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
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