Hypertension and neurological consequences

The nature of pain in neuralgia

Pain in neuralgia occurs as a result of spasm of the intercostal muscles or due to pinched nerve endings in the spinal column.
In the latter case, the problem may be an exacerbation of osteochondrosis, the appearance of a hernia or protrusion. The following symptoms are typical for this type of pain:

1. Most often, the pain is severe, but it can also manifest itself in the form of some discomfort.
2. It intensifies after changes in body position (bending, turning), as well as during coughing or sneezing.
3. Manifests itself as constant or paroxysmal.
4. The sensations are burning, stabbing, pressing.
5. Duration – from 1-2 hours to several days or more.
6. Even a slight touch to the intercostal spaces or at paravertebral points makes the pain unbearable.
7. Irradiation is observed in the arm, back, neck, and left anterior chest. It is this symptom that often leads to a false interpretation of the cause of the disease, as it resembles a heart attack.
8. The skin along the pinched nerve changes sensitivity. Paresthesia (distorted sensation) is observed in the form of burning, crawling, tingling. Sometimes a person complains of numbness in the affected area.
9. The attack is often accompanied by sweating, paleness, and muscle spasms. The latter symptom is caused by impaired blood flow in the area and irritation. The local temperature drops and the body area becomes cool.

All of the above symptoms can occur simultaneously. But sometimes only one or two signs appear. The degree of their severity depends on the sensitivity threshold and other individual characteristics.

Causes

There are a huge number of prerequisites for the diagnosis of “intercostal neuralgia of the thoracic region”. But all the reasons ultimately come down to two main conditions: irritation of nerve fibers in the intercostal space or pinched nerve in the thoracic region.

Pinched nerves can occur due to osteochondrosis, kyphosis, hernia

Pinched nerves in the chest often occur against the background of osteochondrosis in this area. Also, causes of discomfort can be ankylosing spondylitis, herniated intervertebral discs, spondylitis, and kyphosis.

Irritation of the nerves in the area between the ribs can occur as a result of trauma of various etiologies, overexertion during excessive physical activity, or even as a result of psychological stress.

Intercostal neuralgia in rare cases can result from the following ailments:

Heart diseases with similar symptoms

I want to say that there are many cardiac and vascular pathologies that are accompanied by similar symptoms. I propose to consider the most common abnormalities, this will help to understand whether the heart or neuralgia is the cause of the pain.

Angina pectoris

Pain in this case occurs in the area of ​​the heart muscle (but do not forget that there are atypical attacks). It has a diffuse nature, a person is not able to indicate the exact location. Its strength and description are variable: it can be pressing, piercing, cutting, baking. It radiates to the left arm, under the shoulder blade, neck, lower jaw. It does not depend on the position of the body, but can be provoked by physical overload, nervous stress, as well as sudden hypothermia or overheating.

At this moment, there is a fear of death, shortness of breath with difficulty in inhaling. The attack can be one-time, occurring 1-2 times a day or more often. Its duration ranges from 3-5 to 20 minutes. Almost the same signs are characteristic of myocardial infarction. But unlike angina, the attack usually lasts a long time. The patient takes a certain position in bed - sitting with his legs down or lying on several pillows. You can read more about angina pectoris and how to deal with it in the article at the link.

Myocarditis

Inflammatory diseases are accompanied by moderate pain, which is monotonous. Occurs in 90% of all patients. They describe it as aching or pressing. In the acute period, signs of inflammation are observed (fever, body aches), shortness of breath with impaired inhalation or exhalation. The history often reveals a recent infectious disease. There is no clear dependence on physical activity.

Often myocarditis simulates angina pectoris, especially in older people, when pain and lack of air come to the fore, and the rest of the symptoms are smoothed out or do not appear.

Perikadite

The pain of pericarditis gradually increases, but when effusion appears, it can significantly decrease or go away completely. It stings, cuts, radiates to the neck, back, shoulder, to the right side, and lasts for a long time. Some relief occurs in a sitting position with anterior tilt.

In acute dry inflammation, an attempt to make a deep entrance increases the pain, so with this disease a person breathes quickly and shallowly. During auscultation, in this case, I clearly heard the pleural friction noise. The heart most often hurts with this type of pericarditis in the apex area.

