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Pain in chest wall and back: Costochondritis — Symptoms, Causes, Tests, and Treatment for Costochondritis — from WebMD


Costochondritis — Symptoms, Causes, Tests, and Treatment for Costochondritis — from WebMD

What Is Costochondritis?

Costochondritis is inflammation of the areas where your upper ribs join with the cartilage that holds them to your breastbone. These areas are called costochondral junctions. The condition causes chest pain, but it’s typically harmless and usually goes away without any treatment. But any chest pain in adults should be taken seriously, so you should be examined and tested for heart disease.

A rare condition called Tietze syndrome is often referred to as costochondritis, but the two are distinct conditions. You can tell the difference by the following:

  • Tietze syndrome usually comes on all of a sudden, with chest pain spreading to your arms or shoulder and lasting several weeks.

  • Tietze syndrome causes swelling at the painful area (where your ribs and breastbone meet). ​​​​​​​

Costochondritis Causes

Doctors don’t know exactly why costochondritis happens, but they do know that some things can lead to it: 

  • Repeated minor trauma to your chest wall
  • Overuse of your arms
  • Arthritis. Costochondritis can sometimes be a sign of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, or other conditions that affect your cartilage.
  • Tumors. These can move from joints and other parts of your body and settle in your chest.
  • Respiratory infections caused by viruses 
  • Bacterial infections, especially in people who use IV drugs or have had surgery near their upper chest 
  • Fungal infections (in rare cases)

Costochondritis Symptoms

Chest pain linked to costochondritis usually comes on after exercise, minor trauma, or an upper respiratory infection.

  • Sharp pain in the front of  your chest, near where your breastbone and ribs meet, typically on the left side. It may spread to your back or belly.
  • Pain when you take a deep breath or cough. It gets better when you stop moving or your breathing is quieter.
  • Tenderness when you press on your rib joints. If you don’t have this tenderness, you probably don’t have costochondritis.
  •  If costochondritis happens because of an infection after surgery, you’ll have redness, swelling, or pus discharge at the site of the surgery.

Call your doctor if you have any of the following:

Go to a hospital’s emergency room if you have a hard time breathing or any of the following. They’re not usually caused by costochondritis:

  • High fever that doesn’t get better with fever reducers such as acetaminophen or ibuprofen
  • Signs of infection at the tender spot, such as pus, redness, increased pain, and swelling
  • Persistent chest pain of any type when you also have nausea, sweating, or pain in your left arm. These may be signs of a heart attack. If you’re not sure what’s causing your chest pain, go to the emergency room.

Costochondritis Risk Factors

Costochondritis is a common cause of chest pain in children and adolescents. It accounts for 10% to 30% of all chest pain in children. Annually, doctors see about 650,000 cases of chest pain in people ages 10 to 21. The peak age for the condition is ages 12-14.

Kids who often carry heavy book bags over one shoulder can be more likely to develop costochondritis.

In adults, costochondritis affects women more than men (70% vs. 30%).  

Costochondritis Diagnosis

There is no specific test for diagnosing costochondritis. To rule out a more serious cause of your chest pain related to your heart or lungs, your doctor will probably start with tests like an echocardiogram (ECG), chest X-rays, and blood test for heart damage, among others. 

If those tests come back normal, they’ll likely see if you have tenderness in any of your rib joints, usually over the fourth to sixth ribs.

If you’ve had sternum (breastbone) surgery or are at risk for heart disease, they may recommend getting a test to see if infection is the cause of your chest pain. Doctors will:

  • Look for signs of infection such as redness, swelling, pus, and drainage at the site of surgery
  • Recommend a more sophisticated imaging study of the chest called a gallium scan, which will show an increase in the radioactive material gallium 
  • Check your white blood cell count to see if it is high, a sign of infection
  • Recommend a chest X-ray if pneumonia might be a cause of your chest pain

Costochondritis Treatment and Home Remedies

Home Remedies for Costochondritis

These home remedies may provide relief from costochondritis:

  • Over-the-counter  pain relievers such as nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen or naproxen as needed
  • Using local heat or ice to relieve pain
  • Avoiding unnecessary exercise or activities that make the symptoms worse; avoiding contact sports until there is improvement in symptoms, and then returning to normal activities only as tolerated
  • Doing stretching exercises

Medications for Costochondritis

Your doctor may suggest the following:

  • Prescription-strength NSAIDs.
  • A local anesthetic and steroid injection in the area that is tender if normal activities become very painful and the pain doesn’t get better with medicine.
  • Narcotics like hydrocodone/acetaminophen (Norco, Vicodin) or oxycodone/acetaminophen (Percocet, Roxicet, Tylox) can help with extreme pain, but, as with any narcotics, there’s danger of becoming addicted to them.
  • Steroids. Your doctor can give you a corticosteroid shot directly into a painful joint, but that’s considered something of a last resort.
  • Tricyclic antidepressants or cyclic antidepressants like amitriptyline can help ease pain, but they also can have side effects, like weight gain and drowsiness. 
  • Antiseizure drugs, usually gabapentin (Neurontin), are typically used to treat epilepsy, but they also may help with costochondritis.
  • Infectious (bacterial or fungal) costochondritis should be treated with IV antibiotics. Afterward, antibiotics by mouth or by IV should be continued for another 2 to 3 weeks. You should see a doctor during recovery, and then once a year. 

Surgery for Costochondritis

You may need surgery to remove the sore cartilage if other treatments don’t help. Your doctor can refer you to a surgeon.

Costochondritis Prevention

Because inflammatory costochondritis has no definite cause, there is no good way to prevent it.

Costochondritis Outlook

Noninfectious costochondritis will go away on its own, with or without anti-inflammatory treatment. Most people will recover fully.

Infectious costochondritis responds well to IV antibiotics and surgery, but recovery may take a long time.

Other conditions may be causes of chest pain

Heart disease not the only reason for that feeling of angina

Although chest pain is often—and rightfully— associated with heart disease, other medical problems can be causes of chest pain. Angina—feelings of pressure, heaviness, tightness. or pain in the chest—occurs when plaque in the coronary arteries partially blocks blood flow and the heart muscle isn’t getting enough oxygen and nutrients. (You can learn more about angina in the Harvard Special Health Report Diseases of the Heart: A compendium of common heart condition and the latest treatments.) Yet the heart isn’t the only organ in the upper abdomen, and chest pain may be due to conditions affecting the esophagus, lungs, gall bladder, or stomach.

Digestive causes of chest pain

When chest pain—particularly pain in the lower chest— is triggered by a meal, it is likely to emanate from the digestive system, rather than from the heart, and can be due to the following:

Acid reflux or heartburn. When acid from the stomach flows up into the esophagus, it can cause a burning sensation in the chest reminiscent of a feeling of angina  or often mistaken for a heart attack.

Esophageal spasm.   Sudden, forceful contractions of the esophagus, the muscular tube between the mouth and the stomach, can be painful. These spasms can also trap food in the esophagus and prevent it from passing into the stomach.

Gallbladder disease. A sudden pain that often occurs 30 minutes after you have eaten may be a sign of gallstones. Gallbladder pain is usually felt just below the breastbone and may extend to the right arm or between the shoulder blades. It occurs as the gallbladder contracts in an effort to pump bile around the gallstones that are blocking its passage to the liver.

Inflammatory causes of chest pain

Tissues in the chest cavity can become inflamed due to injury, infection, or autoimmune conditions, in which the body’s immune cells attack its own tissues. Common inflammatory causes of chest pain include the following:

Costochondritis. This condition, an inflammation in the chest wall between the ribs and the breastbone, can trigger a stabbing, aching pain that’s often mistaken for a heart attack. Costochondritis is commonly caused by trauma or overuse injuries, often during contact sports, or it may accompany arthritis.

Pericarditis is an inflammation of the pericardium, a protective, double-layered sac surrounding the heart. It has many different possible causes, including a virus or other infection, certain illnesses, an injury to the chest, radiation therapy for cancer, or a reaction to medications. The classic symptom of pericarditis is a sharp, stabbing pain in the center or left side of the chest that worsens when you take a deep breath or lie down. The pain results from the irritated layers of the sac rubbing together.

Lung-related causes of chest pain

The following lung conditions often produce chest pain that may feel like angina. 

Pneumonia can cause shortness of breath and sharp pains that intensify with a deep breath. Unlike angina, it is likely to be accompanied by other symptoms, like fever, chills, or coughing.

Pulmonary embolism—a blood clot that has traveled into the vessels supplying the lungs—can cause chest pain. The pain is often accompanied by a fast or irregular heartbeat, sudden difficulty breathing, or feeling lightheaded or faint. Pulmonary embolisms can be life-threatening, so the symptoms warrant a call to 911.

Psychological causes of chest pain

Both anxiety and panic attack can cause symptoms very similar to angina. These attacks—which can occur out of the blue or in response to a stressful event—include chest pain along with shortness of breath, palpitations, and dizziness. The key difference is that the chest pain is usually fleeting, lasting only a moment or two.

What to do when you’re uncertain

Any time you’re uncertain about the source of chest pain that is recurrent or lasts for several days, you should talk to your clinician. However, if you have chest pain that is building in intensity, has lasted for several minutes, and isn’t relieved by resting, you should get immediate medical attention.

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Costochondritis & Chest Wall Pain

Most Common Less Common
As a result of direct Injury or trauma to chest Stress fractures
Costochondritis Tietze’s syndrome
Slipped Rib Syndrome or lower rib pain syndromes Xiphoidalgia
Pain radiating from thoracic spine or costovertebral joints Spontaneous sternoclavicular subluxation
Intercostal muscle strain or pulled chest muscle
Sternalis syndrome

Costochondritis refer to Inflammation of the cartilage junctions of the sternum and ribs typically felt at the costosternal and costochondral joints. It is a relatively common condition seen in adult and patients who develop pain and tenderness at the front of the chest. It’s felt over the affected cartilage segments in multiple areas, usually on one, or occasionally both sides of the sternum. The most common sites of pain are the anterior cartilage segments of the 2th to 5th ribs at the front of the chest near where the ribs join the breastbone. This pain increases with activity, moving or twisting or when taking deep breaths. Conversely, it decreases as movement stops or with quiet breathing. The reproducible tenderness but without swelling you feel when you press on the sternal and rib joints (costosternal and costochondral junctions respectively) is a constant feature of costochondritis. Without this tenderness, a diagnosis of costochondritis is unlikely.

