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Chest and back pain
I am a 48 year old male, 50 lbs overweight but lost 45 pounds so far this year through diet and lifestyle changes. I have been diagnosed with arthritis in my knees and the intercostal joints of my ribcage. As I was having pains in my chest, my doctor played it safe and had me go through two complete cardiac workups, one in Feb 05 and a follow up in Mar 06. Both times I had all the normal tests, Echo, Bloodwork, Xrays and Thallium Stress test and both time everything came back normal. My blood pressure is contolled and runs 110/70 and my cholesterol levels are well below normal and are in the good range at 170 total, 63 for LDL and 40 for HDL.

I saw my Cardiologist a couple of weeks ago for a 6 month follow up and she says everything with my heart is fine. I have a high tolerence for exercise and my pains are never realted to exertion plus they are localized to specific joints between my ribs and sternum. She feels they are in no way cardiac related.

My doctor refered me to a Rheumatolgist who confirmed the arthritis or possible chronic costochondritis and put me on Celebrex which has worked well. It has cleared up the knees, but has not done as well with the intercostal pain. I posted before and your reccommendation was to see a Pain Management Center which was what my Rhuematologist also refered me to. They put me on a 20 pill step down program of Prednisone which really knocked out the intercostal pain. But that was many weeks ago and the pain is starting to come back. In addition, I have started having back pains just below my left shoulder blade, not under it. It is worse when working at my desk and does not come on with exertion. The Rheumatolgist did say I had bad posture when sitting and did a simple test by pushing down on my head that really caused neck and back pain.

Could the pain in my chest and back be related? I am confident that it is not a heart issue. Are there any arthritic conditions in the spine that may be responsible for both pains? I don't get them at the same time but they persist. What tests would you reccommend?

I see my Rheumatologist in a couple of months for a follow up and would welcome your thoughts before I see him. The pain in my back is much worse than the pain in my chest, which is much better than it had been when I posted previously, but still there. Any help would be greatly appreciated.


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233190 tn?1278553401
It is possible that the pain in the chest and back are related.  I agree that a cardiac condition is less likely.  Back pain and subsequent changes in the posture can lead to additional stress in the intercostal joints.

An ANA, rheumatoid factor and sedimentation rate can be considered to look for intrinsic rheumatological disease - but I'm sure this was already considered.  

Otherwise, referral to a pain management specialist can be considered, as well as consideration of physical therapy.

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.
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