Unexplained Chest and Back Pain: A Family Medicine Perspective

Q: Unexplained Chest and Back Pain: A Family Medicine Perspective

Hello： Although your discomfort is primarily concentrated above the waist, from my perspective, it is still important to address each issue separately. <br>I have broadly categorized your concerns into the following three items： <br>1. <br>Arrhythmia： Given your age, it is necess

Physical discomfort?

This year, I have occasionally experienced issues with arrhythmia, where my heart suddenly pauses.
I have undergone blood tests and various examinations, all of which came back normal.
However, today I experienced it again, but this time it occurred more frequently than usual.
After the episodes, I have pain in parts of my left palm and left arm, and I also have tenderness in my breast—not a swelling pain, but it hurts when I run and it gets touched.
This might be related to premenstrual symptoms, but the tenderness has only appeared in recent episodes.
Additionally, I have back pain, primarily in the upper back and near the sides of my waist.
I have been applying medication for over two months, but it hasn’t been very effective.
Could this be related to my slouching posture? Why are all my discomforts concentrated above the waist?

Ya Ya, 10~19 year old female. Ask Date: 2022/04/08

Dr. Lin Zhebin reply Family Medicine

Hello: Although your discomfort is primarily concentrated above the waist, from my perspective, it is still important to address each issue separately.
I have broadly categorized your concerns into the following three items:
1.
Arrhythmia: Given your age, it is necessary to check for hyperthyroidism or other endocrine system issues.
I would also recommend an echocardiogram and a 24-hour Holter monitor test.
The 24-hour Holter monitor is mainly to identify the type of arrhythmia you may be experiencing during episodes of discomfort.
I'm not sure if your previous examinations included these tests.
Additionally, cardiac issues can indeed cause discomfort in the jaw, left shoulder, and left arm, which is known as referred pain.
2.
Breast tenderness: This could indeed be related to premenstrual symptoms.
I suggest observing the tenderness after your menstrual period ends to see if there is any improvement.
If there is no improvement, then consider seeking medical evaluation.
3.
Back pain: Since your back pain has persisted for at least two months, I recommend getting it checked by a healthcare professional.
Furthermore, your back pain is likely related to your kyphosis.
If there is no history of trauma, it is usually associated with prolonged poor posture, leading to localized muscle and soft tissue tightness.
Topical medications may provide only temporary relief; the fundamental approach should focus on improving your posture and incorporating exercises, stretching, and massage to alleviate muscle tightness and strengthen your core muscles.

Reply Date: 2022/04/08

More Info

Understanding unexplained chest and back pain can be quite complex, especially when multiple symptoms are involved, as in your case. It’s essential to approach this from a comprehensive family medicine perspective, considering both physical and psychological factors that may contribute to your discomfort.

Firstly, the symptoms you describe—irregular heartbeats, left arm and hand pain, breast tenderness, and upper back pain—can be indicative of several underlying issues. While you have undergone various tests that returned normal results, it’s crucial to recognize that not all conditions are easily detectable through standard blood tests or imaging studies. Conditions such as anxiety, musculoskeletal disorders, or even gastrointestinal issues can manifest as chest and back pain.

Potential Causes of Your Symptoms
1. Musculoskeletal Issues: Given your mention of back pain, particularly in the upper back and sides, it’s possible that poor posture, such as slouching or hunching over, could be contributing to your discomfort. Muscles and ligaments can become strained from improper alignment, leading to pain that radiates to other areas, including the chest and arms. Engaging in exercises that strengthen your core and improve your posture may alleviate some of this pain.

2. Cardiac Concerns: Although your tests have returned normal, the combination of chest pain and arm pain should not be ignored. It’s essential to discuss these symptoms with your healthcare provider, especially if they persist or worsen. Sometimes, conditions like angina or even anxiety-induced palpitations can cause similar symptoms.
3. Anxiety and Stress: Psychological factors can significantly impact physical health. Anxiety can lead to muscle tension, which may cause pain in various areas, including the chest and back. If you find that your symptoms worsen during stressful periods, it may be beneficial to explore stress management techniques, such as mindfulness, yoga, or cognitive-behavioral therapy.

4. Hormonal Changes: You mentioned that your breast tenderness might be related to premenstrual symptoms. Hormonal fluctuations can lead to various physical symptoms, including breast pain and changes in mood or anxiety levels. Keeping a symptom diary to track these changes in relation to your menstrual cycle could provide valuable insights.

5. Referred Pain: Sometimes, pain in one area of the body can be referred from another. For example, issues with the spine or muscles in the back can lead to sensations of pain in the chest or arms. A thorough evaluation by a physical therapist or a specialist in musculoskeletal disorders may help identify any underlying issues.

Recommendations for Management
1. Consult a Family Medicine Physician: It’s advisable to have a comprehensive evaluation with a family medicine physician who can take a holistic view of your symptoms. They can coordinate care, possibly referring you to specialists if needed.

2. Physical Therapy: Engaging in physical therapy can help address musculoskeletal issues. A physical therapist can provide exercises tailored to improve your posture, strengthen your back, and alleviate pain.

3. Lifestyle Modifications: Incorporating regular physical activity, maintaining a healthy weight, and practicing good posture can significantly impact your overall health and may help reduce pain.

4. Stress Management: Techniques such as deep breathing exercises, meditation, or yoga can help manage anxiety and reduce muscle tension.

5. Follow-Up: Regular follow-ups with your healthcare provider are essential to monitor your symptoms and adjust your treatment plan as necessary.

In conclusion, while your symptoms may seem overwhelming, a systematic approach involving a thorough evaluation, lifestyle changes, and possibly physical therapy can lead to significant improvements. It’s essential to communicate openly with your healthcare providers about all your symptoms and concerns to ensure a comprehensive treatment plan.

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