The cause is unknown but may be associated with unusual or excessive physical activity, minor trauma particularly repetitive and/or excessive over of use of arms. Occasionally, it can follow a viral infection or rarely a bacterial or fungal infection in patients prone to such infections.

There also appears to be a relationship between chest wall deformities and costochondritis and certainly younger patients with pectus excavatum and carinatum complain of cheat wall pain though it’s difficult ascertain whether this is costochondritis, idiopathic chest wall pain (chest pain in children without an obvious cause) or chest wall pain caused by the anatomical deformity associated with pectus.

Typical location of pain and tenderness noted in Costochondritis

Tietze syndrome is often confused with costochondritis but is rarer and importantly associated with sudden chest pain and localised swelling at junction of the ribs and breastbone. It usually affects the junctions at the 2nd and 3rd ribs. The swelling may last for several months and often radiates to the arms and shoulders. The cause is unknown.

For Lower rib pain syndromes. See Slipped rib syndrome. Pain originating from the thoracic spine and specifically from the ‘spinal-rib complex’ is common. The pain experienced in the front or side of the chest is described as referred pain and may arise from the posterior thoracic spinal structures including the intervertebral discs and facets. Costotransverse disorders or costovertebral joint dysfunction are disorders affecting or involving specifically the costotransverse and costovertebral joints and ligaments which are felt to be related to pain experienced in the thorax. See other associated problems.

Muscle strain or a ‘pulled muscle’ refers to muscle overstretching leading to a partial or complete tear and can occur in any muscle. Muscles affected tend to be in ones that cross two joints; exposed to sudden explosive action, such as sprinting and the hamstrings; or following periods of overtraining. In the chest, sudden twisting or movement ‘at the torso’ particularly against resistance can lead to an intercostal muscle strain. The diagnosis is a clinical one, that is relying on the clinical history and examination as the muscle and injury to it, is hard to ‘see’ using radiology (MRI and ultrasound) and so grades of muscle strain are hard to allocate to intercostal muscle strain. The pain is typically sharp and stabbing immediately but typically becomes a dull ache overtime and can be associated with swelling, muscle spasms, difficulty moving the affected area, pain while breathing and even bruising.

Muscle strains can be categorized into three grades, based on severity

Grade Features
Grade 1 Mild damage to individual muscle fibres (less than 5% of fibres) that causes minimal loss of strength and motion.
Grade 2 More extensive damage with more muscle fibres involved. However, the muscle is not completely ruptured. These injuries present with significant loss of strength and motion.
Grade 3 Complete rupture of a muscle or tendon. These can present with a palpable defect in the muscle or tendon. However, swelling in the area may make this difficult to appreciate.

Activities and Sports that may cause chest wall muscle strain:

Intercostal muscle Pectoralis muscle Latissimus dorsi Serratus muscle
Weight training (side to side against resistance) Weight training (bench press) Weight training (bench press) Weight training (heavy weights)
Heavy lifting with side bending, twisting or turning Heavy lifting from front to chest height Heavy lifting with upper body Repetitive motions against resistance
Bowling Rugby Climbing Swimming
Cricket, Baseball (bowling, throwing) Skiing Cricket, baseball & throwing activities Tennis
Rowing Wrestling Rowing
Tennis Hockey Tennis
Hockey Parachuting

Large chest wall and abdominal muscles

Larger chest wall muscle groups can also be strained. The Pectoralis major muscle is a large muscle at the front of the chest. It used to rotate the arm inwards, pull a horizontal arm across the body, pull the arm from above the head down and pull the arm from the side upwards. Pectoralis Major strain can happen during vigorous sports activity classically weight training. Its weak point is where the pectoralis or pec muscle tendon attaches to the upper humerus (arm bone) though rarely its tendinous insertion to the upper ribs and sternum can also tear. Symptoms of a pec major sprain include a sudden sharp pain at the front of the upper arm, near the shoulder and depending on the grade of muscle strain, swelling (haematoma) of the front of the shoulder and upper arm. Tests which reproduce pain help confirm the diagnosis and include getting the patient to pull their arm across the front of the chest or rotate it inwards against resistance. A visible gap or lump in the muscle may appear.

The Latissimus dorsi muscle or ‘lats’ is another large, flat “V” shaped muscle of the torso. It spans the width of your back and helps control the movement of your shoulders and is often referred as the “climbers” muscle. With a Latissimus dorsi strain, you might feel pain in your low back, mid-to-upper back, along the base of your scapula or shoulder blade, or in the back of the shoulder. You may even feel pain along the inside of the arm, all the way down to your fingers.

The Serratus anterior muscle spans the upper eight or nine ribs. This muscle helps you rotate or move your scapula or shoulder blade forward and up. Sometimes it’s referred to as the “boxer’s muscle,” since it’s responsible for the movement of the scapula when a person throws a punch. Serratus muscle strain typically from repetitive activities such as tennis results in pain in the chest, back, or arm and can make it difficult to lift your arm overhead or have a normal range of motion with the arm and shoulder. It can also be associated with arm or finger pain, difficulty with deep breathing and shoulder blade pain. Serratus anterior myofascial pain syndrome is part of a broader set of conditions known as myofascial pain syndromes. Myofascial pain is a process in which pain and dysfunction are related to the development and persistence of focal sensitive areas or trigger points, that when pressed can cause referred pain (pain felt elsewhere).

Though not strictly a chest wall muscle, the upper Rectus abdominis muscle and External oblique muscle can also be strained, torn or even ruptured leading to pain, which depending on the site of injury can lead to lower chest wall pain and pain when pain twisting from a seated position or when rising from a bed particularly if flexing (bending).

Sternalis syndrome presents with anterior chest pain associated with localised tenderness over the body of the sternum or overlying sternalis muscle; palpation often causes radiation of pain bilaterally. It is an unusual cause of anterior chest wall pain as it appears to be associated with an accessory muscle, the sternalis muscle which is present in only around 5-10% of people and sit in a variable position in front of the main pectoralis muscle. When symptomatic, it is another form of myofascial pain syndrome.

Though uncommon, Stress fractures of the ribs can be seen following repetitive activity or in increased loading. They can occur in the first rib, and less commonly other ribs particularly in those engaged in repetitive forceful sports such as rowers or weightlifters. The pain which is localised to the area with associated tenderness may start gradually but ends to worsen and is only eased with rest and or avoidance of the repetitive activity.

Xiphoid process pain (xiphoidalgia) occurs for varying reasons but is often related to minor trauma to the area or over exercise (such as abdominal crunches). Local inflammation can also occur. See Complex chest wall problems.

Spontaneous subluxation of the sternoclavicular joint is another very specific cause of isolated chest wall pain. See other associated problems.

Stress fracture of right first rib (red ring) in a body builder

Intercostal Neuralgia (Chest wall pain)

Intercostal neuralgia, also known as chest wall pain, is a condition that causes pain along the intercostal nerves between your ribs. It is caused by nerve compression in the area by the ribcage.

Warning Signs & Symptoms

Symptoms usually include pain that is dull and constant. The pain also may be described as sharp, stabbing, tearing, spasmodic, tender, aching or gnawing. Many patients report feeling as though the pain has wrapped around their upper chest like a band.

Those suffering from intercostal neuralgia may experience pain during sudden movements involving the upper chest, such as breathing, sneezing and laughing. Other symptoms include pain in the back, and pain in the side of the ribs, as well as numbness, tingling and shooting pain that extends to the back. In some patients, neuralgia can cause severe, debilitating pain that makes it difficult to move and breathe. If you are experiencing unexplained, severe pain in your rib cage, chest pain, difficulty breathing, or severe shortness of breath, it is important to seek immediate medical care.

Possible Risk Factors

Injury and inflammation of the nerves, muscles, cartilage and ligaments in the rib cage and middle spine area can cause this condition. Other causes may include pregnancy, chest or rib injury, surgery and viral infections such as shingles.

Tests to Diagnose Chest Wall Pain/Intercostal Neuralgia

Any chest wall pain, whether experienced by itself or with other symptoms, should be evaluated by your healthcare provider.

Treatment Options

Thoracic procedures such as intercostal nerve blocks can be used. During the treatment, a local anesthetic or corticosteroid is injected around the affected nerves. This blocks the nerve, which in turn relieves pain.

Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to help reduce inflammation and pain. These include over-the-counter medications such as ibuprofen and naproxen.

Radiofrequency Lesioning is also a good option if the nerve blocks are helpful, but are not long-lasting.


Neuralgia is easier to prevent than to treat. The prevention of this condition includes:

  • Maintaining an active lifestyle
  • Preventing herpes infection
  • Proper nutrition
  • Limiting smoking and alcohol
  • Strengthening the back muscles
  • Exercise

Costochondritis | Chest Pain | Symptoms and Treatment

What is costochondritis?

Costochondritis is a condition of the chest wall that causes pain. People who get chest pain are often frightened they have a heart or lung problem. Fortunately, if the pain is due to costochondritis, there is no need to panic, as it is not a life-threatening condition. It usually gets better on its own with time.

The pain you get if you have costochondritis comes from the protective cage formed by your ribs, and not from the heart or lungs or blood vessels inside your chest. More specifically, it comes from one or more of the joints between your ribs and your breastbone (sternum). These joints have become inflamed if you have costochondritis.

See the bottom of this leaflet for information on how the chest wall works.

Costochondritis symptoms

  • Costochondritis causes chest pain, felt at the front of the chest.
  • Typically, it is sharp and stabbing in nature and can be quite severe.
  • The pain is worse with movement, exertion and deep breathing.
  • Pressure over the affected area also causes sharp pain.
  • Some people may feel an aching pain.
  • The pain is usually confined (localised) to a small area but it can spread (radiate) to a wider area.
  • The pain tends to wax and wane and it can settle with a change of position and quiet, shallow breathing.

The most common sites of pain are close to the breastbone (sternum), at the level of the 4th, 5th and 6th ribs.

Note: without tenderness, the cause of the chest pain is unlikely to be costochondritis. Remember to seek medical advice if you are unsure of the cause of your symptoms (see the section on ‘when to see a doctor’).

Tietze’s syndrome causes similar symptoms to costochondritis. However, it also tends to cause swelling at certain tender points on your chest wall. If you have costochondritis, there is nothing there to actually see.

Bornholm disease is another similar condition but it often leads to muscle aches and pains, as well as chest pain. See the separate leaflet called Bornholm Disease for more details.

How common is it?

