Which Specialist Should I See for My Chest and Back Pain?

Which specialty should I see?

Hello doctor, I am a 21-year-old female.
Recently, I have been experiencing pain in the center of my chest and below my left breast, as well as pain in my upper back near the shoulder blades.
My hands feel numb at times, and I occasionally notice my heart beating heavily or faster than usual.
I went to the hospital, where I had a chest X-ray, an electrocardiogram, and blood tests.
After being observed overnight, the hospital reported that they found no issues and advised me to return for a follow-up in two months.

I also feel some weakness in my limbs, and my fingertips tend to feel cold.
After eating, I sometimes experience chest pain, followed by frequent burping and flatulence, which seems like a gastrointestinal issue.
My stools have been brown and yellow, both of a soft consistency.
About a month ago, I had a night when my entire neck, left shoulder, and left chest, along with my left back, felt a pulling pain regardless of my position.
During the night, I felt a sudden aching and trembling sensation in my left chest, followed by a feeling of coldness.

The next day, while sitting by the counter, the pain subsided, but when I hurried to stand up, I felt dizzy and had a sharp pain in my back.
I have previously been diagnosed with nerve root compression due to carrying heavy objects on one side, which has caused my left shoulder muscles to become tight, resulting in uneven shoulders.
I am unsure if this is affecting my sternum.
Additionally, I experience pain near my left hip close to the pelvis when I stretch.
I have also been diagnosed with a mild panic disorder, and I wonder if my physical discomfort could be influenced by psychological factors.
Should I consult a psychiatrist, a gastroenterologist, a cardiologist, or an orthopedic specialist? I feel uncomfortable every day, and it is very distressing.
I am also afraid that something might be seriously wrong.
Thank you for your response, doctor.

Chan, 20~29 year old female. Ask Date: 2018/05/24

Dr. Liao Yaopan reply Family Medicine

Hello, based on your description, it is still recommended to consult a relevant subspecialist to assess for any physiological abnormalities.
If no related issues are found, it is possible that the physical discomfort may be due to psychological factors.
Please note: online consultations are not equivalent to in-person medical visits and cannot provide diagnoses or treatment recommendations.
Changhua Hospital cares about you.

Reply Date: 2018/05/24

More Info

Based on your description of symptoms, it seems that you are experiencing a complex interplay of physical and possibly psychological issues. Given the variety of symptoms you have mentioned, including chest pain, back pain, numbness in your hands, and gastrointestinal discomfort, it is essential to approach this situation methodically.

1. Chest Pain and Cardiac Concerns: Since you have experienced chest pain and heavy heartbeats, it is crucial to rule out any cardiac issues first. Although you have already undergone chest X-rays, an electrocardiogram (ECG), and blood tests without any immediate findings, if the symptoms persist or worsen, it may be beneficial to consult a cardiologist for further evaluation. They might recommend additional tests, such as a stress test or echocardiogram, to assess your heart's function more thoroughly.

2. Musculoskeletal Issues: Your description of back pain, particularly around the scapula (butterfly bone), and the history of nerve root compression suggests that there may be underlying musculoskeletal issues. A visit to an orthopedic specialist or a physical medicine and rehabilitation (PM&R) physician could be beneficial. They can evaluate your posture, muscle strength, and any potential nerve involvement. Physical therapy might also be recommended to strengthen the muscles around your spine and improve your posture, which could alleviate some of the pain.

3. Gastrointestinal Symptoms: The gastrointestinal symptoms you mentioned, such as chest pain after eating, excessive belching, and changes in bowel movements, could indicate a gastrointestinal issue. Consulting a gastroenterologist would be advisable to explore conditions such as gastroesophageal reflux disease (GERD) or other digestive disorders. They may recommend dietary changes, medications, or further diagnostic tests like an endoscopy if necessary.

4. Psychological Factors: Given your history of panic disorder and the anxiety symptoms you described, it is also essential to consider the psychological aspect of your condition. Anxiety can manifest physically, leading to symptoms such as chest pain, palpitations, and muscle tension. A consultation with a mental health professional, such as a psychologist or psychiatrist, could provide you with coping strategies and possibly medication to help manage anxiety.

5. Multidisciplinary Approach: Given the complexity of your symptoms, a multidisciplinary approach may be the most effective. This means working with various specialists, including a cardiologist, orthopedic specialist, gastroenterologist, and mental health professional, to address all aspects of your health.

In summary, I recommend starting with a visit to a cardiologist to rule out any heart-related issues, followed by consultations with an orthopedic specialist for your musculoskeletal pain and a gastroenterologist for your gastrointestinal symptoms. Additionally, consider seeking support from a mental health professional to address any anxiety that may be contributing to your physical discomfort. Keeping a detailed diary of your symptoms, including when they occur and any potential triggers, can also be helpful for your healthcare providers in diagnosing and treating your condition effectively.

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