Sunday, May 2, 2010

Chest Wall Pain, Esophageal Spasm, and GERD

I am hearing in discussions complaints of chest wall pain, problems taking a deep breath, difficulty swallowing and acid reflux symptoms. I also have these problems so I can speak to this topic with the experience as a patient. Since I have FM, CFID, and chronic myofascial pain (CMP) from myofascial trigger points, I suspect that chest wall pain, esophageal spasm and GERD either co-exist, and are being aggravated by my myofascial trigger points (TrPs), or the untreated TrPs are causing the symptoms. Either way, the TrPs need to be treated.

Having many TrPs in the chest wall and referral pattern areas makes them difficult to treat. The theracane is too hard because my chest is exquisitely tender and having FM intensifies the pain, so I use my fingers and knuckles which exacerbates other TrPs in my hands and forearms. I think that having someone to help with trigger point pressure therapy is important, such as a therapist that is familiar with the work of Travell and Simons.

The study "The Predetermined Sites of Examination for Tender Points in Fibromyalgia Syndrome are Frequently Associated with Myofascial Trigger Points." (Hy, Wang, et al., link, reinforces what I talk about in my book and particularly speaks to the topic of this article. Being properly diagnosed is very important. FM is central nervous system disorder,CMP is a peripheral problem at the junction where the nerve meets muscle forming what we call trigger points. Even though these are separate disorders, then can and often do co-exist in the same patient. When this happens they feed off each other. The trigger points of CMP keep the FM brain in a perpetual hypersensitive state, which blocks the pain relief response. When they co-exist it muddies the diagnostic waters and makes treatment more difficult. It appears from this study that it is possible all FM patients also have CMP (as always, the study will need to be replicated). However, all CMP patients do not have FM, they are two distinct and separate disorders.

As always, explain your symptoms to your physician and rule out other causes, and explore treatment options for your symptoms. There are, and I take, medications for acute esophageal spasm, which can mimic the symptoms of a heart attack, as can GERD. CAUTION, always seek immediate treatment for chest pain if this is a new symptom for you. DO NOT assume it is related to the things discussed here, unless heart disease or acute attack has been ruled out.

If you do not have heart disease, have been diagnosed with or have symptoms of chest WALL pain, esophageal spasm or GERD, FM or FM/CMP complex, check for those knotted up lumps of muscle fiber in a taut band of muscle. TrPs in the intercostals (muscles between your ribs) are usually easily felt unless they are behind the ribs, in which case, they are not treatable, but most intercostals TrPs are thankfully on the outside. Also, TrPs in the pectoralis, sternalis, scalene, and serratus anterior, muscles can refer pain to the chest. Trigger points may also be more difficult to locate if they are behind other muscles, or the taut band of muscle with the TrPs is too tight to locate them, in which case you will need to massage the muscle until it lets up allowing you to feel the TrP so you can treat it. Suspicious areas are those that are tender to touch and radiate pain to other areas with the muscle is manipulated. Chest wall TrPs can also cause difficulty taking deep breaths, thereby limiting the healing oxygen to our blood cells, and can cause a host of other problems.

Twisting of the upper body, slumping over a keyboard, not using proper body mechanics when doing activities, walking or sleeping; lifting too much weight, excessive reaching, a cold or cough, trauma, surgery, improper breathing techniques (chest or shallow breathing), overuse of unconditioned muscles, carrying a baby, backpack, or heavy purse, any activity that causes heavy breathing (exercise or anxiety), arm movement (such as swimming, tennis, racquet ball, golf, weight lifting, or bowling when you are not used to it), can be aggravating factors for the development of TrPs in the chest wall. Metabolic disorders and other conditions such as CFS and GWS can also make TrPs more difficult to treat.

At the very least, if TrPs are present as a co-existing condition, esophageal spasm and GERD symptoms should be treated, paradoxically, these co-existing conditions could aggravate CMP and the pain sensitivity created by the FM brain.

Learn more about the effects of FM, CFID and CMP, co-existing conditions, therapies, and coping in the book.

Lamb hugs, Celeste, author
Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain: The Mind-Body connection.

“One broken person to another, navigating through life with invisible illness, learning to turn tragic into triumph, and accepting that when despite doing everything right, there are just some days we do not prevail, and that's OK.”


Sister said...

hello. have you read this blogg
it is in English about Esophagus spasms

SM said...

I have the chest wall pain with Trigger Points. I had taken few chest X-rays to rule out anything with heart and they were normal. My physician tried cortisone shots (at the trigger point), it helped to some extent earlier. But recently as of today that is also not helping. Could you please share the treatment for this?

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