It is hard to be sure exactly how common it is, as lots of people probably have it but don’t bother to go to their doctor. It seems to be quite common. Of the people with chest pain going to see their GP, about 1 in 5 have a cause related to the muscles, ribs and joints in their chest wall.

What are the common causes of costochondritis?

The basic problem is inflammation but the cause of this is unknown for most people. There are some situations that are associated with inflammation and they include:

  • Chest infections of varying types.
  • Large physical efforts, like lifting heavy objects or repeated bouts of coughing.
  • Accidents which hit the chest, like falls or car accidents.
  • Some types of arthritis.

Who develops costochondritis?

There is no particular person more at risk of costochondritis than any other. It does tend to affect younger people, especially teenagers and young adults. It can affect children. People performing repetitive movements that strain the chest wall, particularly if they are not used to it, as above, might be more at risk of getting this condition. Some studies suggest women tend to be affected more commonly than men.

People with fibromyalgia tend to develop costochondritis more often than others. Fibromyalgia is a long-term (chronic) condition that causes widespread body pains and fatigue. See the separate leaflet called Fibromyalgia for more details.

When should I see a doctor?

It can be very difficult to know if your pain is due to costochondritis or whether – and how urgently – to see a doctor. With chest pain, it makes sense to err on the side of caution if you are unsure.

If you feel unwell, breathless, dizzy, or sweaty, or if your chest pain is very severe or spreading to your jaw or left arm then treat it as an emergency. Call 999/112/911 for an emergency ambulance.

It is more likely that you have costochondritis if:

  • You are young and otherwise healthy.
  • You feel generally well in yourself and have no other symptoms.
  • You have pain which is worse when you move your chest wall or press on it.
  • The pain is relieved with simple painkillers such as paracetamol or ibuprofen.

If you have other symptoms in addition to the pain then consult a doctor. This would include if you have:

  • A cough.
  • A high temperature (fever).
  • Breathlessness.
  • Blood in the mucus you cough up (sputum).
  • Pain which spreads to other parts of the body.
  • A rash.
  • A feeling of having a ‘thumping heart’ (palpitations).
  • Dizziness.
  • Difficulty swallowing.
  • Started to get heartburn or indigestion.

Also consult your doctor if the pain gets worse as you exert yourself (for example, on walking up a hill) rather than as you twist your chest around. Pain on exertion is more likely to be due to angina.

See the separate leaflet called Chest Pain for more information about the different causes of chest pain.

Costochondritis treatment

Treatment options for costochondritis include:

  • No treatment. Sometimes it helps just to be reassured there is no serious cause for the chest pain.
  • Relaxation techniques. Worry can make the pain worse. (Indeed, anxiety is a common cause of chest pain.)
  • Simple painkillers such as paracetamol or ibuprofen.
  • Injections of steroids or local anaesthetic medicines if pain is severe and other treatments have not worked.

Non-medicinal measures can be tried for relief of pain in costochondritis. Examples of such techniques include:

With or without treatment, most people with costochondritis get better gradually over time.

In extreme cases, an intercostal nerve block can be performed (usually by a doctor specialising in acute pain and/or anaesthetics). This involves injection of a local anaesthetic medicine around the painful ribs This blocks the nearby intercostal nerve and temporarily disrupts nerve impulses to stop the pain. Nerve blocks can last several weeks or months. In repeated, severe cases of costochondritis, a series of these injections can be given to permanently destroy the nerve causing the pain.

What is the outlook?

The outlook (prognosis) for costochondritis is generally very good. Most cases are mild and settle reasonably quickly. This happens with or without simple medications. In nearly all cases, the condition has completely gone within a year. Occasionally, if you are unlucky, it lasts longer. Costochondritis may return; however, this is unlikely.

How does the chest wall work?

To understand costochondritis, you need to know a bit about the way the rib cage is put together. The rib cage is a bony structure that protects the lungs. Bones are hard and solid and they can’t bend or move much. Your lungs, however, need to move, so that you can breathe.

When you take a deep breath in, your rib cage expands. (Try it! You will feel and see your rib cage moving.) In order for the ribs to expand, they need something to allow movement. Cartilage allows this. Cartilage is a softer, flexible (but very strong) material found in joints around the body.

Cartilages attach the ribs to the breastbone (sternum) and the breastbone to the collarbones (clavicles). The joints between the ribs and the cartilages are called the costochondral joints. Those between the cartilages and the breastbone are called costosternal joints. Those between the breastbone and the collarbones are called the sternoclavicular joints.

The prefix ‘costo’ simply means related to the ribs. ‘Chondr-‘ means related to the cartilage and ‘-itis’ means inflammation. So, in costochondritis, there is inflammation in either the costochondral, costosternal or sternoclavicular joints (or a combination). This causes pain, which tends to be worse when you move, or when you press down on the affected part.

‘Used with permission of Mayo Foundation for Medical Education and Research. All rights reserved.’

Non-Cardiac Chest Wall Pain – Piedmont Physical Medicine & Rehabilitation, P.A.

Relief for Non Cardiac Chest wall pain can be difficult to come by. Quite often a full evaluation is done to rule out cardiac sources of chest pain but if none are found consideration of non cardiac causes can be lacking.

Non Cardiac Chest wall pain refers to chest pain secondary to musculoskeletal or inflammatory causes. The pain may be secondary to a muscle strain in the chest wall itself, or in the back. It may be secondary to sprained ligaments in the neck, mid back, shoulder or chest wall itself. It may be due to nerve entrapment, irritation or to non cardiac vascular sources (such as thoracic outlet syndrome).

Common symptoms and findings of chest wall pain include pain that is increased with motion of the chest or upper (thoracic) spine. The pain is often worse when breathing deeply, sneezing, or coughing. There may be a region of tenderness in the chest wall or in a muscle group. Chest wall pain SHOULD NOT be associated with shortness of breath, sweating, nausea, or fever.

Evaluation may include a chest x-ray if a rib fracture or pneumothorax is suspected. EKG (ECG) may be done on patients with a cardiac history or in those with significant risk factors for the development of cardiac disease (smoker, diabetic, obesity, high cholesterol, hypertension). Neuro-musculoskeletal sources of chest wall pain are evaluated with different tests including EMG/NCV, Musculoskeletal Ultrasound and Sympathetic Skin Response studies (Thermography).

Initially chest wall injuries and muscle strains are managed with heat, anti-inflammatory medications (such as ibuprofen), muscle relaxers, stretching and physical therapy. In more severe or chronic cases local injection or nerve block may be required. When spinal injuries are the source of chest wall pain they have to be addressed separately. Weight reduction can also decrease chest wall pain in obese patients.

At Piedmont Physical Medicine & Rehabilitation, PA we specialize in the diagnosis of complex, chronic pain, physical medicine & rehabilitation, and peripheral vascular medicine. As a result of expertise across these disciplines we enjoy the challenge associated with the diagnosis and treatment of non cardiac chest wall pain. We also believe that results are improved when the underlying root cause of the pain is treated instead of simply resorting to symptom management.

Somatovisceral Pain

Chest Wall Pain – What You Need to Know

  1. CareNotes
  2. Chest Wall Pain

This material must not be used for commercial purposes, or in any hospital or medical facility. Failure to comply may result in legal action.


What do I need to know about chest wall pain?

Chest wall pain may be caused by problems with the muscles, cartilage, or bones of the chest wall. Chest wall pain may also be caused by pain that spreads to your chest from another part of your body. The pain may be aching, severe, dull, or sharp. It may come and go, or it may be constant. The pain may be worse when you move in certain ways, breathe deeply, or cough.

What causes chest wall pain?

  • Conditions that affect the joints or cartilage of the chest wall, such as arthritis or costochondritis
  • Strain or injury of the chest wall muscles
  • Fractures of the ribs or vertebrae (bones in your spine)
  • Herniation of the discs in the upper or middle section of your spine
  • Shingles

How is chest wall pain diagnosed?

Your healthcare provider will ask you to describe your pain. Tell him when the pain started, what type of pain it is, and what makes it better or worse. He will also ask if you have any other symptoms. He will examine your chest. He may also ask you to move your arms in different directions to see how it affects your pain. Ask your healthcare provider about these and other tests you may need:

  • A chest x-ray may show the cause of your chest wall pain. You may need more than one x-ray.
  • An MRI takes pictures of your chest or spine to show the cause of your chest wall pain. You may be given contrast liquid to help the pictures show up better. Tell a healthcare provider if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell a healthcare provider if you have any metal in or on your body.

How is chest wall pain treated?

Treatment depends on the cause of your chest wall pain. You may need any of the following:

  • NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
  • Acetaminophen decreases pain. It is available without a doctor’s order. Ask how much to take and how often to take it. Follow directions. Acetaminophen can cause liver damage if not taken correctly.
  • A cream may be applied to your chest to decrease pain.
  • Apply heat on your chest for 20 to 30 minutes every 2 hours for as many days as directed. Heat helps decrease pain and muscle spasms.
  • Apply ice on your chest for 15 to 20 minutes every hour or as directed. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel. Ice helps prevent tissue damage and decreases swelling and pain.

Call 911 if:

  • You have any of the following signs of a heart attack:
    • Squeezing, pressure, or pain in your chest
    • You may also have any of the following:
      • Discomfort or pain in your back, neck, jaw, stomach, or arm
      • Shortness of breath
      • Nausea or vomiting
      • Lightheadedness or a sudden cold sweat

When should I seek immediate care?

When should I contact my healthcare provider?

  • You develop a rash.
  • You have other new symptoms.
  • Your pain does not improve, even with treatment.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Learn more about Chest Wall Pain

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90,000 Chest pain

Chest pain – any pain or discomfort in the chest area. It can be caused by various diseases, including pathology of the heart, blood vessels, pericardium, lungs, pleura, trachea, esophagus, muscles, ribs, nerves. In some cases, chest pain is a sign of damage to organs outside the chest, such as the stomach, gallbladder, or pancreas.

Chest pains are very diverse: sharp, dull, aching, cutting, stabbing, pulling, bursting, burning or pressure.Painful sensations differ in different diseases, but pain is not a specific symptom of a particular disease. Pain characteristics may vary depending on the age, gender of the patient, comorbidities, and psychological characteristics. Determining the immediate cause of chest pain is often challenging and requires a number of diagnostic procedures.

It is one of the most alarming symptoms, as it can be a manifestation of severe, life-threatening conditions that require emergency medical care, in particular myocardial infarction.

Synonyms Russian

Thoracalgia, chest pain, chest pain

English synonyms

Chest pain, pain in the chest, thoracalgia.


