Chest Pain After a Car Accident: Causes and Next Steps - Pulmonology

Hello, Director Huang. I have been experiencing pain after a recent car accident?

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On January 28, I went to the emergency room after a car accident.
Besides external bruises, I experienced left-sided chest pain rated around 2 to 4 out of 10.
The pain felt like it was on the surface of the skin (with the main injuries on the left side).
However, after an X-ray, the doctor said there were no abnormalities.
I have a history of spontaneous pneumothorax on the right side and moderate scoliosis in an S-shape.

As days passed, the pain worsened, and by the third day post-accident, it escalated to about 8 out of 10, with the most intense pain occurring while lying down.
The primary pain was located in the upper left chest and back, with secondary pain points in the lower left rib area and on the side.
Pressing on the affected areas also elicited significant pain.
When I moved, such as getting out of bed or rolling over, I experienced a sensation similar to an internal ball being compressed and contracting (the sensation was in the left upper back).

Upon standing and walking after getting out of bed, the left upper chest area would also hurt due to vibrations.
When I sat down, the pain in the left upper chest would gradually move down, and after about 20 minutes, the primary pain point shifted, with the left upper chest pain subsiding and the pain level decreasing to 6 out of 10 (but it would flare up if I accidentally bumped it).
Additionally, the pain would radiate to the left lower rib and transition from the upper back to the lower back.
After sitting for about 40 minutes, the pain would diminish significantly, and upon touching the two affected areas, only the left lower rib would have slight pain, reducing to about 3 out of 10 or even none.
However, once I lay down, the pain would return, particularly in the left upper chest near the center, escalating back to 7 out of 10.
Sometimes, while lying down, I would also feel that ball-compression sensation, making sitting more comfortable than lying flat.
To alleviate the pain while lying down, I used a pillow to elevate myself to about a 30-degree angle, which provided some relief.
I returned to the thoracic surgeon on February 3 and February 7, seeing different doctors.
On February 3, the doctor only reviewed the X-ray from the emergency visit and found no abnormalities, prescribing muscle relaxants.
On February 7, after listening to my complaints, the doctor ordered another X-ray, which also showed no abnormalities.
Both doctors diagnosed the pain as likely due to chest contusions, noting no signs of pneumothorax or fractures, and prescribed medications including muscle relaxants.
However, due to a history of allergic reactions to pain medications that caused rashes and required steroids, the doctor assured me that the prescribed medication contained different components.
Still, if I experienced side effects like dizziness, I should refrain from taking it.

After taking the medication, I felt extremely drowsy, and I was uncertain if I developed a rash, as I had a small itchy bump, prompting me to stop the medication.
Since I have already had two follow-up visits, I would like to ask the doctor why the pain points shift, particularly from lying down to sitting, and why they gradually move downward over time.
If it were a fracture, I wouldn't expect the pain to shift like this.
Could the pain from chest muscle contusions and fascia cause this movement? Or could it be due to another type of internal injury? However, if it were a severe injury, the doctor mentioned that it wouldn't be possible for me to move around comfortably since January 28.
My previous pneumothorax pain was much more severe, with deep breaths causing intense coughing and a feeling of lung expansion being restricted (at that time, I had already undergone thoracoscopic surgery for the right pneumothorax), along with breathing difficulties.

Currently, although my breathing is sometimes not smooth, it is due to my scoliosis rather than respiratory distress.
Could my scoliosis be contributing to the symptoms from the chest contusion? I plan to observe for about a week, and if the pain persists, I am considering whether to continue seeing the thoracic surgeon or to go directly to rehabilitation.
I have read that recovery can take as little as one week or as long as two to three weeks, although the doctor mentioned it could take longer, especially since I have scoliosis.

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Mr. Chen, 30~39 year old female. Ask Date: 2023/02/09