chest pain / anxiety/ somatic syndrome disorder

[Robfromwales]

in an attempt to get a diagnosis of what I am told is non cardiac chest pain I came across this syndrome . It says that one of the symptoms can be sharp pain in chest muscles presumably caused by tension and seems to be related to anxiety rather than Gerd which is what I already know I have but my symptoms aren’t at all classic. Anyone know anything about this?

[Blearyeyed]

We can all get some level of Somatic Syndrome after coping with the pain and symptoms of a health issue which caused us Stress and Anxiety .Feeling each little similar twitch or pain in the same area and worrying that the problem is coming back again.

It's especially common to have SSD if you've had a cardiac or stroke event or suffered with a condition when pain in a particular place is one of the warning signs until you get used to coping with the pain and learning ways to react to it.

This type of coping strategy usually involves using distraction methods , breathing and mental reminders to calm down and reduce the increase in Anxiety.

Many people just use these Mindfulness methods naturally because it's always been part of their mental health behaviour learned from childhood.

But if you have felt trauma from an illness or cope with long term Anxiety you often need to be reminded or restrained to think differently to help the symptoms.

This is when CBT called Habituation Strategy, either self taught or learned through a course if therapy sessions becomes invaluable.

Habituation Strategy teaches two things . To recognise the pain and to distract yourself from it or ignore it until it takes away the power of a normal mild ache or pain to make our heads spin and our body to overreact stimulating more pain and worry.

The therapy teaches you that most mild pains can be dealt with by a simple soothing rub , deep refreshing breath or sip of water and will not necessarily be a sign of something more serious , so controlling the Somatic Syndrome.

Obviously, if you do also have other things like GERD , gastric reflux , IBS or muscular aches and pains you still need to use the diet and lifestyle changes that help control these each day to prevent the initial pain from happening as often or being as severe. The GERD could cause the initial chest twinge you just need to remind your brain that it is GERD and you know how to deal with it.

But when the pains do come and go the CBT/ Habituated Strategy controls the Somatic Syndrome and reduces the risk of Anxiety become worse or long term and increasing other stress related physical symptoms by reminding us that not every pain is a red flag but a common symptom we can feel and cope with each day.

The same Habituation Strategy can be used for the various Somatic symptoms that cause people Anxiety , especially after a heart attack or stroke like a pain in the head , or thumping in the heart when we are being a bit more active , breathlessness when we exercise after being very still for a long time or occasional dizziness if we get up too quick or indigestion.

[Robfromwales in reply to Blearyeyed]

Thanks for such a detailed reply. Before reading about SSD I always thought that the symptoms created the anxiety not the anxiety the symptoms. From what I have read ( and I could be easily be wrong) it seems that eg anxiety can create sharp chest pain. Admittedly , as you say, Gerd could be in the background and so more than one thing can be going on. I have had chest pain for nearly three years that isnt angina, micro vascular, or vasospastic and classed as non cardiac chest pain. I have had an endoscopy and have oesophagitis but my symptoms arent normal at all. I guess thankfully I had (have these) as without them I would have never found out about a large thoracic aneurysm (since repaired) or a bicuspid aortic valve (neither of which I knew about till aged 61!).

[Blearyeyed in reply to Robfromwales]

It can be a mental health vicious circle, get a mild physical symptom, get anxiety about it , physical symptom feels worse which seems to confirm your worst thoughts , get tense , get a stress response, get more anxiety , physical symptoms increase again and so on and so on....

But as you have had other heart issues as well clearly your original physical symptoms will have been caused by the heart problems you had , so no wonder you would feel anxious if you feel a similar pain in that area again , there is a rational behind your Anxiety it's not coming from nowhere.

The step now is to treat the mental side of post illness recovery just as you treated the physical problems so that you can keep your anxiety or feelings about physical pains well managed.