A complete collection of information about pericarditis and its treatment methods is here.

Aortic aneurysm

The symptoms of this acute condition are largely reminiscent of myocardial infarction. A sharp increase in blood pressure, stress or physical activity can be a provocation. The pain is tearing, bursting, localized in the retrosternal region, radiating to the neck, lower jaw, right side of the chest, and sometimes runs along the spine. Has a wavy character. In some cases, it spreads to the projection area of ​​the abdominal aorta and even to the legs.

At the same time, sharp pressure surges appear; when the pressure drops, a collapsible state may occur. There is an asymmetry of the pulse on the left and right arms. As blood begins to accumulate under the inner lining of the aorta, symptoms of anemia (pallor and blueness of the skin, dizziness) quickly develop.

Pulmonary embolism

Pulmonary embolism is accompanied by sharp and severe pain, which is localized in the center of the sternum, as well as to the left or right of it. It can last from a few minutes to 3-5 hours and is associated with respiratory movements of the chest. At the same time, a lack of air comes to the fore, a sharp decrease in pressure, up to collapse. Clinical manifestations depend on the location of the thrombus and its size. When the lumen of a large vessel is blocked, cyanosis appears in the upper part of the body, arrhythmia with an increase in pulsation frequency. When small arteries are blocked, the skin develops blue, shortness of breath, the pain is most often moderate, cough and sputum streaked with blood are observed.

How to distinguish heart pain from osteochondrosis and neuralgia

It is possible to distinguish heart pain from osteochondrosis of the thoracic region by a number of signs presented in the table:

How to distinguish

To distinguish heart pain from neuralgia and other pathologies that are successfully masked by cardialgia, it is necessary to take into account the following factors:

• duration;
• localization and depth;
• provocative factors;
• drugs to relieve symptoms.

When trying to determine the cause, I always pay attention to the accompanying signs. This allows you to fairly accurately diagnose the disease, even at the stage of a preliminary survey, before using additional research methods.

Angina pectoris lasts 3-20 minutes, and a heart attack is characterized by a long-lasting attack (the same pain is observed with myocardial inflammation, pericarditis and aneurysm). Suffering of varying intensity and duration is observed with pinched nerves and myositis.

It is necessary to determine the depth and localization of pain. In case of cardiac pathology or vascular problems, it is internal, as if going outward. Superficial sensations are characteristic of neuralgia and muscle inflammation. In this case, it is possible to distinguish pinching from pain in the heart using palpation.

Provoking factors for the development of IHD are psycho-emotional stress or physical overload. The latter factor can also provoke an exacerbation of osteochondrosis and hernia. Myositis occurs against the background of general inflammation, hypothermia or intoxication.

If the attack is relieved by sublingual nitroglycerin, then angina pectoris should be suspected. For a heart attack, acute aneurysm or thromboembolism, this action will not have a significant effect; in this case, only narcotic analgesics, which are administered to the patient immediately after admission to the department, will help. To distinguish intercostal neuralgia from cardiac pain, you should know that the first pathology can be easily eliminated with the help of non-steroidal anti-inflammatory drugs and the use of muscle relaxants, but cardiac problems cannot be solved in this way.

Can osteochondrosis cause pain in the mammary gland?

If a woman suffers from osteochondrosis, then her nerve fibers located next to the mammary gland are pinched. How to reduce pain and how to be examined and diagnose the disease? And also, what ways will help relieve chest pain?

Can pain “flow” due to spinal osteochondrosis?

The pain syndrome that occurs due to osteochondrosis can actually be felt in the area of ​​the mammary gland. Pain varies in its manifestation:

• Tingling sensation;
• Drawing sensation;
• Acute pain;
• Pressing sensations;
• Intense pain;
• Mild pain symptoms.

Clamping of nerve endings, resulting from a disease of the spinal column, leads to pain in the thoracic region. As the pathology progresses, bone growths over time cause muscle spasms and also spasm the nerve fibers. The spasm manifests itself even with low activity and becomes stronger with overload, excessive cooling and coughing. Eventually, the woman begins to feel strong pain sensations that reach various parts of the limbs and torso, which includes the area of ​​the mammary glands. These signs of pathology often cause difficulties in diagnosing the disease.

