Chest pain causes and therapy

Synonym

Chest pain, sternal pain, chest pains.

Definition of chest pain

Chest pain is a term used to describe pain whose cause is either in the chest and can be located there or in other parts of the body and radiates into the chest. Chest pain is usually complained of by middle-aged patients. The symptom complex is not yet present in small children, while in children between 12 and 14 years of age it increases to a percentage of 1.4%.

3.7% of patients aged 45-64 years and 2.8% of patients over 74 years complain of chest pain. Women and men suffer from it about equally frequently, with women complaining of complaints at a later age. Breast pain can be experienced by the patient in very different forms, in terms of strength and pain character.

For example, patients may complain of dull pain in the area of the breast or of pulling, cutting and burning sensations in this area. The intensity of the pain ranges from slight pain that can only be triggered in certain situations to the strongest pain that triggers fear of death, which patients usually have never had before in this form. Various side effects can occur when taking the pill, including chest pain.

There are fundamental differences between the various contraceptives – while condoms are based on a mechanical protection principle, the Pill causes hormonal changes in the woman which prevent fertilisation. Depending on the composition of the active ingredients in the Pill, different hormones are affected. The micro pill, which is usually prescribed, is a further development of the contraceptive pill and contains both progestins and oestrogens.

The latter act on the female breast. They promote the storage of fat and water in the breast tissue. This increases the size of the breast and can lead to painful tension in the corresponding area of the skin, but also internally in the tissue.

If the side effects are too strong, you should consider together with your gynaecologist whether a change to another preparation is advisable. The minipill, which is often confused with the micropill, does not contain any estrogens, for example, and only affects the progestin level. This affects the consistency of the cervical mucus and thus mechanically prevents sperm from entering the cervix.

Progestins have no corresponding effect on the female breast. Nerve pain (called neuralgia or neuropathic pain in medical terminology) is pain that is caused by damage to peripheral nerves. This can be caused by mechanical pressure, for example in the course of a herniated disc in the thoracic spine, or by metabolic disorders, for example diabetes mellitus.

Inflammatory processes, such as those occurring in multiple sclerosis, can also trigger nerve pain. Damage caused by radiation or burns is also possible, although much less common. This can damage various nerve components.

On the one hand, the nerve fibres can be directly affected. For reasons not yet clarified, a kind of numbness develops in the supply area of the nerve at the beginning, which can often turn into pain later on. Damage to the myelin sheath, which isolates the nerve from surrounding tissue and other nerves, is much more common.

Typically, this is characterized by a sudden onset of severe (neuralgiform) pain caused by the skipping of electrical impulses. Finally, a neuralgia, also known as intercostal neuralgia in the thorax, can also be caused by a circulatory disorder of the nerve, for example by pressure on the nerve or metabolic disorders. This usually disappears as soon as the mechanical pressure is removed.

This is probably the most likely cause of neuropathic pain in the chest area. The mechanical irritation of the nerves (in this case the rami mammarii of the intercostal nerves) is usually caused by an incarceration between the ribs and the muscles in between. Pain can be caused by movement or by touching the skin area supplied by the nerves, which is usually not painful.

A causal treatment is always the ideal solution for nerve pain. In the case of chest pain, however, this is difficult because the cause is often not completely clear. However, a number of drugs can be used for symptomatic treatment.

Antidepressants (e.g. amitryptilin, venlafaxine or citalopram) are primarily used for this purpose. Also effective are anticonvulsants (e.g. carbamazepine), which are also prescribed to treat epileptic seizures, and opioids. For some time now, capsaicin, the substance responsible for the pungency in chilli, has also been used in combination with local anaesthetics with good long-term effects.

Inflammation of the nerves or neuritis is an inflammatory disease of one (mononeuritis) or more nerves (in this case called polyneuritis). If the inflammation is located at the nerve root at the exit of the nerve from the spinal cord, it is called radiculitis (from Latin radicula, “small root”). The causes of nerve inflammation are manifold.

Very common are infectious processes, especially virus infections, or traumatic events. Toxic or metabolic causes, for example in the context of diabetes mellitus or alcohol abuse, are also not rare. Allergic backgrounds or circulatory disorders are also possible causes.

In many cases, neuritis is characterised by paralysis of the muscle supplied by the inflamed nerve. In the case of chest pain caused by nerve inflammation, however, numbness and pain in the skin area supplied by the nerve are more likely to be noticeable. These can typically be caused by normally non-painful touch in this area of the skin.

Side effects such as reddening of the skin and altered sweat secretion can also occur. Viruses are a quite common cause of nerve inflammation. The viral disease of shingles (herpes zoster) is particularly common in chest pain caused by nerve inflammation.

This disease represents a renewed infection with the chickenpox virus (varicella zoster virus), which has remained in nerve nodes since the first infection. It mainly affects older people or people with a weakened immune system. In more than half of the cases, the intercostal nerves are affected, which run between the ribs (intercostal) and are responsible for supplying the skin above the chest.

Early symptoms of herpes zoster can include a burning sensation in the chest and other pain of varying severity. In addition, there may be sensations on the skin and general symptoms such as fatigue and fever. In the following days, the skin symptoms typical of shingles finally appear in the form of painful skin blisters. Treatment is carried out with medication using virustatics.