What is this pain in my side that won’t go away?

Dr Flo, I have had on and off chest pain on my left side for the last seven years. I have seen several doctors, had two ECGs, three chest x-rays and most recently, an echocardiogram, but nothing abnormal with my chest or heart has been found. What could be causing this pain and how can I manage it? Joyce

Dear Joyce,

The left side of the chest consists of the heart, left lung and pleura (lining of the lung), part of the oesophagus, muscle, bones, cartilage, nerves and blood vessels. From the tests you have described, it seems like the lungs and pleura, the heart and the major blood vessels are all okay. That leaves us with the less obvious possible causes of recurrent chest pain on the left side of your body. Let’s take a look at the possible causes of chest pain from the remaining parts:

The oesophagus – In its journey between the mouth and the stomach, the oesophagus passes through the chest, and in some portions, seems to be pushed more towards the left. Sometimes, problems with the oesophagus can present as left-sided chest pain. These include oesophagitis (inflammation of the oesophagus), hyperacidity and reflux and oesophageal strictures caused by scarring of the lining of the oesophagus. In addition to the left-sided chest pain, you might also have heartburn, discomfort or pain when swallowing food, nausea and/or vomiting, and other gastrointestinal problems. If you have these symptoms, it would be advisable to have an endoscopy done by a gastro-enterologist (stomach specialist), to determine the cause, and to get started on treatment.

The muscles – In between the ribs, there are three layers of muscles, known as the intercostal muscles, there are also many other muscles on the front and back of the chest and along the spine. Any of these muscles could ache, what is called myalgia (muscle pain), either due to recurrent strain, repetitive activity or even from muscle cramps. Usually after some rest, this pain goes away on its own, or you may require painkillers and muscle relaxants.

The nerves – There are many nerves running within and across the chest wall. Any of them could get “trapped” or damaged, leading to chest pain. This is usually much more difficult to diagnose, but the treatment is medication for pain, and usually the pain goes away with time. If a number of nerves are involved, however, an MRI should be done to determine the exact source of the problem for appropriate intervention.

The bones (and cartilage) There is cartilage that connects the ribs and the sternum (the breast bone). In some cases, there is inflammation between the cartilage and the bone (either the ribs or the sternum). This is called costochondritis, and the resultant pain may feel as though the heart has a problem. The pain is usually on the left side of the chest, and it may be sharp or it might feel like pressure. The pain gets worse when you take a deep breath, when you cough and when you engage in physical activity, and it usually affects more than one rib. It usually has no clear cause, though it may be triggered by injury, or physical strain, or arthritis. Less likely causes include infection or tumours in the joint. Treatment includes pain medication, physiotherapy with stretching and nerve stimulation exercises (TENS), hot or cold compresses and rest. Usually the pain improves on its own after several days or weeks, but sometimes will recur after several months.

Send your medical questions to [email protected] for absolutely free expert advice.