In many cases, women perceive a pulling sensation in the chest as heart disease, cancer or mastopathy.

However, after visiting a doctor, they learn that the discomfort appeared as a result of the development of osteochondrosis of the spinal column. This disease is not fatal, however, this is not a reason to ignore it, since the disease affects the chest area at the very last stage, at which colossal damage occurs to the blood flow in the body.

What other symptoms may appear?

To make a correct diagnosis, the doctor needs to make a clinical picture. To begin with, it will include the characteristic symptoms of the disease:

• Pain in the area of ​​the mammary glands, between the ribs and shoulder blades, felt when breathing, often when inhaling. The woman is unable to take a deep breath due to severe spasm.
• Burning sensation in the chest.
• Aching pain symptoms flowing into the chest area, armpits and other parts of the body, affecting internal organs.

A burning sensation in the mammary gland is another sign of osteochondrosis of the chest.

• The pain becomes stronger with sudden body movements, jerking, bending and raising the limbs.
• Limbs go numb.
• The pain becomes stronger when tired, the woman wakes up with a stiff feeling in her body.
• There is a sharp tingling sensation in the chest, interpreted by women as heart disease.
• It can often become worse due to excessive cold, dampness or draft.

Acute osteochondrosis is accompanied by incessant pain, concentrated in the chest and shoulder blades. In addition, blood flow in the area of ​​the mammary glands worsens, and this, together with the presence of hormone-related disorders, provokes the development of mastopathy.

Exceptions: differential diagnosis.

When diagnosing, the most important thing is not to confuse similar signs of the disease, undergo a full examination and receive timely treatment. Chest pain with osteochondrosis means an extreme degree of development of the pathology. Take a closer look at the characteristic features and duration of pain, thereby you will conduct a differential diagnosis of mastopathy and heart disease.

• During palpation of the chest and spinal column, you can see tight muscles in the form of painful points.
• Long-term spasms that last for days or weeks.
• The pain becomes stronger during sudden movements of the arms or body.
• Nitroglycerin will not save you from acute pain; a non-steroidal anti-inflammatory drug may help.
• Prolonged sitting can also trigger symptoms.
• The mammary glands become rougher, pain is felt during palpation.
• Breasts feel heavy.
• The menstrual cycle significantly influences the manifestation of symptoms and the degree of their severity.
• There may be discharge from the nipples.

Pain may decrease after using nitroglycerin for heart disease.

• The spasm is short-lived, lasting about a couple of minutes.
• Pain points are not detected by palpation. The pain syndrome is concentrated behind the chest.
• Heavy physical activity or a constant state of stress can cause pain.
• With an active lifestyle, your health does not get worse.

Osteochondrosis can trigger the development of heart disease because it affects the blood flow in the chest. Most likely, this problem affects women more often due to a less active lifestyle.

How to treat chest pain caused by osteochondrosis

As a rule, the following medications are prescribed:

• Non-steroidal anti-inflammatory drugs in the form of gel, tablets or injections.
• If non-steroidal anti-inflammatory drugs and other methods do not provide adequate treatment, then glucocorticosteroids are used.
• Analgesics.
• Chondroprotectors.
• Diuretic medications will help remove swelling.

The doctor prescribes medications, taking into account the woman’s clinical picture, age and related illnesses. When undergoing an acute form, to prevent osteochondrosis, it is recommended to carry out the following therapeutic measures: it is necessary to completely establish a sleep and leisure schedule, sleep should take place on a comfortable and hard mattress, the room should be well ventilated for 7 to 8 hours a day.

When diagnosing osteochondrosis, the patient must be scrupulous about her well-being and follow the doctor’s recommendations.
Therapy should not stop at defeating pain, as in the future it can manifest itself in the chest and arms, neck and organs. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Necessary examinations

When I encounter such phenomena, I immediately refer the patient for an ECG. This is especially true for people over 45 years of age, even if the signs are not typical for myocardial ischemia. It is better to make sure that the person is not in danger, and only then calmly carry out treatment for neurological or other abnormalities. If you have angina, you should do an ECG with stress, since it may not show any changes when pain is eliminated.

