Chest Pain Syndromes
POSTHERPETIC NEURALGIA
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:
- Sharp and jabbing, burning, or deep and aching pain
- Extreme sensitivity to touch and temperature changes
- Itching and numbness
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:
- Lidocaine skin patches
- Drug therapy (Antidepressants, Anticonvulsants, Pain Medication, Steroids)
- TENS
- Spinal Cord Stimulation
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:
- Drug Therapy
- Physical Therapy
- Anesthetic/Corticosteroid Injections
- Facet Joint Nerve Rhizotomy
- Occupational therapy
- Spinal Cord Stimulator
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:
- Pain
- Joints are tender to touch
- Clicking sensation with movement of the joint
- Testing:
- Plain X-rays
- Bone Scan
- Lab Work
- MRI
Diagnosis:
A targeted history and physical examination combined with appropriate testing should help the clinician identify and properly treat this condition.
Treatment:
- Drug Therapy
- Heat and Cold Therapy
- Elastic Rib Belt
- Intra-articular Injection of Costosternal Joint
The pain of intercostals neuralgia is due to damage or inflammation of the intercostal nerves.
Signs and Symptoms:
- Pain is constant
- Pain is burning in nature
- Testing:
- Plain X-rays
- Bone Scan
- Lab Work
- CT Scan
Diagnosis:
A targeted history and physical examination combined with appropriate testing should help the clinician identify and properly treat this condition.
Treatment:
- Drug Therapy
- Heat and Cold Therapy
- Elastic Rib Belt
- Injection
Causes of Post-thoracotomy Pain:
- Direct surgical trauma to the intercostal nerves
- Fractured ribs due to the rib spreader
- Compressive neuropathy of the intercostals nerves due to direct compression of the intercostals nerves by retractors
- Cutaneous neuroma formation
- Stretch injuries to the intercostals nerves at the costovertebral junction.
Sign and Symptoms:
- Tenderness along the healed thoracotomy incision
- Decreased sensation
- Allodynia
- Bulging of the abdomen
Testing:
- Plain X-rays
- Bone Scan
- Lab Work
- CT
- Electromyography
Diagnosis:
A targeted history and physical examination combined with appropriate testing should help the clinician to identify and properly treat this condition.
Treatment:
- Drug Therapy
- Heat and Cold Therapy
- Elastic Rib Belt
- Intercostal Nerve Block