Chest Pain Syndromes

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Postherpetic Neuralgia

Young man with chest pain bent over holding his chest

What is Postherpetic Neuralgia? 

Postherpetic neuralgia is caused when a nerve is irritated or inflamed as a result of a recent viral infection from herpes zoster (shingles). Shingles is caused by a reactivation of the varicella-zoster virus, the same virus that causes chickenpox.

Signs and Symptoms:

Testing:

Testing is generally used to identify other treatable coexisting diseases or to rule out the underlying disease responsible for the patient’s immunocompromised state.

Diagnosis:

A targeted history and physical examination combined with appropriate testing should help the clinician identify and properly treat this condition.

Treatment:

Complex Regional Pain Syndrome (CRPS)

Man with chest pain holding his chest

Complex Regional Pain Syndrome (CRPS) also called reflex sympathetic dystrophy syndrome(RSD), is a chronic pain condition in which high levels of nerve impulses are sent to an affected site.

Causes:

Experts believe that CRPS occurs as a result of dysfunction in the central or peripheral nervous systems. CRPS is most common in people aged 20-35.

The syndrome also affects women more often than men.


Signs and Symptoms:

  • Pain
  • Constant Pain/burning pain
  • Stabbing type of pain
  • Allodynia (even simple touch or breeze aggravating the pain)
  • Hyperpathia (marked painful respnse to even a simple stimulation)
  • Spasms in the blood vessels of the skin and resulting in a cold extremity.
  • Movement disorders such as dystonia (involuntary muscle spasms resulting in tremors)
  • Weakness and clumsiness of the extremities
  • Tendency to fall
  • Inflammation
  • Skin rash
  • Changes of the skin color
  • Tendency for bleeding in the skin/bruising easily
  • Insomnia
  • Emotional distrubances: depression, irritability, agitation

Testing:

  • Thermography
  • Sweat testing
  • Bone scan
  • X-Rays
  • Electrodiagnostics
  • Sympathetic nervous system tests
  • Magnetic resonance imaging (MRI)

Diagnosis:

A comprehensive physical exam and medical history is needed as there is no single test that can definitively diagnose complex regional pain syndrome.


Treatment:

Costosternal Syndrome

Older man with chest pain bent over holding his chest

Costosternal joints become a source of pain due to inflammation as a result of overuse or misuse or due to trauma secondary to acceleration/deceleration injuries or blunt trauma to the chest wall. The costosternal joints are also susceptible to the development of arthritis and also subject to invasion by a tumor.

Signs and Symptoms:

Diagnosis:

A targeted history and physical examination combined with appropriate testing should help the clinician identify and properly treat this condition.

Treatment:

Intercostal Neuralgia

Man with chest pain holding his chest with two hands

The pain of intercostals neuralgia is due to damage or inflammation of the intercostal nerves.

Signs and Symptoms:

Diagnosis:

A targeted history and physical examination combined with appropriate testing should help the clinician identify and properly treat this condition.

Treatment:

Post-Thoracotomy Pain

CGI model of a man with chest pain clutching his arm

Causes of Post-thoracotomy Pain:

Sign and Symptoms:

Testing:

Diagnosis:

A targeted history and physical examination combined with appropriate testing should help the clinician to identify and properly treat this condition.

Treatment: