Chest Pain: Causes Beyond Heart and Gastro Issues

Chest pain with tenderness upon palpation?

I have been experiencing chest pain for quite a long time, probably over a year (I haven't paid much attention to it).
I consulted a cardiologist, and an electrocardiogram showed no abnormalities.
I also saw a gastroenterologist; although I do have gastroesophageal reflux disease (GERD), I feel that my chest pain is different from the pain associated with GERD.
I don't have the burning sensation typical of heartburn.
I visited a pulmonologist and had an X-ray, which also showed no abnormalities.
Initially, the pain only occurred when pressed, located in the bone area, but for the past six months, it has been painful even without touch.
However, the pain is not unbearable, and I do not experience shortness of breath; deep breathing does not exacerbate the pain.
Both sides of the sternum hurt, but the left side is more painful.
There is also pain near the bones (left side of the chest on the right and right side of the chest on the left).
It does not affect my daily life, but I am puzzled about what the issue could be.
In middle school, I did slip and fall while getting off a bus, injuring my coccyx, but I didn't see a doctor at that time, thinking it wasn't serious.
I wonder if that fall could have caused any long-term effects? However, can an injury to the coccyx affect other areas? Currently, my coccyx only hurts after sitting for long periods, sitting on hard surfaces, or doing sit-ups; otherwise, it doesn't hurt.
Sometimes, I do experience lower back pain.

Qi Xuan, 20~29 year old female. Ask Date: 2021/11/22

Dr. Ye Qianyu reply Family Medicine

Hello! Chest pain should not be related to the coccyx.
Based on your description, there is tenderness over the sternum.
Since the sternum is thin and the skin covering this area is also thin, the sensory nerves in the periosteum are quite abundant, making it very sensitive to pressure, often resulting in noticeable tenderness.
It is recommended that you reduce pressure on the area and consider using topical analgesic ointments for relief.
If discomfort persists, please seek medical attention at a healthcare facility.

Reply Date: 2021/11/22

More Info

Understanding chest pain can be quite complex, especially when it has persisted for an extended period, as in your case. Given your history of gastrointestinal issues, particularly gastroesophageal reflux disease (GERD), and the fact that you've already consulted with cardiology and gastroenterology without finding any significant abnormalities, it’s essential to consider a broader range of potential causes for your chest pain.

Possible Causes of Chest Pain Beyond Cardiac and Gastrointestinal Issues
1. Musculoskeletal Pain: Your description of the pain being localized to the bones and the fact that it can be triggered by pressure suggests that musculoskeletal issues could be a significant factor. Conditions such as costochondritis, which is inflammation of the cartilage connecting the ribs to the sternum, can cause sharp pain in the chest that may mimic cardiac pain. This type of pain can be exacerbated by certain movements or positions and may not necessarily be related to any underlying heart or gastrointestinal condition.

2. Nerve-Related Pain: Another possibility is that the pain could be neuropathic in nature. Conditions such as intercostal neuralgia, where the nerves running between the ribs become inflamed or irritated, can lead to persistent chest pain that may not respond to typical treatments for heart or gastrointestinal issues.

3. Psychogenic Factors: Anxiety and stress can manifest as physical symptoms, including chest pain. If you have been experiencing anxiety or stress, this could contribute to your symptoms. Chest pain related to anxiety often does not correlate with physical activity and may be accompanied by other symptoms such as palpitations or a sense of impending doom.

4. Referred Pain: The body’s pain pathways can sometimes lead to referred pain, where discomfort in one area is felt in another. For instance, issues with the spine, particularly if you had a previous injury like the one you mentioned from your fall, could lead to pain that radiates to the chest area. The thoracic spine can influence the perception of pain in the chest, especially if there are underlying issues such as muscle strain or vertebral disc problems.

5. Chronic Conditions: Conditions like fibromyalgia or myofascial pain syndrome can also lead to chronic pain in various areas of the body, including the chest. These conditions are characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas.

Recommendations for Further Evaluation
Given the complexity of your symptoms and their persistence, it would be prudent to consider the following steps:
- Consult a Pain Specialist: A specialist in pain management can help evaluate your symptoms more thoroughly and may suggest treatments such as physical therapy, medications, or alternative therapies that could alleviate your discomfort.

- Physical Therapy: Engaging in physical therapy may help address any musculoskeletal issues, improve posture, and strengthen the muscles around your chest and back, potentially alleviating pain.

- Psychological Evaluation: If anxiety or stress is suspected, speaking with a mental health professional could provide strategies to manage these feelings, which may, in turn, help with your physical symptoms.

- Imaging Studies: If not already done, further imaging studies such as an MRI of the thoracic spine could help identify any underlying structural issues that may be contributing to your pain.

Conclusion
In summary, while your symptoms may initially seem to be linked to cardiac or gastrointestinal issues, there are numerous other potential causes for your chest pain. A thorough evaluation by a multidisciplinary team, including pain specialists, physical therapists, and possibly mental health professionals, may provide you with a clearer understanding of your condition and lead to effective management strategies. It’s important to continue advocating for your health and seeking answers until you find relief from your symptoms.

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