Chest pain can be of various types. Sometimes it is given to the arm, shoulder, shoulder blade, back, neck. The patient may complain not only of pain, but also of tightness, burning, discomfort in the chest area.

Unpleasant sensations can be aggravated by coughing, deep breathing, swallowing, pressing on the chest, changing the position of the body (constant or periodic).Pain and discomfort in the chest may be accompanied by a number of additional symptoms, depending on the underlying disease: belching or bitterness in the mouth, nausea, vomiting, difficulty swallowing.

General information about the disease

Chest pain is a manifestation of various diseases, each of which requires a specific medical approach.

  • Acute myocardial infarction (heart attack). Acute chest pain in people over 40 is most often associated with this disease.Myocardial infarction occurs when an area of ​​the myocardium is damaged and destroyed as a result of circulatory disorders in the coronary vessels. Most often, it manifests itself as acute pain behind the sternum or to the left of the sternum, which radiates to the back, neck, shoulder, arm and does not decrease when taking nitroglycerin or at rest. Symptoms vary from patient to patient. Elderly women are characterized by atypical symptoms: severe weakness, nausea and vomiting, rapid breathing, abdominal pain.
  • Angina pectoris.A condition in which, as a result of atherosclerosis and narrowing of the coronary vessels, the blood supply to the heart muscle is disrupted. Pain in angina pectoris resembles those in myocardial infarction, however, it occurs during exercise, decreases at rest and is stopped by nitroglycerin.
  • Aortic dissecting aneurysm. The aorta is a large vessel that carries blood from the left ventricle of the heart to organs and tissues. With a dissecting aneurysm, the intima (inner lining) of the aorta ruptures with the penetration of blood into other layers of the aortic wall and subsequent dissection of the wall, which most often leads to a complete rupture of the aorta and massive internal bleeding.In most cases, the disease ends in death within a few hours or days, even with timely diagnosis and timely treatment.

Aortic dissecting aneurysm is most often a consequence of long-term arterial hypertension, and can also occur in Marfan syndrome, as a result of chest trauma, during pregnancy, or as a late complication of heart surgery.

Pain with dissecting aortic aneurysm is similar to pain with myocardial infarction and angina pectoris, can last for several hours or days, does not decrease at rest or when taking nitroglycerin.

  • Pulmonary embolism. Blockage by a thrombus of the pulmonary artery or its branches, through which venous blood flows from the right ventricle to the lungs for oxygenation. As a result, gas exchange is disrupted, hypoxia occurs, and the pressure in the pulmonary arteries increases. Chest pain occurs suddenly, increases with a deep breath, is accompanied by rapid breathing and, in some cases, hemoptysis. The risk of thromboembolism increases after surgery, prolonged forced immobility, during pregnancy, taking oral contraceptives, especially in combination with smoking, and cancer.
  • Pneumothorax. The accumulation of air or other gas in the pleural space – the slit space between the membranes that line the surface of the lungs and the inner surface of the chest. It is accompanied by acute chest pain, rapid breathing, anxiety, loss of consciousness.
  • Pericarditis. Inflammation of the heart sac (pericardium), that is, the serous membrane of the heart. The pain occurs due to the friction of the inflamed pericardial layers. Pericarditis can result from a viral infection, rheumatoid arthritis, systemic lupus erythematosus, and renal failure.Idiopathic pericarditis, that is, pericarditis of unknown etiology, is common. The pain is acute, occurs only in the initial stages of the disease, may be accompanied by rapid breathing, fever, and malaise.
  • Mitral valve prolapse. Pathology of the valve, which is located between the left atrium and the left ventricle of the heart. In some people, the mitral valve flexes into the atrium as the left ventricle contracts, and some of the blood from the left ventricle flows back into the left atrium.For most patients, this does not cause unpleasant sensations, however, some have an increased heart rate and chest pains that do not depend on physical exertion and do not radiate, unlike angina pectoris.
  • Pneumonia. Inflammation of the lung tissue. Chest pain with pneumonia, as a rule, is one-sided, aggravated by coughing, accompanied by fever, malaise, and coughing.
  • Esophagitis. Inflammation of the esophagus. It is accompanied by chest pain, swallowing disorder.Symptoms do not improve with antacids.
  • Gastroesophageal reflux disease. A chronic condition in which acidic stomach contents are thrown into the esophagus, causing damage to the lower esophagus. In this case, there may be acute, cutting pain in the chest along the esophagus, heaviness, chest discomfort, belching, bitterness in the mouth, impaired swallowing, dry cough.
  • Pleurisy. Inflammation of the pleura. Friction of the inflamed pleural layers causes pain.Pleurisy can be the result of a viral or bacterial infection, cancer, chemotherapy or radiation therapy, rheumatoid arthritis.
  • Rib fracture. In this case, the pain increases with deep breathing and with movement.
  • Other causes: pancreatitis, gallstone disease, depression.

Who is at risk?

  • People over 40.
  • Obese.
  • Patients with arterial hypertension.
  • People with high blood cholesterol levels.
  • Recently underwent surgery.
  • Alcoholics.
  • Smokers.
  • Pregnant.
  • Suffering from cardiac arrhythmias.
  • People with cancer.
  • Taking certain drugs.
  • People with chronic lung disease.


Chest pain is not a specific symptom and can unambiguously indicate a particular disease.However, when this sign appears, the doctor must first of all exclude a number of life-threatening conditions that require immediate assistance. Sometimes only additional laboratory and instrumental studies can accurately establish the cause of chest pain.

Laboratory research

  • Complete blood count. Leukocytosis (with pleurisy, pneumonia), anemia (with dissecting aortic aneurysm), thrombocytosis and erythremia (with pulmonary embolism) can be detected.
  • Erythrocyte sedimentation rate (ESR). Non-specific indicator of inflammation. ESR can be increased with pleurisy, pericarditis, pneumonia and other diseases.
  • C-reactive protein. Increased in inflammatory diseases, as well as in myocardial infarction. With angina pectoris, the level of C-reactive protein does not change.
  • NT-proBNP (sodium uretic brain propeptide). Protein, the bulk of which is found in the cells of the myocardium. It is a precursor of the sodium uretic peptide, which is responsible for the excretion of sodium in the urine.This indicator is used to assess the risk of heart failure, identify the initial stages of heart failure, and evaluate the therapy. It is highly specific. May be elevated in myocardial infarction.
  • Troponin I. Troponin is a protein involved in muscle contraction. The cardiac form of troponin is found in the heart muscle and is released when the myocardium is damaged. It can be increased in case of myocardial infarction and other diseases, accompanied by the destruction of cardiomyocytes.
  • Myoglobin. A protein similar in structure to hemoglobin and responsible for the storage of oxygen in muscle tissue, including the heart muscle. It increases with damage to muscle tissue, in the first hours after myocardial infarction.
  • Alanine aminotransferase (ALT). An enzyme that is found primarily in the liver, as well as in skeletal muscle, kidney and myocardium. An increase in ALT indicates liver damage, but may also indicate myocardial infarction and is an indicator of the extent of the damage to the heart muscle.
  • Aspartate aminotransferase (AST). This enzyme is found mainly in the myocardium, skeletal muscles, liver. An increase in AST levels is a sign of myocardial infarction. The value of AST corresponds to the degree of damage to the heart muscle.
  • Total creatine kinase. An enzyme involved in energy metabolism reactions. Its various isoforms are found in different tissues of the human body. An increase in the level of total creatine kinase is observed in myocardial infarction and myopathies.
  • Creatine kinase MB. Isoform of creatine kinase, which is found mainly in the myocardium and tissues of the nervous system. Its level corresponds to the extent of myocardial damage.
  • Lactate dehydrogenase (LDH) total. An enzyme that is involved in energy metabolism and is found in almost all tissues of the body. Different types of LDH are present in different organs. Total lactate dehydrogenase can be increased in myocardial infarction and liver disease.
  • Lactate dehydrogenase 1, 2 (LDH 1, 2 fractions).These are types of lactate dehydrogenase, an increase in which is a more specific indicator of myocardial and renal damage.
  • Lipase. Pancreatic enzyme. An increase in lipase levels is specific to pancreatic disease.
  • Total cholesterol. This is the main indicator of fat metabolism in the body. It is used to diagnose atherosclerosis and liver diseases.
  • D-dimer. Fibrin cleavage product. It is an indicator of the fibrinolytic activity of the blood.The D-dimer level may change with pulmonary embolism, dissecting the aortic aneurysm.
  • The main blood electrolytes are potassium, sodium, chlorine, calcium. A change in the level of blood electrolytes may indicate pathology of the kidneys, adrenal glands, endocrine diseases, and malignant neoplasms.
  • Urea, serum creatinine. These are the end products of nitrogen metabolism, which are excreted from the body by the kidneys. Their increase may indicate kidney pathology.

Instrumental research methods

  • Electrocardiography (ECG). Changes in the ECG are detected with myocardial infarction, angina pectoris, pericarditis. Helps to determine the localization and degree of myocardial damage.
  • Radiography, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (ultrasound) of the chest. These are imaging methods that allow assessing the state of the chest organs, identifying injuries, neoplasms, signs of internal bleeding and other pathological changes.
  • Transesophageal echocardiography. An ultrasound scan in which a probe is inserted into the esophagus. With its help, the condition of the heart, its valves, large vessels is assessed. It is of great diagnostic value in pulmonary embolism, aortic aneurysm.
  • Angiography. X-ray examination of blood vessels using a non-toxic contrast agent that is clearly visible on the images. Allows you to assess the condition and patency of blood vessels, including coronary.


Treatment depends on the underlying condition, the symptom of which is chest pain. Therapy can consist of both the use of appropriate medications and surgical procedures.


There is no specific prophylaxis for most diseases accompanied by chest pain. However, to reduce the risk of their development, it is useful to quit smoking and alcohol, sufficient physical activity, a healthy diet, and timely preventive medical examinations.

Recommended analyzes

90,000 Caution: thoracic osteochondrosis – Department of Health of the Tambov region

Thoracic osteochondrosis is less common than other types of disease – cervical and lumbar osteochondrosis due to the least mobility and the greatest protection due to muscles and ribs. However, if you do not pay attention to this disease in time, it can lead to serious consequences. Specialists of the Tambov Region Medical and Physical Training Dispensary spoke in detail about how to recognize thoracic osteochondrosis, as well as measures to prevent this ailment.

Signs of chest osteochondrosis:

1. chest pain, aggravated at night, with a long stay in one position of the body, with hypothermia, when bending to the side and turning, with great physical exertion;
2. interscapular pain when the right or left arm rises;
3. pain worsens with deep breathing;
4. Pain between the ribs while walking;
5. Squeezing sensation in the chest and back.
Pain during an exacerbation of the disease may last for several weeks.

There are additional symptoms of thoracic osteochondrosis:

– individual areas of the skin become numb;
– cold feet, sometimes burning and itching;
– skin peels off, nails break;
– pain in the pharynx and esophagus;
– the digestive organs do not work well.

Thoracic osteochondrosis has two symptoms – dorsago and dorsalgia.
Dorsago is a sharp, sharp pain in the chest. Occurs after monotonous work in the same position. When an attack occurs, it becomes difficult to breathe, and if the upper body rotates, the pain increases.
Dorsalgia – not severe pain in the area of ​​the affected intervertebral discs, begins gradually and lasts up to 2-3 weeks. The sensations of pain intensify when breathing deeply, at night and there may be a lack of air. It passes after a short walk.

Causes of thoracic osteochondrosis:

– computer work;
– frequent driving;
– received injuries of the spine;
– weak back muscles;
– scoliosis and other posture disorders.

What is the danger of chest osteochondrosis:

If the treatment is not timely and incorrect, then osteochondrosis of the thoracic spine can cause the following diseases:
– protrusion and hernia of the thoracic spine;
– spinal cord compression;
– problems with the heart, intestines, liver, kidneys and pancreas;
– disorders in the duodenum, intestinal motility, gallbladder dyskinesia;
– Intercostal neuralgia – compression or irritation of the intercostal nerves.
What can be confused with osteochondrosis of the chest
Due to the variety of symptoms, it is easy to confuse it with the following diseases:
– angina pectoris, heart attack. Difference: after taking heart medications, chest pains do not go away, the patient’s cardiogram is normal;
– appendicitis, cholecystitis, renal colic;
– gastritis, ulcer, colitis;
– pathology of the mammary glands;
– pneumonia. Inflammation of the lungs is distinguished from osteochondrosis by cough, shortness of breath and fever.
Prevention of thoracic osteochondrosis
We recommend for the prevention of the disease:
– lie down for 40-50 minutes during the day – relieves the load from the spine;
– change your position every 2 hours, get up from a chair, do 2-4 tilts in different directions, stretch, straighten your shoulders, if the work is sedentary;
– it is advisable to do water sports: swimming, diving, water aerobics;
– try not to overcool, keep your back warm;
– regularly do physiotherapy exercises (exercise therapy).

Exercise therapy is an effective way to form a strong muscle corset, thanks to which recurrence of the disease can be avoided in the future. It is possible to increase the mobility of the thoracic spine, to increase the range of motion in the joints: both in the intervertebral and in the costal-vertebrates;
ensure correct deep breathing; develop and strengthen the muscles of the shoulder girdle; to strengthen the muscles of the back, restore physiological curves and form the correct posture, thereby reducing the load on the spine and intervertebral discs; eliminate the stiffness of the deep muscles of the back; strengthen the respiratory muscles; improve ventilation of the lungs; prevent possible complications.
Exercise therapy affects the improvement of pulmonary ventilation – this is very important for patients who are afraid to take a deep breath, since a deep breath provokes severe back pain. The presence of such a connection forces patients to gradually reduce the depth of the entrance, hypoventilation (insufficient ventilation) of the lower parts of the lungs is obtained, which can provoke the development of pneumonia and a number of other pulmonary pathologies.
Exercise therapy has an extremely positive effect on the course of the disease.

All rights to materials and news published on the website of the Health Department of the Tambov Region are protected in accordance with the legislation of the Russian Federation.Quoting is allowed with the obligatory direct reference to the Health Department of the Tambov Region.

Pain on inspiration – OSTEOMED network of clinics

Chest pain during inhalation, coughing, or other breathing movements usually indicates the pleura and pericardial region or mediastinum as a possible source of pain, although chest wall pain is also likely to be influenced by respiratory movements. Most often, pains are localized in the left or right side and can be both dull and acute.

An experienced osteopath can find out the exact cause of the pain symptom and painlessly eliminate it, who treats both the smallest and elderly patients. Sensitive hands, “running” through your body, will surely find in what place and what exactly causes discomfort.


  1. Chest pain on inhalation is caused by inflammation of the membrane that lines the inside of the chest cavity and covers the lungs. Dry pleurisy can occur with various diseases, but most often with pneumonia.
    Painful sensations with dry pleurisy are reduced in the position on the affected side. Limitation of respiratory mobility of the corresponding half of the chest is noticeable; with an unchanged percussion sound, weakened breathing can be heard due to the patient’s sparing of the affected side, pleural friction noise. Body temperature is often subfebrile, there may be chills, night sweats, weakness.

    2. Restriction of the movement of the chest or pain in the chest during inhalation and exhalation with shallow breathing is observed with functional disorders of the rib frame or thoracic spine (limited mobility), pleural tumors, pericarditis.

    3. With dry pericarditis, chest pain increases with inhalation and movement, so the depth of breathing decreases, which aggravates shortness of breath. The intensity of pain on inspiration varies from mild to severe.

    4. With the shortening of the interpleural ligament, a constant coughing is observed, which intensifies during conversation, deep inhalation, physical exertion, stitching pains when inhaling, running.
    The interpleural ligament is formed from the fusion of the visceral and parietal pleural layers of the lung root region.Further, descending caudally along the medial edge of the lekhi, this ligament branches out in the tendon part of the diaphragm and its legs. The function of providing a springy resistance during the caudal displacement of the diaphragm. In the presence of an inflammatory process, the ligaments are shortened and limit the caudal displacement

    5. With intercostal neuralgia along the intercostal space, acute “shooting” pains occur, sharply intensifying when inhaling.

    6. With renal colic, pain is localized in the right hypochondrium and in the epigastric region and then spreads throughout the abdomen.The pain radiates under the right scapula, to the right shoulder, increases with inhalation, as well as with palpation of the gallbladder region. There is local pain when pressed in the zone X-XII of the thoracic vertebrae by 2-3 transverse fingers to the right of the spinous islets.

    7. From a blow or compression of the chest, rib fracture may occur. With such damage, a person feels a sharp pain in the chest when inhaling and coughing.

90,000 Pain in the heart in children

Often, children are brought to an appointment with a cardiologist who complain of heart pain.I want to warn parents right away so that they do not get scared and do not panic: if your child was healthy before this event, he passed all the screening examinations necessary for age (Echo-KG, i.e. ultrasound examination of the heart at 1 month, 6-7 years , ECG at 1y, 7 years, 14 years) and at the same time he did not reveal abnormalities, most likely, his complaints are not related to heart disease. ⠀ ⠀ ⠀ ⠀ ⠀ ⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀⠀ ⠀ ⠀⠀ ⠀⠀⠀⠀⠀⠀⠀ ⠀⠀
By itself, the heart in children almost never hurts. Ischemic pain, heart attacks in children – fortunately, an extremely rare pathology.In addition, the localization of ischemic pain is retrosternal, and not under the left nipple, which is most often shown by our young patients. Children with heart disease, as a rule, do not complain of pain. They are worried about general weakness, the inability to perform physical activities on a par with their peers, shortness of breath (not to be confused with a feeling of lack of air, inability to take a full breath), swelling, feelings of interruptions in the heart. ⠀ Why do children complain of heart pain?
It must be understood that these are not pains in the heart, but rather pains in the region of the heart.What your child is feeling is not pain, but rather discomfort. There are many reasons. I want to highlight the 3 most common:

  • The first reason: various pathologies of the spine. Even the usual violation of posture (a common condition in children), under the conditions that the child spends a lot of time in a forced position (in the classroom at school, then at the desk at home, at the computer, etc.), can cause painful sensations in the chest , incl. in the area of ​​the heart. This is especially true if there is little physical activity in the child’s life, when he can use other muscles, train them.
  • The second fairly common cause can be diseases of the gastrointestinal tract: gastritis, peptic ulcer disease (unfortunately, more frequent in childhood), anomalies and dyskinesias of the biliary tract.
  • And finally, the third, perhaps the most common cause: neurotic states. Children overloaded with studies, tutoring, music and art schools are forced to live in a 10-12-hour working day. Perhaps they do not complain of fatigue, but the body signals problems with such pains in the area of ​​the heart.⠀ ⠀ ⠀ ⠀ ⠀ ⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀⠀ ⠀ ⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀

The same applies to children (especially adolescents) who try to study well, not disappoint parents and teachers, and are constantly preparing for lessons and exams. Prolonged stay in stressful conditions causes depletion of the body’s compensatory capabilities.

And one more reason: dear parents, please think about it! Perhaps you are too busy with work, household chores, caring for other children in the family, and began to pay less attention to your grown up and seemingly successful child.You don’t hug him as often as you used to; do not talk “heart to heart” with him about his problems (what problems can there be at that age!) And your son or daughter still needs to know that he is the best, the most beloved. And if this is not the case, the child feels left out and may experience a variety of painful sensations and will try to draw your attention to this.

When should the pain in the region of the heart (I repeat, in a previously healthy child) should alert you? If your child has suffered (especially on the legs) a viral infection, and he still has weakness, sweating, a temperature “tail”, he clearly cannot recover, do his usual work for himself – then, without fail, you need to contact a pediatrician or pediatric cardiologist to avoid serious problems.

Love your children and be healthy! ⠀⠀⠀⠀⠀⠀

Costal chondritis (Tietze’s syndrome) – treatment, symptoms, causes, diagnosis

Costal chondritis (often called Tietze’s syndrome) is an inflammation in the area of ​​the cartilaginous attachment of the ribs to the sternum. The disease is characterized by local soreness in the chest, aggravated by palpation and pressure on these areas. Costal chondritis is relatively harmless and usually goes away without treatment. The cause is not known.

  • Costal chondritis is a common cause of chest pain in childhood and adolescence and accounts for 10-30% of all chest pain at this age. Most often occurs between the ages of 12-14 years.
  • Costal chondritis is also considered a possible diagnosis in adults who have chest pain. Chest pain in adults is considered a potentially serious symptom of the disease and, first of all, it is necessary to exclude cardiac pathology (ECG, tests, examination, etc.)e). Only after a thorough examination and exclusion of the cardiac genesis of pain can the presence of costal chondritis be assumed. Differential diagnosis is sometimes difficult. In adults, costal chondritis is more common in women.