[Robfromwales in reply to Blearyeyed]

Hi blearyeyed and thanks . The heart issues I had/have aren’t meant to produce any of the symptoms I have had for the 2-3 years. I can’t say it isn’t anxiety that produces the non cardiac chest pains but my own sense is that the symptoms cause the anxiety not the other way around. But I may be wrong !

[dunestar in reply to Robfromwales]

It's very difficult to isolate cause and effect because mind and body are so intimately connected. It's a circle rather than a straight line whether from mind to body or the other way.

[Blearyeyed in reply to Robfromwales]

My point exactly, 9 times out of ten something can cause a physical pain first , even if that's a normal daily pain or linked to another health problem you have like GERD , muscle issues or rebound pains after an infection from months before, but past experience can then make us react quicker to that pain or feel anxiety that it is cardiac because of our previous experience.I spent many years with the brush off until I finally had the confidence to say I don't have pain because I have Anxiety but I am sometimes frustrated or anxious because I have pain and it hasn't been diagnosed yet, there is a big difference.

[Robfromwales in reply to Blearyeyed]

I don’t think the pain is anywhere near normal and never had it before but recognise also that bodies are ageing and things change.

[Milkfairy Heart Star in reply to Blearyeyed]

"I don't have pain because I have Anxiety but I am sometimes frustrated or anxious because I have pain and it hasn't been diagnosed yet, there is a big difference."

This is so true. I was so relieved when the cause of my persistent chest pain was determined.

Once I knew why I was having my symptoms I was able to psychologically manage my pain better.

[Robfromwales in reply to Milkfairy]

Agree

[Blearyeyed in reply to Milkfairy]

Exactly. It's far harder to ignore a pain when you don't know why it came in the first place.

[WeeHoolet]

Hello Robfromwales

Many years ago, following an investigation of non-cardiac chest pain, I was diagnosed with Tietze syndrome, an inflammatory and usually minor, self-limiting condition that may or may not be similar or related to Costochondritis (depending on which medical journals, health service etc. you consult). As I was then suffering from mental health issues including anxiety, my experience suggests that your pain may be physical or anxiety-driven.

You really need a dialogue with your GP to help determine the root cause. If it is anxiety, access to support should be available through him or her, though I know that waiting times for and availability of such support can be a postcode lottery.

Assuming anxiety, Blearyeyed has explained admirably the strategies and therapy that you might find helpful.

Wishing you well, 🦉

[Robfromwales in reply to WeeHoolet]

Dear Weehoolet - believe it or not my father (now sadly dead at 91 mind you) said he had this syndrome. I was aware of it and had looked it up but its normally in people under 40 ( I am 64) and normally is accompanied by inflammation , swelling and redness (which I dont get). But its a good shout and I have wondered about it and will think on it a bit more given your helpful comments.

[WeeHoolet in reply to Robfromwales]

Some sources say under 40, others suggest any age apart from the very young, so it might be worth chasing up.

[WeeHoolet in reply to WeeHoolet]

And I had no external signs of inflammation!

[Robfromwales in reply to WeeHoolet]

True. How would you describe your pain? And how long would episodes last?

[Robfromwales]

Interesting - was it diagnosed based on exclusion of other causes? I normally have left sided chest pain but certainly once it was right sided. My situation slightly complicated as I have GERD and I recognise elements of Somatic chest pain but as I said I am not sure what produces the pain in the first place! If Tietze it would be another family gene passed down!

[WeeHoolet in reply to Robfromwales]

It was exclusion to a degree, though my GP had an idea what it was immediately after prodding me, having seen it before. My ticker was fine back then, but got checked because of father's heart condition; x ray/scan were fine; bloods fine; no infection; no indisputable injury. Manual work can pull you about a bit at times, though! I have no idea what tests they run on people now, but I expect that diagnosis is quicker and easier.

[WeeHoolet]

Stabbing, somewhat grasping, sudden chest pain, just below centre left of sternum, sometimes out of the blue, sometimes on exercise, lifting, or sudden movement of upper body, occasional ache in upper left arm. Transient but frequent episodes.

