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Continuous chest pain with normal CHEST XRAY and EKG.

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Dear Doctor,

I am a 29 year old female suffering from a continuous chest pain since January 2014. I currently live in Florida and visited doctors in my locality. They performed different tests on me. The chest X-ray and EKG verified no fracture in the bone and the heart function is normal. Deep breathing test also verified lungs is working properly.

The blood tests showed everything normal. No signs of internal inflammation or infection. The second doctor now suspects as it doesn't seem to be a bone, chest or blood related problem, it might be a nerve/spinal damage related disease.

The pain is continuous, triggered by any sort of physical movement (turning, bending etc.) and also is worst when I sneeze. It is on the central part of my chest, and seems to be on the surface.. as if on the sternum bone or the accompanying muscles of chest.
I am attaching a detailed description of my symptoms and medical test results.

Please let me know what you think might be the cause and what treatment I should pursue.
I am eagerly waiting for your response.
Thank you.

Sabrina S Siddique


Category: Neurologist, Medical

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Category: Pediatric Neurologist
Dr. Sudhir Kumar is online now

Expert:  Dr. Sudhir Kumar replied 4 Days.


Hello.
Thank you for posting your query at DoctorSpring.com
I have noted your symptoms and investigation reports so far.
I would agree with your doctor that the most likely diagnosis in your case could be costochondritis or Teitz syndrome. Blood tests may be normal in most cases of costochondritis.
A course of 8-12 weeks of anti-inflammatory agents such as ibuprofen or diclofenac may be useful in this case.
Regarding neurological causes, there is a possibility of intercostal neuralgia, however, it is an uncommon condition. The symptoms that could favour a neurological origin of pain are sharp, shooting nature of pain, associated with burning, tingling, pins and needle sensations, etc. If these features are present, medications such as pregabalin or gabapentin capsules may be useful.
I hope it helps.
Feel free to discuss further,
Regards
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)


Patient replied :

Dear Dr. Sudhir Kumar,
Thank you so much for your reply. I went to my neighborhood pharmacy but came to know from there that Diclofenac cannot be sold in the USA without a doctor's prescription. Ibuprofen is available over the counter, but I tend to vomit continuously if I take it. Last time I tried taking it coupled with Pepcid for stomach support, but after 2-3 days, I started to vomit again.

Actually I forgot to mention, as I was unable to take painkiller medicines by mouth, I was prescribed a topical pain gel (Voltaren, diclofenac sodium gel 1%) to apply in the chest area. I used it for a couple of weeks and it seemed to numb the pain at first, but then after 10-15 days it was not as effective any more so I stopped using it regularly and now only use it few and far between.

In order to get prescription of Diclofenac and/or proceed treatment for Costochondritis do you suggest I visit any particular doctor or specialist here in Florida, USA? I live in Tallahassee and there isn't many options here under my health insurance, could you kindly suggest me a particular specialist that would be most helpful in my case??

I am attaching scanned copy of all the blood reports here if you want to see them. I also thought this must be Costochondritis. Because the symptoms match more, specially the terrible hurting with sneezing. But I have a question, if my condition is indeed Costochondritis/Tietze's syndrome, and I have inflammation internally then isn't it supposed to have some indication in any of the blood test results (e.g. presence of protein, sedimentation etc.)??

I really hope that my condition may not be Intercostal neuralgia, because I feel very scared and nervous about Nerve related problems and their treatment (nerve injection, surgery etc.). My another question would be,is there a way to be absolutely sure which one of this two is causing my pain, either Costochondritis or Intercostal Neuralgia, and not the other one??

I should also mention that I have been having shoulder pain and lower back pain almost all the time. I ignore the lower back pain because I have had sporadic occurances of it since I was 12 yeard old. I had trouble with Sinusitis for a long time (16-17 years ago) and it caused headaches in the past. I Also I had foot heel pain for the past 2-3 months, only recently it has been reduced after using a good quality hiking keds (I wear it all the time), and taking warm water epsom salt soak. Not sure if these are related, but I just wanted to include all my conditions.

I am really worried about my chest pain. It is effecting my life in terrible sort of way and I feel almost disabled to go on even with normal day to day activities. Eagerly waiting for your reply.
Thank you. Sabrina


Expert:  Dr. Sudhir Kumar replied 3 Days.

Hello, Thank you for getting back and informing in detail.
You can visit a GP/family physician and get a prescription for diclofenac tablets.
Blood reports are normal. In costochondritis, the inflammation is local and not widespread. Therefore, the blood reports are normal.
The clinical picture can help us differentiate between costochondritis and intercostal neuralgia. I do not feel you have intercostal neuralgia.
I hope it helps. Would be glad to answer any follow-ups.


Patient replied :

Thank you Dr. Sudhir Kumar.
I wasn't able to go to visit a doctor here recently. But I plan to go this week for the Diclofenac prescription like you advised. I have also asked my family in Bangladesh to send me some tablets, they are sending it by someone, it will take some time as he arrives here in September. When I start taking the tablets, what dosage do you prescribe? How many/day? How many miligrams? and how long must I continue?
Meanwhile I am just using Diclofenac Gel and tiger balms, although they don';t work that well to reduce the pain. I forgot to mention to you that sometimed my Collar-bones hurt a lot in addition to the chest pain, do you think they may be related?
Today I have a new symptom which has been bothering me since 4-5 hours and still hurting now. It is not going away. On my back starting just below the neck bone and ending 2-3 inches down the spine, it is hurting a lot constantly. It feels like there is some kind of weight/ pressure on it. At first I wasn't alarmed, but then when it hurt so much even after resting I felt worried. Do you think it is something serious? What can be the probable cause for it?
I am attaching a picture and marking the area of spine pain in case my description wasn't clear.
Waiting for your reply.
thank you.


Expert:  Dr. Sudhir Kumar replied 2 Days.

Thank you for getting back.
Diclofenac tablets are used two or three times per day and the dose is 50-75 mg per dose.
Collar bone pain may be related. The spine/back pain could be muscular pain and you can apply the doclofenac get at that area to get relief.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist


Dr. Sudhir Kumar
Category: Pediatric Neurologist
Experience: 
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
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