Costal chondritis is often referred to as Tietze’s syndrome. Tietze syndrome is a rare inflammatory disorder characterized by chest pain and swelling of the cartilage at the attachment of the second or third rib to the sternum. The pain arises sharply and there is irradiation in the arm, in the shoulder.Both men and women are sick more often between the ages of 20 and 40. It occurs mainly in people whose work is related to physical activity or athletes.


Costal chondritis is an inflammatory process in the cartilage tissue, usually without any specific cause. Repeated minor trauma to the chest and acute respiratory infections can provoke the appearance of soreness in the area of ​​attachment of the ribs (the effect of both the viruses themselves and frequent coughing on the areas of attachment of the ribs).Sometimes costal chondritis occurs in people taking parenteral drugs or after surgery on the chest. After operations, damaged cartilage tissue is more susceptible to infection due to disturbances in its blood supply.


Chest pain associated with costal chondritis is usually preceded by physical overload, minor trauma, or acute upper respiratory tract infections.

  • Pain, as a rule, appears acutely and is localized in the anterior region of the chest.The pain may radiate downward or more often to the left side of the chest.
  • The most common localization of pain is the region of the fourth, fifth and sixth ribs. The pain increases with movement of the trunk or with deep breathing. Conversely, there is a decrease in pain at rest and with shallow breathing.
  • Soreness, which is clearly visible on palpation (pressing in the area of ​​attachment of the ribs to the sternum). This is a characteristic feature of chondritis and the absence of this sign suggests that the diagnosis of costal chondritis is unlikely.

When rib chondritis is caused by postoperative infection, you may notice swelling, redness and / or pus in the area of ​​the postoperative wound.

Given that the symptoms of chondritis are often similar to emergency conditions, it is necessary to urgently seek medical help in the following cases:

  • Breathing problems
  • High temperature
  • Signs of an infectious disease (swelling, redness in the area of ​​rib attachment)
  • Chest pain persistent, accompanied by nausea, sweating
  • Any chest pain without clear localization
  • Increased pain during treatment


The basis of diagnosis is the medical history and external examination.A characteristic feature of this syndrome is pain on palpation in the area of ​​attachment of 4-6 ribs.

Radiography (CT, MRI) is usually not very informative for the diagnosis of this syndrome and is used only for differential diagnosis with other possible causes of chest pain (cancer, lung disease, etc.). ECG, laboratory tests are necessary to rule out heart disease or infections. The diagnosis of rib chondritis is made last after excluding all possible other causes (especially heart disease).


If the diagnosis is verified, then the treatment consists in prescribing NSAIDs for a short time, physiotherapy, limiting physical activity for a certain period of time, sometimes injecting an anesthetic into the area of ​​pain localization together with a steroid.

Osteoarticular pain in the thoracic spine and chest

N.V. PIZOVA, MD, DSc, Professor, Yaroslavl State Medical Academy, Ministry of Health of Russia



The article discusses in detail the causes and mechanisms of occurrence of vertebral pain syndromes.A differentiated approach to therapy is presented, taking into account the pathogenesis and stage of the underlying disease. The advantages of using combined drugs (diclofenac and B vitamins) in the treatment of patients with back pain are described.

Keywords: back pain, vertebrogenic pain syndromes, nonsteroidal anti-inflammatory drugs, diclofenac, Neurodiclovit

Back pain is one of the most frequent sufferings of modern man.It is associated with significant economic losses due to temporary and even permanent disability in young and middle-aged people. Back pain accounts for up to 6% of all direct costs of treatment of various diseases, 15% of all days of disability and 18% of causes of disability [1]. Acute and chronic back pain can be a manifestation of any disease. And a doctor of any specialty has two main tasks – to identify the cause of pain and find a drug that adequately helps with it.

All back pain syndromes can be classified into the following categories:

1) for a reason – vertebral and non-vertebral;

2) by the mechanism – reflex, compression, against the background of instability of the spinal motion segment (VMS), vascular, inflammatory;

3) by localization – local, reflected and radiating;

4) in duration – acute and chronic.

During life, back pain occurs in 70-90% of the population, and 20-25% are recorded annually. In the vast majority of patients, as a result of the therapy, pain is relieved within 4 weeks. At the same time, 73% of patients develop at least one exacerbation during the first year [2-4]. Thus, according to a Russian study, the most frequent localization of pain (576 patients – 60.6%) was the back. According to medical records, back pain was regarded as dorsopathy in 417 (72.4%) patients and, as a result of herniated disc in 104 (18.1%) patients.In 34 (5.9%) patients, osteoporotic fractures of the vertebral bodies were established, and in 21 – other causes of back pain [5].

Chronization of back pain is observed in 20-25% of cases, and this category of patients accounts for up to 80% of the economic costs associated with the pain syndrome of this localization [6]. Chronic pain is the result of complex interactions between biological, psychological, social and cultural factors that make it difficult to diagnose and treat pain [7, 8].Chronic back pain can be classified as nociceptive, neuro-

tic, inflammatory, dysfunctional, or may be mixed when there are characteristics of several types of pain [9]. Although the causes and clinical manifestations are different, the mechanisms by which these types of pain occur may overlap and the patient may develop chronic back pain with more than one type of pain.

■ According to medical records, back pain was regarded as dorsopathy in 417 (72.4%) patients and as a result of herniated disc in 104 (18.1%). In 34 (5.9%) patients, osteoporotic fractures of the vertebral bodies were established, and in 21 – other causes of back pain

A source of back pain can be a pain impulse associated with the spine itself – vertebral factors (ligaments, muscles, periosteum of processes, annulus fibrosus, joints, roots), and with other structures – ex-travertebral factors (muscles, visceral organs, joints).Traditionally, thoracalgia, like other pain syndromes, depending on the cause, are divided into vertebrogenic (pathogenetically caused by changes in the spine) and non-vertebral pain syndromes. Vertebrogenic thoracalgic syndromes include lesions of the thoracic roots in a herniated disc, stenosis of the spinal canal, spondylolisthesis and instability, arthropathic syndrome in degenerative lesions of the facet and costal-transverse joints. Vertebrogenic causes of pain in the thoracic spine also include relatively rare malignant neoplasms of the spine (primary tumors and metastases), inflammatory (spondyloarthropathies, incl.including ankylosing spondylitis) and infectious lesions (osteomyelitis, epidural abscess, tuberculosis), as well as compression fractures of the vertebral bodies due to osteoporosis. The cause of non-vertebral pain syndromes can be the pathology of internal organs and muscle pain syndromes, which can form under the influence of both vertebrogenic and non-vertebral changes. Therefore, the division by verte is

ferrogenic and non-vertebral pain syndromes can be considered rather relative.In addition, psychogenic pain syndromes (panic attacks and hyperventilation disorders) are a possible cause of non-vertebral chest pain.

Clinical syndromes in spondylogenous torus-calgia include [10]:

1. Local vertebral syndrome, often accompanied by local pain syndrome, tension and soreness of the adjacent muscles, soreness and deformity, limited mobility or instability of one or more adjacent segments of the spine.

2. Remote vertebral syndrome.

3. Reflex (irritative) syndromes: reflected pain, muscular-tonic, neurodystrophic syndromes, autonomic (vasomotor, etc.) disorders, etc.

4. Compression (compression-ischemic) radicular syndromes.

5.Compression (ischemia) syndrome of the spinal cord.

Vertebral pain syndromes are conventionally divided into

reflex (found in 85-90% of cases) and compression (observed in 10-15% of cases). Reflex pain syndromes occur due to irritation of the receptor apparatus in muscles, tendons and fascia, ligaments, joints of the spine, intervertebral disc, etc. due to the formation of sites of nociception with a local nonspecific inflammatory reaction.Under conditions of activation of the synthesis and release of pro-inflammatory and algogenic substances (substance P, kinins, prostaglandins, leukotrienes, cytokines, nitric oxide, tumor necrosis factor, etc.), the excitability (sensitization) of nociceptors increases. As a result, a powerful stream of nociceptive afferentation is formed, which enters through the dorsal roots into the neurons of the dorsal horns of the spinal cord, from where, along the ascending nociceptive pathways, reaches the central parts of the nervous system (reticular formation, thalamus, limbic system and cerebral cortex), causing in these structures NMDA-dependent increase in intracellular calcium concentration and activation of phospholipase A2.The latter stimulates the formation of free arachidonic acid and the synthesis of prostaglandins in neurons, which, in turn, enhances their excitability [11, 12]. Simultaneously, in the posterior horns of the spinal cord, the flow of pain impulses through the intercalary neurons activates the neurons of the lateral horn with the activation of adrenergic (sympathetic) innervation and the motor neurons of the anterior horns of the spinal cord. Activation of the latter leads to a spasm of the muscles innervated by this segment of the spinal cord (sensorimotor reflex).Muscle spasm is an additional source of pain due to the activation of muscle nociceptors due to its shortening, the development of neurodystrophic changes and impaired microcirculation in muscle tissue. As a result, a vicious circle is closed “pain, neurogenic inflammation – increased protective muscle tension, pathological changes in the mouse –

tsach – increased pain “, which contributes to the development of persistent reflex muscular-tonic syndrome [11-13].Normally, there is a strictly balanced relationship between the intensity of the stimulus and the response to it. The antinociceptive system carries out downward inhibitory cerebral control over the conduction of pain impulses, inhibits the transmission of pain stimuli from primary afferent fibers to intercalary neurons. The interaction of these structures leads to the final assessment of pain with an appropriate behavioral response. However, long-term preservation of nociceptive impulses leads to the formation of stable pathological connections, the appearance of pronounced dystrophic changes in the surrounding tissues, which, in turn, become a source of pain signals, thereby increasing peripheral pain afferentation, which contributes to the depletion of the antinociceptive system [11-13] …The chronic course can be facilitated by inadequate treatment of acute pain, excessive limitation of physical activity, “painful” personality type, low mood background, in some cases, the patient’s interest in long-term disability, aggravation of existing symptoms or “rent” attitude to the disease. With a long course of the disease, pathological changes occur in the roots with the development of axonal and / or demyelinating processes.

