Right Chest Pain: When to Seek Medical Help - Rehabilitation

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Understanding right chest pain can be quite complex, especially when it is accompanied by other symptoms like back pain and discomfort during breathing. Given your description, it seems that you have already consulted multiple specialists, including a pulmonologist and an orthopedic doctor, without finding a definitive cause for your pain. This can be frustrating, but it's important to approach this systematically.

Firstly, the pain you are experiencing in your right chest that worsens with breathing could be due to several factors. Since you've already had X-rays that showed no significant issues, we can rule out major structural problems like fractures or significant lung issues. The fact that the pain radiates to your back and underarm area suggests that it could be related to muscular or nerve issues rather than a direct problem with the lungs or heart.

1. Musculoskeletal Issues: Given that the initial assessment pointed towards a muscle strain, it is possible that you are dealing with a myofascial pain syndrome. This condition can cause localized pain in the muscles and can sometimes refer pain to other areas, such as the back or ribs. If muscle relaxants and pain medications have not provided relief, physical therapy might be beneficial. A physical therapist can assess your posture, movement patterns, and muscle strength to develop a tailored rehabilitation program.

2. Nerve Involvement: Since you mentioned that you are considering seeing a neurologist, this is a wise choice. Nerve compression or irritation, such as from a herniated disc in the cervical or thoracic spine, could lead to pain that radiates to the chest and back. Nerve conduction studies and possibly an MRI of the spine could help identify any nerve-related issues.

3. Referred Pain: Sometimes, pain in the chest can be referred from other areas, such as the abdomen or even the heart. Although you mentioned that you have not experienced any trauma, it is still important to consider all possibilities. Conditions like gallbladder disease or even cardiac issues (though less likely given your age and lack of risk factors) can present with similar symptoms. If you have any risk factors for heart disease (such as family history, smoking, high blood pressure, etc.), it would be prudent to discuss this with your doctor.

4. Psychosomatic Factors: Chronic pain can sometimes be exacerbated by stress or anxiety. If you find that your pain worsens with stress or emotional turmoil, it might be worth exploring this aspect with a mental health professional or a pain management specialist.

In summary, I recommend the following steps:
- Consult a Neurologist: Since you are already considering this, it would be beneficial to get a thorough neurological evaluation, including nerve conduction studies and possibly imaging of the spine.


- Physical Therapy: Engage in physical therapy focused on the thoracic and cervical spine, as well as the muscles of the chest and back. This can help alleviate muscular pain and improve function.

- Consider a Pain Management Specialist: If your pain persists, a pain management specialist can provide additional options, including injections or alternative therapies.

- Follow-Up with Your Primary Care Physician: Keep your primary care physician in the loop regarding your symptoms and any new developments. They can help coordinate your care and ensure that all potential causes are being investigated.

It's essential to remain proactive about your health and seek further evaluations until you find a satisfactory explanation for your symptoms. Pain can be a complex issue, and sometimes it takes time and persistence to arrive at the right diagnosis and treatment plan.