A 45-Year-Old Patient with Chronic Chest Wall Pain

Abstract

Chronic chest wall pain syndrome is a rare phenomenon in which a patient may experience recurrent sharp, shooting, or dull, achy pain along part of or the entire chest wall. Due to a number of diseases, some of them life threatening, associated with chest pain, patients often undergo a series of tests to rule out a variety of different etiologies, including pain secondary to cardiac, pulmonary, and oncologic pathologies. Often times, as a last resort effort to determine the cause of the pain, patients will undergo an MRI of the thoracic spine, showing a mildly herniated intervertebral disc impinging on one or more intercostal nerves. While rare in the thoracic vertebrae, disc herniation can lead to this chronic chest wall pain syndrome and should be dealt with in a stepwise manner. Treatment options include conservative management in the beginning, including physical therapy, stretching, ice and hot packs, and anti-inflammatory medications to relieve the pain. With further intractable pain, more invasive treatment options are available, and include thoracic epidural steroid injections, intercostal nerve blocks, intervertebral discectomy, radiofrequency ablation of the intercostal nerves, and implantation of spinal cord stimulators. Early interventions have been shown to decrease both the time to alleviation and risk of recurrence of chronic chest wall pain syndrome, while longer episodes have been associated with an intractable form of the condition.