■ Under osteochondrosis (Greek.osis – bone, Chondros – cartilage, osis – suffix, denoting a pathological condition) understand a congenital or acquired degenerative-dystrophic cascade process, which is based on disc degeneration with subsequent secondary involvement of the bodies of adjacent vertebrae, intervertebral joints and ligamentous apparatus

The term “osteochondrosis” was proposed in 1933 by the German orthopedist Hildebrandt to denote involutional changes in the musculoskeletal system [14].Osteochondrosis (Greek osteon – bone, Chondros – cartilage, osis – suffix, denoting a pathological condition) is understood as a congenital or acquired degenerative-dystrophic cascade process, which is based on disc degeneration with subsequent secondary involvement of the bodies of adjacent vertebrae, intervertebral joints and ligamentous apparatus … In turn, the intervertebral disc is a component of the intervertebral symphysis – a complex connection of the vertebrae in the spinal column. In the symphysis of the spine, in contrast to the synovial joints, between the surfaces of the vertebrae covered with hyaline cartilage, there is not synovial fluid, but a specific formation of a cartilaginous nature – an intervertebral disc, consisting of a nucleus pulposus and an annulus fibrosus.

The first in morphological structure approaches hyaline cartilage due to the high content of proteoglycans, hyaluronic acid, type II collagen and water. Whereas the annulus fibrosus belongs to fibrous cartilage with a high collagen content (up to 68%), mainly due to type I collagen in the outer plates of the annulus, and rich in sulfitated glycosaminoglycans integrated into large proteoglycan molecules, with their characteristic ability to retain water [11, fifteen].Nevertheless, despite the existing differences in the morphological structure of synovial joints and intervertebral symphysis, there is an opinion about the similarity of arthritic changes occurring in them, expressed in the imbalance of anabolic and catabolic processes in the matrix-se cartilage [16]. An imbalance of the most important homeostatic processes leads to a decrease in the synthesis of complete collagens and proteoglycans by chondrocytes. Non-sulfated glycosaminoglycan, hyaluronic acid, is no exception, providing the formation of matrix proteoglycan aggregates and hydration of the nucleus pulposus, which plays the role of a protective cushion (due to hydration and changes in its volume).Changes in the quality and quantity of hyaluronic acid in osteochondrosis leads to a decrease in the content of bound water in the nucleus pulposus and to the destruction of the collagen network, especially in the pericellular zones of chondrocytes [17-19]. The latter is primarily associated with an increase in the synthesis of metallo-proteinases (collagenase, stromelysin), which ultimately leads to the complete disappearance of the pericellular collagen network, to the loss of the amortization properties of the intervertebral disc as a whole.

■ Diagnosis of vertebrogenic pain syndromes includes establishing the nature of pain and their relationship

with static and dynamic loads, detection of trigger points, symptoms of tension of the nerve trunks

Osteochondrosis and spondyloarthrosis are provoked by identical pathogenetic factors, in response to which, in the involved structures of the PDS (including two adjacent vertebrae and an intervertebral disc, own articular, muscular-ligamentous apparatus, the vascular system, as well as the area of ​​the spinal cord corresponding to this level, roots and spinal vegetative ganglia with their connections within this segment) there is a release of biochemically and immunologically active mediators interacting with sensitive receptors, which, in turn, triggers complex and not yet fully understood neurophysiological mechanisms of pain formation [11].It has been established that the source of pain can be an anatomical structure innervated by unmyelinated fibers or containing substance P (or peptides similar to it) [20, 21].

The intervertebral disc has long been considered indifferent to the generation of pain impulses by the formation, since no nerve endings were found in it. More detailed anatomical and histochemical studies have shown the presence of thin nerve endings in the outer third of the annulus fibrosus – 1-2 segments above or below its outlet [11, 18, 19].

Another source of pain is considered to be the facet joints, the synovial capsule of which is richly innervated by the articular nerves, which are the branches of the posterior branches of the spinal nerves, and by the small accessory nerves from the muscle branches. The facet joints, due to their vertical orientation, offer very little resistance to compression, especially flexion. This slight resistance is most likely due to the stretching of the capsular ligaments.Under conditions of extension, the facet joints account for 15 to 25% of the compression forces, which can increase with disc degeneration and narrowing of the intervertebral space [11, 21]. With sudden unprepared movements associated with the rotation of the torso, lifting weights, when working with arms raised above the head, facet syndrome often occurs. The pathogenesis of this syndrome is associated with the convergence of the articular surfaces of the facet (facet) joints and their blockage when the load on the joint and its ligamentous apparatus increases.Pain associated with facet syndrome in the thoracic spine can range from mild to severe discomfort and severe disability. It usually increases with extension and decreases with flexion of the spine and can be reflected on the anterior surface of the chest. Below and above the level of joint blocking, reflex spasm of the muscle that straightens the spine is often determined [22-26].

One of the causes of chest pain may be Tietze’s syndrome, first described by Tietze in 1921.This syndrome is a relatively rare condition characterized by the presence of nonspecific benign reversible painful edema in region II (in 60% of cases) or III costal cartilage. In 80% of cases, there is a unilateral lesion limited to one costal cartilage. The pain is usually well localized, but it can radiate along the entire front surface of the chest wall, as well as in the shoulder girdle and neck. Redness, fever and other changes in the skin over the affected area are absent.The pain usually regresses spontaneously after 2-3 weeks, but it often bothers for several months, and residual edema can persist for up to several years. The disease usually develops in young or childhood years. Its reasons are unknown [22-26].

Costo-sternum syndrome is one of the most common causes of chest pain. This syndrome is much more common than Tietze’s syndrome. In case of rib-sternum syndrome, palpation in 90% of cases reveals multiple zones of pain: in the left paraster –

nal region, below the left breast, in the projection of the pectoral muscles and sternum.There is no local edema in rib-chest syndrome. The cartilages of the II and V ribs are most often affected. With the defeat of the upper costal cartilage, pain irradiation to the region of the heart is often noted. The pain usually increases with chest movements. The disease is more common in women over 40 years of age [22-26].

Sliding rib syndrome is another common cause of chest pain. The syndrome is characterized by intense pain in the projection of the lower edge of the costal arch and an increase in the mobility of the anterior end of the costal cartilage, usually X and, less often, VIII and IX ribs.It is believed that this condition has a traumatic origin and is associated with recurrent subluxation of the costal cartilage during torso rotation. Unlike the superior ribs, the cartilaginous parts of which form the sternocostal joints, the cartilaginous parts of the VIII-X ribs form articulations with the cartilaginous parts of the superior ribs using the external intercostal membrane. This zone is anatomically the weakest area of ​​the chest, prone to trauma. Following damage to the cartilaginous articulation, the free cartilaginous part of the rib deviates upward, shifting in the vertical or anteroposterior direction during breathing relative to the overlying cartilage, which is accompanied by pain and a characteristic clicking sensation.The pain, as a rule, is acute or shooting in nature, is localized in the upper quadrant of the abdominal wall and is provoked by hyperextension of the chest when lifting the arms up. In the acute stage of the disease, the patient often takes a forced position with the torso tilted forward and to the painful side to reduce the tension of the abdominal wall muscles attached to the costal corners. In some cases, displaced costal cartilage can injure the perichondrium of the superior rib and intercostal nerve. Pathognomonic for this condition is the test described by Holms, which consists in pulling the edge of the rib anteriorly with a bent finger.In this case, a typical pain pattern is reproduced, accompanied by a characteristic click. Carrying out such a manipulation on the healthy side is not accompanied by the described phenomenon. The diagnosis can also be confirmed by infiltration of the space between the separated cartilage and the rib with 5 ml of 0.5% lidocaine solution, leading to a complete regression of pain sensations 10 minutes after the procedure [22-26].

Diffuse idiopathic skeletal hyperostosis (Forestier disease) is a disease that is relatively common in middle-aged and elderly people, mainly in men.The main symptoms are usually mild to moderate pain and a feeling of stiffness in the thoracic and lumbar spine. On examination, an increase in thoracic kyphosis, limitation of the range of motion in the thoracic spine and chest excursions are determined. Local tenderness is often detected on palpation of the thoracic and lumbar spine. To confirm the diagnosis of diffuse idiopathic

Per. certificateLS-002517 dated 11/29/2011


modified release capsules No. 30

* neuralgia and neuritis

* inflammatory

and degenerative diseases of the joints and spine

* acute gouty arthritis



reduction of the therapeutic dose of diclofenac and the duration of treatment (due to synergy: diclofenac + B vitamins) **

start of treatment

►1 capsule * 3 times a day

capsules * 1-2 times a day

** 1.H. I. Rocha Gonzalez et al-Proc West Pharmacol Soc., 2004; G. Vetter et al-Z Rheumatol., 1988; 2. G. Bruggemann et al – Klin Wochenschr., 1990; A. Kuhlweln et al – Klin Wochenschr., 1990; 3. DOLOR-study 2009;


* More information in instructions £

for medical use of the drug £

Manufacturer: Lannacher Heilmittel GmbH, Austria Owner Per.certificate: LLC “VALEANT”, Moscow, Shabolovka, 31, ar. 5

skeletal hyperostosis, it is necessary to conduct an X-ray of the spine, which reveals hyperostosis, which is most pronounced in the thoracic region and manifests itself by linear ossification along the anterior surface of four adjacent vertebrae and more, while maintaining X-ray clarification between the bone deposits and the vertebral bodies, as well as the relative preservation of the height of the intervertebral space.Also characteristic is the formation of osteophytes between the bodies of adjacent vertebrae, which are interconnected in the form of “bridges” [22-26].

Diagnostics of vertebrogenic pain syndromes includes establishing the nature of pain and their relationship with static and dynamic loads, identifying trigger points, symptoms of tension in the nerve trunks. Computed tomography and magnetic resonance imaging and radiography are important for determining the nature of the process, assessing the degree of existing changes.Electroneuromyography is used to determine the functional state of the roots, to determine the place and stage of their lesion [2, 6, 12, 13]. Already at the first examination of the patient, danger symptoms (“red flags”), which are generally recognized in dorsalgia, should be excluded, namely, to pay attention to the presence of fever, local pain and local temperature rise in the paravertebral region, which are characteristic of an infectious lesion of the spine. A tumor (primary or metastatic) may be evidenced by an unreasonable decrease in body weight, a history of malignant neoplasm of any localization, persistence of pain at rest and at night, as well as the patient’s age over 50 years.Compression fracture of the spine is more often observed with trauma, the use of corticosteroids, and in persons over 50 years of age. With a tumor lesion of the spinal cord, pain can be constant or recurrent, appear at rest and decrease with movement, often leads to sleep disturbance, forcing to move or sleep in a forced position, for example, sitting. Against the background of constant pain, lumbago is often noted, provoked by coughing or sneezing. Motor and sensory disorders are identified, corresponding to the level of damage.With syringomyelia and multiple sclerosis, pain can also occur, the localization of which depends on the area of ​​the spinal cord injury.

