender to the touch, almost like a severe bruise after i have one of these episodes?? I will speak to doctor about trying a different medication combination. I actually go to the VA but mental health is the one area it is easy to get in touch with your doctor. I also forgot to mention that my BP has been a little elevated since this started avg around 130/85-90, but usually drops back down to normal range, but when i arrived at hospital the first few times this happened it spiked as high as 170/120, before going right back down.. I apologize for leaving that out.

Answered by Dr. Alexander H. Sheppe (3 minutes later)

Brief Answer:
Further Follow-up required.

Detailed Answer:
Welcome back to HCM.

The blood pressure is not relevant here.

I would speak to your doctor about making the medication changes I suggested to help your anxiety.

Cymbalta and Klonopin seem to be the best options to me.

tinyurl.com/DrSheppeAnswers

Above answer was peer-reviewed by : Dr. Arnab Banerjee