Persistent Chest Pain for Three Months: Which Specialist to Consult?

Chest pain has been present for more than three months?

Hello, I would like to ask about a situation that started three months ago.
While sleeping, I suddenly experienced difficulty breathing, followed by chest pain that feels close to my throat.
I have seen a rheumatologist (I have ankylosing spondylitis and have regular follow-ups) and also consulted a rehabilitation specialist, who prescribed muscle relaxants.
They provided some relief, but the pain returns, especially when I lie down to sleep each night, accompanied by a pulling sensation that makes it difficult to fall asleep.
This has been my ongoing condition.
Which specialty should I consult for this situation? Thank you, doctor.

Jienikesi, 20~29 year old female. Ask Date: 2017/09/14

Dr. Liao Yaopan reply Family Medicine

Hello, regarding your symptom description, it indeed presents as more non-specific signs.
I recommend consulting your family physician for an initial evaluation, and then determining if a referral to another specialty at Changhua Hospital is necessary.
Take care.

Reply Date: 2017/09/14

More Info

Persistent chest pain, especially when it has lasted for three months, is a concerning symptom that warrants careful evaluation. Given your history of ankylosing spondylitis and the nature of your symptoms, it is crucial to approach this situation methodically.

First and foremost, it is essential to understand that chest pain can arise from various sources, including musculoskeletal issues, gastrointestinal problems, and cardiac conditions. Since you have already consulted a rheumatologist and a rehabilitation specialist, it may be beneficial to consider a few additional avenues.

1. Cardiology: Given that chest pain can sometimes be indicative of heart-related issues, it would be prudent to consult a cardiologist. They can perform tests such as an electrocardiogram (ECG), echocardiogram, or stress tests to rule out any cardiac causes of your symptoms.

2. Pulmonology: If your chest pain is accompanied by breathing difficulties, a pulmonologist may be able to help. They can assess for any underlying respiratory conditions that might be contributing to your symptoms, such as asthma or other lung diseases.

3. Gastroenterology: Sometimes, chest pain can be related to gastrointestinal issues, such as acid reflux or esophageal spasms. A gastroenterologist can evaluate these possibilities and suggest appropriate treatments.

4. Pain Management or Orthopedics: Since you have a history of ankylosing spondylitis, which can lead to chronic pain and stiffness in the spine and chest area, consulting a pain management specialist or an orthopedic doctor may also be beneficial. They can provide targeted therapies, including physical therapy, injections, or other pain management strategies.

In addition to seeking further medical evaluation, there are several self-care strategies you might consider to help manage your symptoms:
- Physical Therapy: Engaging in physical therapy can help improve your posture, strengthen your back and chest muscles, and enhance your overall mobility. A physical therapist can design a program tailored to your specific needs, particularly considering your ankylosing spondylitis.

- Medication Review: Since you mentioned that muscle relaxants provided some relief, it might be worth discussing with your physician the possibility of adjusting your medication regimen. There may be other medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or even low-dose antidepressants, that can help manage chronic pain.

- Lifestyle Modifications: Incorporating gentle exercises like yoga or swimming can improve flexibility and reduce pain. Additionally, practicing relaxation techniques such as deep breathing, meditation, or mindfulness can help manage stress and may alleviate some of the discomfort associated with your symptoms.

- Sleep Hygiene: Since you mentioned difficulty sleeping, establishing a good sleep routine is crucial. Ensure your sleeping environment is comfortable and conducive to rest. Consider using supportive pillows to help maintain proper alignment while sleeping.

In summary, while it is essential to consult with specialists to rule out serious conditions, there are also various supportive measures you can take to help manage your persistent chest pain. It is crucial to communicate openly with your healthcare providers about your symptoms and any changes you experience, as this will guide them in providing the best care possible.

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