Therapy | Chest pain causes and therapy

Therapy

The therapy of chest pain depends entirely on the triggering cause (see corresponding clinical pictures). In the case of muscular or skeletal causes, medication with analgesic or antispasmodic drugs (e.g. ibuprofen) can be used. Psychogenic causes should be further treated by an established specialist in psychiatry.

When can chest pain occur?

Chest pain that can occur during breathing can come from the lungs, pleura, surrounding muscle and bone structures or nerves. Many inflammatory respiratory diseases cause pain when breathing. Usually this is limited to an unpleasant pulling sensation when breathing in and out deeply, but a severe cough can also cause pain (see: Pain when coughing).

Pneumonia itself does not usually cause pain. However, if it is not treated, it may spread further. It can happen that the pleura, the pleura, is also affected.

The pleura surrounds the entire lung with one layer and lies with its other layer on the inside of the chest. Between the layers is the pleural gap, which is filled with pleural fluid and ensures that the lung is opened up during the breathing movement. In the case of severe pneumonia, the pleura can also become inflamed, resulting in painful pleuritis (inflammation of the pleura).

With each breath the inflamed tissue is irritated again and causes pain. Muscles can also become inflamed. If this happens to parts of the respiratory muscles, for example the intercostal muscles, the inflammation leads to painful breathing.

The lung tissue, including the pleura, can tear in the event of inflammation or due to traumatic effects (accident, etc.). The negative pressure in the pleural gap, which otherwise holds the lung in place, is lost and the lung collapses (collapses and can no longer be used for breathing). This causes sudden stabbing pain, partly dependent on breathing.

Another traumatic change can be a broken rib. This can also cause chest pain when breathing: on the one hand, due to the damaged tissue with nerve contact, on the other hand, due to bone fragments piercing the surrounding tissue or lungs. Intercostal neuralgia (intercostal = between the ribs; neuralgia = nerve pain) can also be the cause of chest pain while breathing.

The causes of such neuralgia are controversial and a plausible explanation cannot always be found. The intercostal nerves, which run between the ribs, are hypersensitive and react to every movement with pain – also when breathing. Pregnancy means a change for every expectant mother.

The body tries to prepare itself in the best possible way for the care of a growing person in the womb. There are also changes that are intended to adjust the nutrition after delivery. A cardiovascular system disease, which is in principle associated with chest pain, does occur – gestational hypertension – but does not lead to chest pain.

There is a risk that bronchial asthma develops due to the enormous changes in the female body. Women who were already ill before pregnancy are particularly susceptible to this. In bronchial asthma, the airways in the lungs become narrower and a seizure can cause breathing difficulties.

In connection with this, those affected often describe chest pain. The risk of developing gallstone disease is increased during pregnancy. A gallstone, which can vary in size, lies in the bile duct.

This causes the muscles surrounding the stone to spasm, which leads to so-called biliary colic, a combative, extremely strong pain. Although the gall bladder and the bile duct are located in the abdominal cavity, they can still project the pain into it due to their local proximity to the thorax. Processes in the female breast (mamma) can also trigger chest pain.

Hormone levels are readjusted during pregnancy. This influences the development of the mother’s breast. The mammary glands continue to develop and prepare for future production.

The tissue is strained – this can lead to feelings of tension in the skin and to sensitivity to pressure. Another possibility where breast pain can come from is an inflammation of the mammary glands. Although this only develops after birth, it is caused by the act of breastfeeding.

When the baby drinks, it transmits bacteria to the nipple, which migrate and cause the inflammation of the mammary gland – mastitis puerperalis. Ovulation is at the centre of the female cycle. Before ovulation, in the periovulatory phase, the level of estrogen in the woman’s blood continues to rise.

This not only leads to maturation of the egg cell, but also has an effect on the female breast. The oestrogen reaches its highest point shortly before or during ovulation and thus has the strongest effect on the breast tissue. In this tissue, the hormone promotes the storage of fatty tissue and water, which causes the skin over the breast to become tight and the breast to become painful.

After ovulation, the oestrogen level falls sharply, but rises again slightly and continuously after a short time. This second increase can also have the same effect on the breast tissue as described above. Breast pain can of course be independent of the cycle and still occur during or after ovulation.

However, most women notice that the cause of the pain is of a different origin. The female breast can hurt both during and after breastfeeding. Breast pain can have various causes.

Some women are more sensitive to the breast than others. Sucking the baby can be very painful. If the baby gets teeth relatively early, breast pain can be caused by the unwanted biting.

Many mothers fear a milk congestion because it is very painful and they are afraid that they will not be able to continue breastfeeding. However, due to good treatment options, the prognosis is very good. Milk congestion is a build-up of breast milk produced in the glandular tissue because the fluid already present has not drained or could not drain.

As a result, the breast becomes hard and painful. An inflammation of the mammary glands can also lead to pain. The baby transmits pathogens to the nipple during the drinking process. These migrate there and establish themselves – this leads to mastitis puerperalis, an inflammation of the mammary glands.