Chest Trauma: Pain Management and Recovery Tips

Today, I went to see the thoracic surgery department again?

Hello Doctor, I was in a car accident on January 28, and it seems I hit my chest.
Since then, I have been experiencing pain in that area, which was initially rated at 3 to 4 out of 10.
I went to the emergency room where an X-ray was taken.
I have a history of pneumothorax (on the right side), but this injury is on the left side, and I also have moderate scoliosis, so I was unsure if that would affect anything.
The doctor examined me closely and did not find any signs of hemothorax or pneumothorax.
The X-rays showed no fractures or bone injuries.
However, after returning home, I experience severe pain (6 to 8 out of 10) when lying flat.
Deep breathing causes pain to radiate from the side of my chest to the front and even to my back.
Turning over or getting up also causes pain, and I feel a sensation as if something inside is being compressed, like a ball expanding and contracting.
This sensation is present both in the front of my chest and in a specific area on my back.
After sitting up, I still experience pain for a while, but it gradually decreases from an 8 to a 1, or even becomes unnoticeable.
However, I experience pain every night when going to bed, and the discomfort when lying flat is worse than when sitting up.
There are still painful spots upon palpation, but I cannot determine if the pain is from bone or muscle; it feels deeper.
Last week, I returned to the surgical clinic, and the doctor, after hearing my description, suspected a chest wall contusion and prescribed muscle relaxants.
Due to my history of drug allergies, he did not prescribe any pain medication at that time, but I still felt uncomfortable.
Today, I decided to return for a follow-up because the pain seemed to have increased.
I consulted a thoracic surgeon, who ordered another X-ray.
The doctor reviewed the results and also did not see any abnormalities, agreeing that it is likely a chest wall contusion.
However, since I reported significant pain, he prescribed Fentanyl, stating that this pain medication has a slight sedative effect and contains different ingredients from the medications I am allergic to, so I could try it.
My question is, after two follow-ups, aside from the discomfort mentioned, why does sitting for a while not cause pain, while lying down does? This symptom is peculiar.
I have looked into rib fractures, which have similar symptoms, but the X-ray did not show any issues.
There is also some concern about mediastinal emphysema, which feels somewhat similar but not quite the same as pneumothorax.
If it is a chest wall contusion, how should I rest? Should I just sleep and sit normally, or do I need to engage in some normal activities? I read online that regardless of the type of injury, as long as it is not severe, some appropriate activity is necessary.
When I had pneumothorax, the doctors encouraged me to move as much as possible and practice deep breathing and side sleeping.
If I sleep on the affected side, is that inappropriate? However, it seems more comfortable to sleep on the affected side than the other side, and getting up from the other side causes more pain.
Getting up from the affected side is less painful.
Should I lie flat with a cushion under my back to avoid lying too flat? Or should I lie down? Additionally, when should I return for follow-up if I experience any discomfort? How long will it take to recover to normal? Do I need to see a rehabilitation specialist for treatment? I am quite concerned that this injury might affect my ability to ride my road bike comfortably in the future.
I understand that online inquiries can only serve as a reference, and I still need to seek medical attention, but I have already seen three different doctors, and their answers have all been consistent.

Mr. Chen, 30~39 year old female. Ask Date: 2023/02/08

Dr. Chen Bingze reply Surgery

It has been almost two weeks since your injury, and there shouldn't be any major issues.
It is likely that the pain you are experiencing is due to contusions in the chest, which can cause fascia and muscle pain.
Sometimes, this type of pain can persist for quite a while.
If you are allergic to a certain pain reliever, you might want to try acetaminophen combined with a muscle relaxant, which should still provide some relief.

Reply Date: 2023/02/08

More Info

Chest trauma can be a complex and concerning issue, especially following a car accident. Your symptoms suggest that you may be experiencing a chest wall contusion, which is a bruise of the chest wall that can cause significant pain, particularly when lying down or taking deep breaths. Here’s a comprehensive overview of your situation and some recommendations for managing your recovery.

Understanding Your Symptoms
1. Pain on Lying Down: The fact that you experience increased pain when lying flat could be due to the pressure on the chest wall and the surrounding muscles. This is common in cases of contusion or soft tissue injury. When you lie down, the weight of your body can exacerbate the pain in the affected area.

2. Radiating Pain: The pain radiating from the side of your chest to the front and back could indicate irritation of the intercostal muscles or nerves. These muscles can become strained during trauma, leading to pain that feels deep and may be exacerbated by movement or certain positions.

3. Feeling of Pressure: The sensation of something being compressed inside your chest could be related to muscle spasms or inflammation in the area. This can occur with contusions, where the muscles and soft tissues are bruised and may spasm in response to pain.

Management and Recovery Tips
1. Rest and Positioning: It’s important to find a comfortable position that minimizes your pain. If lying flat is uncomfortable, consider propping yourself up with pillows to create a more inclined position. This can help alleviate pressure on the chest wall and may reduce pain during sleep.

2. Pain Management: Since you have a history of medication allergies, it’s crucial to communicate this with your healthcare provider. The muscle relaxant prescribed may help alleviate some discomfort, but if pain persists, discuss alternative pain management strategies with your doctor. Over-the-counter pain relievers like acetaminophen or ibuprofen may be options if you are not allergic.

3. Breathing Exercises: Deep breathing exercises can help prevent complications such as pneumonia, especially after chest trauma. Try to take slow, deep breaths several times an hour, even if it causes some discomfort. This will help keep your lungs clear and promote healing.

4. Gentle Activity: While rest is important, gentle movement is also beneficial. Avoid strenuous activities, but try to incorporate light movements such as walking around your home. This can help improve circulation and prevent stiffness.

5. Heat Therapy: Applying a warm compress to the affected area may help reduce muscle tension and alleviate pain. Just ensure that the heat is not too intense to avoid burns.

6. Follow-Up Care: Since you have already seen multiple doctors and received consistent feedback, it’s essential to continue monitoring your symptoms. If you notice any worsening of pain, difficulty breathing, or new symptoms such as fever, seek medical attention promptly.

7. Physical Therapy: If your pain persists or limits your daily activities, consider asking your doctor about a referral to a physical therapist. They can provide targeted exercises to strengthen the chest muscles and improve flexibility, which may help alleviate pain over time.

When to Seek Further Medical Attention
- Increased Pain: If your pain escalates significantly or becomes unmanageable despite medication.

- Breathing Difficulties: If you experience shortness of breath, wheezing, or any new respiratory symptoms.

- Signs of Infection: Such as fever, chills, or increased redness and swelling around the injury site.

Recovery Timeline
Recovery from chest wall contusions can vary widely depending on the severity of the injury and individual factors such as age and overall health. Generally, mild to moderate contusions may take a few weeks to heal, while more severe injuries could take longer. Regular follow-ups with your healthcare provider will help track your progress and adjust your treatment plan as needed.

In conclusion, while your symptoms are concerning, they are not uncommon following chest trauma. By managing your pain, engaging in gentle activities, and following your doctor's advice, you can facilitate your recovery. Always keep an open line of communication with your healthcare providers to ensure that your treatment plan is tailored to your specific needs.

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