[WeeHoolet]

It used to get me at night, too, when turning over in bed. A long time ago now, and no recurrence.

[Robfromwales]

sounds familiar. Length of episodes ? as often I get what I would call bursts of pain say every minute or so in same location . Then stop for a while then back again . Mine are normally completely out of the blue and not connected with movement or anything. They also are t aligned with what I would call periods of anxiety. Symptoms produce the anxiety if that makes sense!!

[WeeHoolet]

Frequency/abeyance, that is, the 'clusters' was indeed similar, but the number of clusters varied by the day. Any condition, of course, varies between sufferers, most especially in severity and duration.

With your other health issues in mind, anxiety is perfectly understandable as a symptom of heightened bodily awareness and/or reaction to illness, and equally understandable as an effect or symptom of a new condition or in some cases, a cause. Which returns us to the suggestion of approaching your GP, and perhaps putting these ideas to him or her. What do you think?

[Robfromwales]

all sounds very helpful indeed. We are currently mainly going to gastro route but while I have some of those classic symptoms as well ( pain behind sternum ) the stabbing pains and clusters aren’t as far as I am aware gastro related. By the way it’s not oesophageal spasms according to GP. On the gastro side the next thing that will happen I think is ph and mamoetry testing. But I think tietze needs to be in the diagnostic thinking !

[WeeHoolet in reply to Robfromwales]

Hello Robfromwales, eek (manometry)!

More seriously, I hope that you soon get a diagnosis. Apart from the application of medication and/or medical intervention which that initiates, it's easier on a mental level to fight an enemy you can name.

All the best 🦉

[Robfromwales in reply to WeeHoolet]

I knew I hadn’t spelt it right!

[WeeHoolet in reply to Robfromwales]

🙂

[Bunkular in reply to Robfromwales]

I've known tietze as costrochondritis & am thinking that's one of my 'syndromes' because of a 3 year long experience with chest pain. Anxiety makes things worse. I have come to learn that even wearing a heavy winter coat makes my shoulders, neck & chest pain worse too, so I'm looking forward to spring!

[Robfromwales in reply to Bunkular]

How would describe the pain Bunkular?

[Bunkular in reply to Robfromwales]

I have had injury to my C6 & C7 cervical, neck spine and so it's sometimes difficult for me to tell if my left shoulder, neck, ear and even sometimes my whole left arm pain is from my neck or my heart. Checking my KardiaMobile helps me to relax that the spasms, numbness, tingling and knife-like pain in those areas will ease up and go away. I've also noticed that that pain only has happened when I've been sitting down without any physical activity so therefore it can't be heart related. Whenever the other chest pain happens in my chest it's when I've been walking uphill or 'walk-running'. That pain is more like a pressure weight on my sternum and off to the right side a bit. That pressure didn't occur yesterday at all while I put myself through my fast pace walk, so I am guessing I have inter-rib muscle spasms (costochondritis) which my nurse practitioner told me a few years ago. Since we got the most snow overnight than what we've had all winter I will be testing myself today by getting my X-country skis out. My angiogram test last Tues showed 40%, 30% and a 3rd coronary artery with 20% occlusion I know that my pain can't be angina or the cardiologist would have implanted a stent. He said they put stents in when the artery is 70% blocked. I shall be putting myself through a fast paced workout today to check for aches. BTW I am on Metoprolol, Perindopril, Statin & low dose aspirin to keep my sometimes dreadful PVCs under control. I can report how my ski "test" went afterwards. While typing this out I felt a few "kaboom" heartbeats - my palpitations are always reminding me of their erratic behaviour.

[Robfromwales in reply to Bunkular]

Thanks bunkular

[Keano99]

that’s so informative, thank you for sharing.

