Unexplained Pain

[atc]

Two months ago I began to have some chest pain and chest spasms that radiated to my back. Also it seems to be tender at my sternum. The pain became more frequent and much more intense so I went to the Doctor.  I have had the following tests:

Stress Test - Normal
EKG (several) - all normal
Upper GI with Barium Swallow - Normal
HIDA Scan - Normal
Blood work (several) - all normal except high triglyceride levels
Thoracic MRI - Normal
CT Scan - Normal
Nuclear Imaging of Heart - Normal
Endoscopy - Normal
PH Probe - Normal
Chest Xrays - Normal
Spinal xrays - Normal (minor curvature of the spine)

The pain continues, often severe.  My Doctors are stumped.  Some suspect neurological cause, others suspect a functional problem, but no firm diagnosis.  I am taking pain medication, which sometimes helps but often doesn't eliminate the pain.  Pain increases after eating and also when lying on my back.  Recently, I experience what I can only describe as a head rush.  It feels as if all the blood is rushing to my head.  I think this may be a side effect of so much pain medication but I am not sure.  I am 47 years old and exercised regularly until all this started.  Can anyone offer help or know of anyone with similar problems?  Any help would be greatly appreciated.

[Cleveland Clinic]

the fact that you pain seems to originate from the sternum and radiates to the pack would make me suspocious for a neurologic or a muscluar/ligamentous problem.  Both muscle and nerve run under the ribs and extend posteriorly, ie radiate to the back.  The most common cause of this type of pain is costochondritis or inflammation of the ligaments and the cartilage in the sternum and the chest wall.  As in your case, all the tests are normal.  typically, this is treated with NSAIDS which bring down the inflammation.  This may take a few months, but typically goes away.  The fact that your pain gets worse with laying down would also make me suspicous for pericarditis, but the EKG and echo would have revealed that.  Finally, with a normal hyda scan it would be very unusual that this would be gallbladder related.    

[Predaphin]

Does the pain subside when sitting up? How long does the pain(s) last? How frequent are they?

[atc]

The pain really never subsides and is mainly constant.  The intensity varies from moderate to extreme.  I can only sleep with the help of medication.  As I am typing this I have the pain.  There really is no escaping the pain, only moderating the intensity with med's.  I have lost about 10 pounds, not because my appetite is gone, but because I don't want to face the pain that follows.

[erijon]

I'm sure the doctors will give you a good idea where to start looking, although it sounds like you have been pretty well checked out. I had the same experience with constant long term mild chest pain. I also had all the same tests as you, all normal except my HIDA scan which revealed gallstones. Much of the pain went away when I had my gallbladder removed, but not all., The final "cure" was when I was referred to a Rheumatologist and after more bloodwork he determined I had RA and it was affectig the costal joints between my ribcage and sternum, like constant costochondritis. I went on meds for the RA and the pain went away after a few weeks.

Just throwing it out there, good luck.

Jon

[atc]

I just got back from a stay at UCLA Hospital.  The current "feeling" is that I have XIPHODYNIA or XIPHOIDALGIA.  I had never heard of these but they are defined as an uncommon musculoskeletal disorder that mimics a number of common abdominal and thoracic diseases.  The diagnosis is suggested when a given patient's chest or abdominal discomfort is completely or almost completely reproduced with light pressure on the xiphoid process.  Local injection with an anesthetic-steroid combination is frequently curative.  My next step is to coordinate with a local doctor who performs this procedure.  Hopefully, this is the cure!!!  Thanks to all who took the time to respond, and I will post the results of my procedures.

[marlinspike]

Thanks for updating us. I hope your treatment goes well and your problem is resolved. Best wishes.

[atc]

Had the injection and.......no pain relief.  Pain is actually worse due to the manipulation of the area by the surgeon.  My next step is....to begin again.  Off to a neurologist or a rheumatoligist and continue the search.  I MUST get off of these damn painkillers!!

[leaney]

exactly the same symptoms but after cardiac stent placement 2 yrs ago .never been pain free in chest ever since.  tested for every thing under the sun