Chest Pain: Causes, Concerns, and Connections to Back Pain

Chest tightness or chest discomfort?

Hello, doctor.
Recently, I've suddenly experienced chest tightness and pain over the past few weeks.
Sometimes it’s on the left side, sometimes on the right, and the location of the pain varies.
It seems to move around.
I went to the hospital for an electrocardiogram, a chest X-ray, and blood tests, and the doctors said everything was fine.
However, the chest pain issue persists.
In the last few days, I've also started to feel pain in my back, especially around the spine.
I visited a local clinic recently, and the doctor told me that the pain in my back is related to my spine, which in turn affects the chest pain.
He mentioned that the nerves in the back are connected to the nerves in the chest, indicating a relationship between the two.
The question is whether the back pain is causing the chest pain or vice versa.
The pain sensation started in my chest.
I looked up some symptoms of myocardial infarction online, and some symptoms seem similar, such as numbness in the left arm, soreness in the left shoulder, and stiffness in the left neck.
I'm really afraid of having a sudden heart attack.
I haven’t been sleeping well these days, fearing that I might just disappear.
I’m not sure what you think about my symptoms.

Huang Shuai Ge, 40~49 year old female. Ask Date: 2016/12/22

Dr. Hong Yuanbin reply Internal Medicine

Hello, chest pain is often most concerning for heart disease.
The heart is located on the left side of the body, and based on your description, it occasionally radiates to the right side.
The symptoms you describe do not strongly resemble typical heart disease, which usually shows abnormalities in an electrocardiogram (ECG) and blood tests for cardiac enzymes.
If your tests are normal, it is likely not a heart-related issue.

Based on your description, there are three potential conditions that may be most likely:
1.
Spinal nerve compression: You may want to consult an orthopedic specialist.
A preliminary assessment can be made with a spinal X-ray, and if necessary, an MRI may be required.
2.
I am not sure if you have had a recent cold, but pleuritis (inflammation of the pleura) can occur after a cold or severe coughing, which may cause similar symptoms.
The hallmark of pleuritis is that deep breathing tends to be more painful.
If this is the case, there is no need to worry; usually, taking some acetaminophen or anti-inflammatory medication will help, and you should recover in a few days.
3.
I am also unsure if you have recently lifted heavy objects or engaged in activities or positions that you do not usually do, or if you have experienced a strain.
These situations can also lead to the symptoms you described, and typically, resting for a few days will suffice for recovery.
Thank you for your inquiry.

Reply Date: 2016/12/22

More Info

Chest pain can be a concerning symptom, and it’s understandable that you’re feeling anxious about it, especially given the potential seriousness of conditions like myocardial infarction (heart attack). However, it’s important to consider the various potential causes of chest pain, as not all of them are related to the heart.

From your description, it seems that you have experienced intermittent chest pain that shifts in location, which can be indicative of several different issues. Since you have already undergone tests such as an electrocardiogram (ECG), chest X-ray, and blood tests, and your doctor has indicated that these results are normal, it’s a positive sign that serious cardiac issues have been ruled out.
The relationship between back pain and chest pain is indeed a complex one. The nerves that supply the chest area also originate from the spine, particularly from the thoracic region. This means that issues in the spine, such as muscle strain, herniated discs, or even poor posture, can lead to referred pain in the chest. Your doctor’s explanation about how back pain can influence chest pain is consistent with this understanding.
Musculoskeletal pain is one of the most common causes of chest pain, especially if the pain is sharp and changes with movement or position. Conditions such as costochondritis (inflammation of the cartilage connecting the ribs to the sternum) or muscle strain can cause pain that feels like it’s coming from the chest but is actually due to issues in the back or rib cage.

Given your symptoms, it’s also worth considering anxiety and stress as potential contributors. Anxiety can manifest physically, leading to muscle tension and pain in various areas, including the chest and back. If you find that your pain is exacerbated by stress or anxiety, addressing these underlying factors through relaxation techniques, therapy, or lifestyle changes may help alleviate your symptoms.

It’s also important to monitor your symptoms closely. If you experience any new symptoms, such as shortness of breath, severe pain, or changes in your heart rate, you should seek immediate medical attention. While your current symptoms may not indicate a heart issue, it’s always better to err on the side of caution.

In conclusion, while your symptoms are concerning, the normal results from your tests suggest that a serious cardiac issue is unlikely. The connection between your back and chest pain is plausible, and addressing any musculoskeletal issues, along with managing stress and anxiety, may provide relief. If your symptoms persist or worsen, consider following up with a healthcare provider who specializes in musculoskeletal disorders or a pain management specialist for further evaluation and treatment options.

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