[wardywill]

if it helps anyone,I’ve had heart problems but in and amongst I’ve had a pain in centre of chest across to right breast,it was a tightness than throbbing going through to the shoulder blade.It comes on once a month and lasts a couple of days.It has been getting a stronger pain where it pulls you up wow that was strong pain.Everyone has blamed angina since 2019 but I’ve nattered and nattered to be taken seriously and I managed to get them to do an ultrasound as my friends suggested it might be gallstones.No gallstones but found a tumour on the kidney so I’ve had that frozen successfully and on an MRI they’ve spotted an artery supplying spleen,kidneys and pancreas is partially blocking possibly causing the intermittent pain…… thank goodness I was thinking I was a hypcondriac

[honeybubs]

I had stabbing pains and started feeling very ill last year (I have HF EF35 with Bigeminy) and was admitted to hospital and after tests I had inflammation around and in my heart both myopericarditis and was told to rest which took a few months. Probably not this in your case but maybe a possibility. Hope it gets sorted for you whatever is causing it. Joy

[Robfromwales]

thanks honeybubs.

[Zed1063]

Hi

I have not been diagnosed with this condition but been in A&E several times with chest pain and back pain and told not cardiac. Scares the life out of me but they seem to think it is anxiety which causes it. I suppose it does! I have all the pains I had when I had my HA, well I think I do, then I get anxious which makes it worse, then my brain takes over and I get worse! so hard to overcome the fear and terror of having another HA

[Robfromwales]

I don’t get pain anywhere but chest but it’s in bursts/ waves in specific locations,

[Robfromwales in reply to Robfromwales]

I normally these days get such bursts lasting in total a couple of hours but spaced out. Get them a minimum of once a week and sometimes more. A and E loads of time but not cardiac

[Robfromwales]

been reading up and tietze and costochondritis ( sooty about spelling) seem to come on with physical activity when my pains often start at rest or certainly not always associated with movement. It’s also not worse with coughing or breathing. Next time it happens I will try and be more conscious if the rib area in the literature seems tender or painful. I suppose I can’t believe that a and r or gp would miss this possibility given all the times I have seen medics

[Milkfairy Heart Star in reply to Robfromwales]

Another symptom of costochondritis is that when the area near your breast bone is pressed it causes pain which doesn't happen if you have angina.

[Robfromwales in reply to Milkfairy]

I suppose as I had OHS in April 2023 it would feel tender anyway?

[Milkfairy Heart Star in reply to Robfromwales]

Maybe

[Bunkular in reply to Robfromwales]

Keep in mind that sitting still for a hour or more can bring on aches & pains from previous pulled muscles or ligaments. If a person is active at something there may not be any aches until after remaining still for a while. That's the way it is for me anyway. When I go for a long walk or X-country ski I won't feel sore muscles till after I have returned home & sat still for an hour. My chest pains are the same. It's been ruled out through tests that these aches are not related to cardiac issues & physiotherapy does help with pain relief.

[Robfromwales in reply to Bunkular]

Hi bunkular

Thanks. It doesn’t feel like muscle ache at all mind. But GP said stomatitc neeve pain in muscles can be sharp and stabbing whereas organ pain is normally diffuse and dull and more achey in nature.

[Jedx]

Well Robfromwales lm going to put a spanner in your works here, sorry in advance. I had that chest pain you described and A&E trip ect. I had to see a cardiologist he examined me and asked about a scar on back of my neck l had a trapped nerve and surgery to release it. He then said he didn’t think it was cardiac pain and asked how my thoracic spine was. I had no idea so he sent me for a scan and heart tests. Apparently if you have issues in that area of your spine you can get referred pain in your chest, commonly mistaken for heart pain. Turned out l have bone spurs up my spine l told my son it’s official lm turning into a dinosaur. Don’t know if this will help or hinder you but good luck with everything

[Robfromwales]

thanks Jedx. I have bone spur in my hip so yes maybe prone to something like that. I will mention this as well

[Robfromwales in reply to Robfromwales]

So jedx - have you had surgery to do something to the bony spur or are you saying the cardiologist noticed a scar on your neck from an unconnected operation?