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Arthritis (Expert Forum)
Rib Cage Pain - Where to go next?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions and support regarding arthritis issues such as: Arthritis, Autoimmune Disease, Bursitis, Fibromyalgia, Gout, Juvenile Rheumatoid Arthritis, Lupus, Myositis, Neuralgia, Osteoarthritis, Polymyalgia Rheumatica, Rheumatoid Arthritis, Sciatica, Tendinitis, Vasculitis.
Rib Cage Pain - Where to go next?
by Toneman, Sep 17, 2006 12:00AM
I am a 48 year old male, 65 lbs overweight, but have lost 40 this year, with a history of chest and rib cage pain. Not servere or dibilitating, but enough to make life difficult. I have had it for many years, but in Feb 05 I went to the ER to have the chest pain checked out. They did not think it was cardiac in nature, but kept me overnight for tests. I had all the tests, bloodwork, xrays, echo and thallium stress test. All normal and was discharged to my family doctor. He reviewed the test results and though it was GERD or Costochondritis. He started me on Aciphex and many symptoms went away, but the mild chest pain remained.
During my annual physical this past Mar 06, he asked about the pains and I told him I still had some pain on most days. Given my age, he felt it would be wise to see a cardiologist, which I did and as I was a new patient, she repeated all the tests from the year before, echo, bloodwork and thallium stress test, all came back normal. My cholesterol levels are good at 170 with an LDL of 63 and an hdl of 40, Tri's are high at 300. My blood pressure is controlled and runs under 120/80 and I exercise daily and have no pain with exertion or any other cardiac symptoms. Given these results both the Cardiologist and the family doctor do not feel the pain is related to my heart.
My doctor did find a diseased gallbladder with an abdominal ultrasound and I had it removed in May 06, but the rib cage pain remained.
I have also been experienceing severe knee pain for the past several years and had been seeing an Orthopedic surgeon who said that there was possibly some cartilage damage and definately some arthritis. He wanted to operate on the knees, but I wanted my family doctor's opinion first. He said he would be more comfortable with me seeing a Rhuematologist before we did the surgery as the surgeon was not sure if he could take care of the pain.
The Rhuematologist examined me and looked at the MRI's of my knees and agreed it was early onset arthritis and prescribed Celebrex (with my Cardiologist's blessing). We also spoke about the rib cage /chest pain and he agreed with my family doctor that it was most likely chronic costonchondritis or even a form of arthritis and that I may need to live with it for the rest of my life. The Celebrex does ease both the knee and chest pain, but does not take it totally away. It seems to be more effective on my knees than it is on the chest pain. The chest pains are more affected by position and bending over. He also has given me vicodin to take when the pain keeps me from sleeping.
My question is, where do I go next and Does this sound like a reasonable diagnosis and if so what is the next step and is there anything I can do to make the chest pains go away on my own?
I think we've taken all the steps we can to eliminate the heart as a cause so I just don't know what to do next, I just know these pains make life diffcult.
Any suggestions would be greatly appreciated.
Tony
During my annual physical this past Mar 06, he asked about the pains and I told him I still had some pain on most days. Given my age, he felt it would be wise to see a cardiologist, which I did and as I was a new patient, she repeated all the tests from the year before, echo, bloodwork and thallium stress test, all came back normal. My cholesterol levels are good at 170 with an LDL of 63 and an hdl of 40, Tri's are high at 300. My blood pressure is controlled and runs under 120/80 and I exercise daily and have no pain with exertion or any other cardiac symptoms. Given these results both the Cardiologist and the family doctor do not feel the pain is related to my heart.
My doctor did find a diseased gallbladder with an abdominal ultrasound and I had it removed in May 06, but the rib cage pain remained.
I have also been experienceing severe knee pain for the past several years and had been seeing an Orthopedic surgeon who said that there was possibly some cartilage damage and definately some arthritis. He wanted to operate on the knees, but I wanted my family doctor's opinion first. He said he would be more comfortable with me seeing a Rhuematologist before we did the surgery as the surgeon was not sure if he could take care of the pain.
The Rhuematologist examined me and looked at the MRI's of my knees and agreed it was early onset arthritis and prescribed Celebrex (with my Cardiologist's blessing). We also spoke about the rib cage /chest pain and he agreed with my family doctor that it was most likely chronic costonchondritis or even a form of arthritis and that I may need to live with it for the rest of my life. The Celebrex does ease both the knee and chest pain, but does not take it totally away. It seems to be more effective on my knees than it is on the chest pain. The chest pains are more affected by position and bending over. He also has given me vicodin to take when the pain keeps me from sleeping.
My question is, where do I go next and Does this sound like a reasonable diagnosis and if so what is the next step and is there anything I can do to make the chest pains go away on my own?
I think we've taken all the steps we can to eliminate the heart as a cause so I just don't know what to do next, I just know these pains make life diffcult.
Any suggestions would be greatly appreciated.
Tony
Doctor's Answer
by Kevin Pho, MD, Sep 19, 2006 12:00AM
, Sep 19, 2006 12:00AM
You have had a pretty comprehensive evaluation thus far. With the multiple cardiac tests, it would make intrinsic heart disease less likely.
GI causes can be considered, and be further evaluation with an upper endoscopy or upper GI series. A more specialized test would be a 24-hr pH study to definitively rule out GERD.
If the pain is determined to be musculoskeletal in origin, a referral to a physiatrist (rehabilitation MD) or physical therapy can be considered. Procedures like trigger point injections can be considered.
Also to be considered is a referral to a pain management specialist for chronic medication treatment to manage the discomfort.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
GI causes can be considered, and be further evaluation with an upper endoscopy or upper GI series. A more specialized test would be a 24-hr pH study to definitively rule out GERD.
If the pain is determined to be musculoskeletal in origin, a referral to a physiatrist (rehabilitation MD) or physical therapy can be considered. Procedures like trigger point injections can be considered.
Also to be considered is a referral to a pain management specialist for chronic medication treatment to manage the discomfort.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
Your chest pain symptoms sound familiar to me. Years ago, in my 30's, I had a similar experience with chest pain that would not go away. Added to that was fatigue that came suddenly, cold sweat, and nasuea. The symptoms were similar to a heart attack. I was given all of the standards test of that time and finally, I mean finally, I was diagnosed by a neurologist (who has retired) as having inflammation of the xyphoid. Holy smokes, I never even knew I had a xyphoid,let alone that it was inflammed. I was pretty sick by then with the pain, etc. This same doctor gave me 3 shots of some heavy duty cortizone right in the base of my sternum,as the xyphoid is located there. It worked for 30 years, but here I am again with some of the same symptoms. Suggest you try pushing on the bottom of your sternum with you finger to see if it hurts. If it does and the symptoms show up almost immediately after you push and prod a bit, my thought is you may have found the problem.
Dr. Reeves, the neurologist, is now retired. I have the same symptoms again and he said that it could happen. He also said I have had all of the cortizon that I could have. So, I am wondering if this is still true, or is there another treatment?
I hope this is some help for both of us.
JoeD
when I breath deeply I can feel it but not too bad.does anyone know whatcan be causing this. My doctor doesn't