In some cases, it is necessary to use other instrumental methods:

1. Coronary angiography. It is carried out using contrast injection and helps determine the presence of narrowing in the vessels of the heart.
2. EchoCG. Ultrasound is used for this. It allows you to see the structure of the chambers of the heart muscle, the condition of the valves, the thickness of the walls, and the presence of inflammatory processes.
3. Tomography of the spinal column (or MRI). Performed after ruling out cardiac pathology. During the manipulation, the size of the intervertebral spaces and the condition of the bone tissue, the presence of disc protrusions and pinched neurovascular roots are assessed.

The laboratory evaluates biochemical markers (ALT and AST), their increase indicates the development of a heart attack or myocarditis. More modern ways to determine acute necrosis are to increase the concentration of troponins in the blood.

How to eliminate pain

Providing assistance depends on the cause of the pain, it is carried out as follows:

1. "Nitroglycerin" and "Aspirin" during angina pectoris.
2. "Analgin" or "Ibuprofen" for pinched roots. Simultaneous use of ointments and gels “Deep-relief”, “Menovazin”.
3. In case of a heart attack, aneurysm or embolism, the attack is stopped in intensive care with the use of narcotic analgesics.

If pain radiates to the abdominal area, you should not self-prescribe treatment until a doctor arrives. This will help eliminate acute conditions of the abdominal organs.

Treatment of intercostal neuralgia during pregnancy

During pregnancy, the presence of neuralgia is considered a fairly serious problem. It requires proper attention, which will help avoid complications for the expectant mother and baby.

All treatment that will be given to a pregnant woman for neuralgia must be prescribed by the attending physician. Self-therapy is extremely undesirable, as it can greatly harm the woman and the child in the womb.

Many patients prefer not to take medications. They limit themselves to vitamins and mineral complexes, use ointments and warm compresses, observe bed rest and perform simple physical exercises.

Gymnastics for neuralgic pain in pregnant women is very effective. Physical exercise does not allow blood to stagnate in the joints and parts of the spine.

If the pain becomes unbearable, novocaine blockades are prescribed with caution.

Expert advice

If severe pressing pain appears in the chest area, I recommend that a person adhere to the following tactics:

• calm down and take a position in which some relief is felt;
• stop any active movements;
• take Aspirin and put a Nitroglycerin tablet under your tongue;
• in the case where a history of angina pectoris was diagnosed, during a prolonged attack, continue to use sublingual nitrates every 15-20 minutes;
• Call an ambulance and, before it appears, try to determine the nature of the sensation (dependence on breathing, posture, movement).

It is very important to tell the doctor what preceded the attack, after which it began, and what measures were taken to eliminate it.

Treatment of neuralgia

Treatment options for neuralgia vary depending on the type and severity of the condition.

Ointments, local nerve blocks, and steroid injections may provide temporary pain relief for mild neuralgia.

Treatment for severe neuralgia pain may require prescription drugs, surgical procedures, or both.

Medications

Painkillers are generally not very effective in controlling neuralgia pain. Medications that can treat the underlying causes of neuralgia include :

• anticonvulsants such as carbamazepine, topiramate, and lamotrigine
• antidepressants such as amitriptyline
• muscle relaxants such as baclofen
• membrane stabilizing drugs such as gabapentin

Case from practice

A 56-year-old woman came to see me with complaints of chest pain that radiated to her arm.
She noticed her first attacks 1.5 years ago, with a history of large-focal infarction of the anterior wall. Palpation reveals increased sensations in the area of ​​the 6-7 thoracic vertebrae. Some relief is noted after lying on a flat, hard surface. After taking an ECG and conducting additional drug tests, cardiac pathology was excluded. The patient was referred for consultation to a neurologist. An MRI reveals an intervertebral hernia. Treatment is rest during an exacerbation, NSAIDs, massage, electrophoresis with novocaine, traction. After completing the full course, my condition is satisfactory.