After a surgical procedure involving the thoracic wall, it is frequent to experience chronic pain. Another main cause is post-herpetic pain. In both cases, the patient should be monitored by a specialized pain management team. The Radiofrequency or Crioablation of intercostal nerves or some blocks such as the Epidural, Paravertebral or Erector Spinae Plane (ESP) Block, are outstanding tools for the treatment of this pain, when it does not respond to the conventional treatment.
Most Common Syndromes
Post-herpetic pain among post-surgical syndromes are two of the main causes for Thoracic Pain.
Costochondritis is inflammation of the costal cartilage at the articulation of the ribs and sternum. It is a benign disorder, as in contrast to myocardial ischemia or infarction. The history is often characterized by insidious onset of chest wall pain with a history of repeated minor trauma sometimes with palpation of affected costochondral joints. Pain control with anti-inflammatory drugs may be useful.
Muscle strains are a common cause of chest pain. A strain of pectorals or intercostal muscles can begin gradually from repetitive motions or it can have a sudden onset. Pain, tenderness and difficulty breathing are often symptoms of these conditions. Ultrasounds (less accurate) can be performed or an MRI can be requested to better evaluate the lesion. Pain control with anti-inflammatory drugs or with an interventional technique may be useful.
Lower rib pain syndrome is characterized by pain in the lower chest or upper abdomen a tender spot on the costal margin, and reproduction of the pain by pressing on the spot. It is more common among women and in those with a mean age in the mid-40s. Even after a definitive diagnosis is made, one-third of patients undergo further evaluations for other causes of pain.
The sternalis syndrome is a rarely described and generally self-limited condition. It is characterized by localized tenderness overlying sternalis muscle or over the body of the sternum or overlying, and palpation often causes radiation of pain bilaterally. Complementary imaging exams can be requested to well characterize the condition. Sometimes management of pain could be necessary.
Thoracic spinal pain syndromes are relatively common. Some conditions are: snapping scapula syndrome that is associated with pain in the upper back with overhead or throwing activities of the upper extremities; and thoracic disc herniations (more rarely). Costovertebral joint dysfunction is an uncommon condition characterized by posterior chest wall pain aggravated by coughing or deep breathing.
Peripheric Nerve Block
This minimally invasive procedure, as radiofrequency ablation and cryoablation, should be guided for ultrasound or fluoroscopy.
Pharmacological management pain is commonly part of the treatment and a wide range of drugs can be used to manage pain.
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