Herpes zoster with the development of postherpetic neuralgia, diabetes mellitus, as well as fractures of the thoracic vertebrae can be other causes of lesions of the thoracic roots. The pain in these cases, as a rule, is long-term, intense, localized in the area of ​​the corresponding segment, has a constricting or burning character, is often accompanied by short lumbago, may be lancinating.The pain increases at night and with movements in the thoracic spine. Hyperesthesia, hyper-algesia and hyperpathy are often detected in the affected segments. To clarify the diagnosis, it is necessary to carry out X-ray, CT, MRI of the thoracic spine. With injuries of the ribs, the interosseous nerves can be affected, which is accompanied by sharp superficial, burning pains in the area of ​​their inner nerves.

Vations. The pain increases with inspiration or with movement of the chest, resembling pain with pleurisy.As a rule, a small area of ​​segmental hyperalgesia or hyperesthesia is detected, which occurs even when one nerve is damaged.

After identifying the cause, mechanism, nature and duration of the pain syndrome, the question of the selection of adequate therapy is decided. Treatment should always be individualized. It depends on the nature of the underlying disease and is subdivided into undifferentiated and differentiated therapy. The main objectives of undifferentiated therapy are to reduce pain or the patient’s reactions to pain and eliminate autonomic reactions.The main direction of differentiated therapy of pain syndromes in the back is the influence on their pathogenetic mechanisms; treatment also depends on the phase of the underlying disease. The basic principles of conservative treatment include: 1) drug treatment with the use of analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), dehydration, vascular and phlebotonic agents, angioprotectors, antihypoxants, antioxidants, muscle relaxants, B vitamins, biostimulants, anti-inflammatory drugs, chondibroprotectors , neuroprotectors, metabolites, anticholinesterase, absorbable and vegetative-tropic drugs; 2) reflex treatment using acupuncture, laser therapy, physiotherapy, massage (segmental), thermal procedures, physiotherapy exercises (exercise therapy), manual therapy, local irritants; 3) orthopedic treatment involving immobilization, traction therapy, massage, exercise therapy, manual therapy; 4) local anesthetic treatment with the appointment of chloroethyl irrigation, blockades, applications of Dimexidum, analgesic and anti-inflammatory ointments, gels, patches.

■ In modern medicine, the recognized standard for the treatment of diseases with severe pain syndrome is diclofenac, which is one of the most commonly prescribed pain medications

The first and fundamentally important task facing the doctor is the fastest and most effective pain relief. NSAIDs are the most widely used drugs for symptomatic pain relief [27].They are quite effective, easy to use, inexpensive and generally well tolerated. It should be noted that the effectiveness of NSAIDs as analgesics is determined not only by the peripheral action associated with a decrease in the synthesis of prostaglandins, as well as other mediators of pain and inflammation in damaged or inflamed tissues.

The most widely used NSAIDs are from the group of non-selective cyclooxygenase inhibitors (COX). Basic

recommendations for the use of NSAIDs (in monotherapy mode or in combination with other analgesic drugs): 1) their appointment is advisable for acute or chronic diseases and pathological conditions, manifested by pain associated with both inflammatory and degenerative lesions of the organs of the musculoskeletal system, acute trauma and surgery; 2) the duration of the use of NSAIDs depends on the duration and intensity of pain in a particular situation; 3) for the relief of acute pain syndrome, it is advisable to prescribe parenteral forms of NSAIDs or giving the most pronounced analgesic effect with a minimum risk of side effects; 4) with a long course of treatment, NSAIDs with a medium or long half-life are recommended orally or in the form of rectal suppositories.These drugs are characterized by a good analgesic and anti-inflammatory effect, provide a relatively rapid elimination of pain.

In modern medicine, the recognized standard for the treatment of diseases with severe pain syndrome is diclofenac, which is one of the most commonly prescribed pain medications. Like other NSAIDs, diclofenac inhibits the activity of the COX enzyme involved in the formation of prostaglandins from arachidonic acid.Diclofenac also inhibits the activity of the lipoxygenase enzyme. According to Russian studies, with the simultaneous administration of diclofenac and B vitamins, a higher value of the Cmax indicator was noted compared with the use of only diclofenac [28]. To increase the therapeutic effect of diclofenac, while minimizing its dose, with the help of B vitamins, a highly effective combined preparation Neurodiclovit was created, one capsule of which contains 50.0 mg of diclofenac, 50.0 mg of vitamin B1, 50.0 mg of vitamin B6 and 250.0 mcg of vitamin B12.B vitamins have a wide range of pharmacodynamic properties and are involved as coenzyme forms in most metabolic processes. It is known that thiamine (vitamin B1) has a significant effect on the regeneration processes of damaged nerve fibers, provides energy for axoplasmic transport, regulates protein and carbohydrate metabolism in the cell, affects the conduction of nerve impulses, and promotes the development of an analgesic effect. Pyridoxine (vitamin B6) is a cofactor for many enzymes acting in the cells of the nervous tissue, participates in the synthesis of neurotransmitters of the antinociceptive system (serotonin, norepinephrine), supports the synthesis of transport proteins and sphingosine, a structural element of the nerve fiber membrane, ensures the delivery of fatty acids to cell membranes, and myelin sheath.Cyanocobalamin (vitamin B12) provides the delivery of fatty acids to cell membranes and myelin sheath. The use of vitamin B12 contributes not only to remyelination (due to the activation of the transmethylation reaction, which ensures the synthesis of phosphatidylcholine of the membranes of nerve cells), but also to a decrease in the intensity of pain syn-

1 Table 1. Basic treatment measures

Nosological form Therapeutic measures

Tietze Syndrome Local warming procedures and the use of NSAIDs.With a high intensity of pain syndrome – infiltration of the affected joints with local anesthetics (0.25-0.5% novocaine solution), sometimes in combination with corticosteroids

Cost-sternal syndrome Intercostal nerve blocks with local anesthetics in the posterior axillary line

Sliding rib syndrome Explaining to the patient the benign nature of the condition, NSAIDs, blockages with local anesthetics and corticosteroids.If the above measures are ineffective, sometimes they resort to resection of the edge of the rib

Sternoclavicular hyperostosis NSAIDs, warming physiotherapy and exercises aimed at strengthening the back muscles

Facet syndrome Infiltration of the affected joints with a local anesthetic solution, warming the painful area and active physiotherapy aimed at strengthening the muscles of the abdominal wall and the muscle that straightens the spine

droma, which is associated with the intrinsic antinociceptive effect of high doses of cyanocobalamin [29].Experimental studies have shown that vitamin B1 alone or in combination with vitamins B6 and B12 is able to inhibit the passage of pain impulses at the level of the posterior horns of the spinal cord and thalamus [30]. B vitamins perform the function of coenzymes in metabolism, in particular in the nervous tissue, which enhances the analgesic effect of diclofenac. Using B vitamins in the treatment of pain syndrome, it should be remembered that their analgesic properties decrease accordingly: B12> B6> B1 and that the multivitamin complex (B1 + B6 + B12) has a more pronounced analgesic effect than monotherapy with vitamin B1, B6 or AT 12.In the treatment of acute back pain, the combination of B vitamins with NSAIDs is more effective than NSAID monotherapy [31]. The drug Neurodiclovit is used for inflammatory and degenerative diseases of the joints and spine (chronic polyarthritis, rheumatoid and rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, spondyloarthrosis). Neurodiclovitis has a low incidence of unwanted complications and good individual tolerance, which allows it to be recommended for widespread use in the treatment of patients with osteoarticular pain in the thoracic spine and chest.

The main therapeutic measures of individual forms are presented in table 1.

You can request a complete list of references from the editorial office.

90,000 Numbness of fingers, pain in ribs and changes in odors – is it from the nerves or is it more serious? We speak as a neurologist | 74.- Approx. ed. ), acquired dementia (dementia), alcoholism, the consequences of tick-borne encephalitis, peripheral nerve injury and some others. Also, this condition can be observed with pathology of the endocrine system (thyrotoxicosis, diabetes mellitus), poisoning with toxic substances, excessive consumption of coffee, lack of vitamin B12, stress, excessive physical exertion.

The degree of manifestation is within the normal range

The norm can be considered if the tremor occurs with excitement (if it does not interfere with a person in his professional and personal life) or after excessive physical exertion.

Propensity to the problem

We must not forget that tremor can manifest itself in people who abuse alcohol. The tendency to essential tremor is inherited.


Find out the reason, if possible eliminate the provoking factor, take medications prescribed by your doctor.

Where to go?

If you are concerned about this problem, see a neurologist. Sometimes the therapist can cope with the problem, if the reason is not in the pathology of the nervous system.

Root cause of changes

It can be glaucoma and other eye diseases, increased or decreased blood pressure, atherosclerosis of the vessels that feed the retina of the eye and neck vessels, cerebrovascular accident (stroke), poisoning with certain medicinal substances, lack of trace elements (for example, iron, vitamin B12 and folic acid in the development of anemia). And also a sharp rise from a lying or sitting position.

The degree of manifestation is within the normal range

If this condition occurs with a sudden change in position and there are no other symptoms that bother the person, it does not require treatment.In other cases, it is necessary to look for and eliminate the cause.

Propensity to the problem

This condition is possible if the eyes are fatigued due to prolonged stay at the computer.


The most important thing is to organize your workplace correctly, relax your eyes – during breaks, look out the window, and not at the phone. If it doesn’t help, we run to the doctor.

Where to go?

Oculist, neurologist.

The root cause of changes

This happens with orthostatic hypotension – redistribution of blood from the head to the lower extremities.

The degree of manifestation is within the normal range

This can be normal and pathological. Norm – if a person sat and jumped up abruptly, tall and thin people are especially prone to this state. In diseases of the endocrine system, as well as in the elderly, this is an additional factor in falls and requires treatment.This condition can be caused by drugs.

Propensity to the problem

This problem often occurs in the elderly, as well as tall and thin people (due to the fact that the blood does not have time to quickly redistribute through the vessels).


The doctor recommends controlling your actions and trying not to get up suddenly. If you still feel dizzy, then take a comfortable position – sit back or lie down and lift your legs at an angle of 45 degrees.

Where to go?

If the problem occurs frequently, then your specialist is a cardiologist, if necessary and if cardiological pathology is excluded, he will redirect you to a neurologist.

Root cause of changes

There are two types of headaches – primary and secondary.