Fibromyalgia is a complex chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbances and other symptoms.
Chest pain is not considered a core feature of fibromyalgia, but some research indicates chest pain and discomfort may occur in certain patients.
Chest Pain in Fibromyalgia Patients
Several studies have found a higher prevalence of chest pain in fibromyalgia patients compared to the general public:
- A 2005 study found that around 18% of fibromyalgia patients experience frequent chest pain, compared to just 1% of control subjects [1]Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995;38(1):19-28..
- Research has connected greater occurrence of chest wall tenderness and pain upon palpation in fibromyalgia patients [2]Yunus MB, Inanici F, Aldag JC, Mangold RF. Fibromyalgia in men: comparison of clinical features with women. J Rheumatol. 2000;27(2):485-490..
Chest pain associated with fibromyalgia appears to be primarily musculoskeletal rather than cardiac in origin. Potential sources include:
- Costochondritis causing inflammation of cartilage and pain in the costosternal joints
- Tender points and trigger points in the chest wall musculature
- Thoracic spine immobility or dysfunction
The quality and nature of chest pain (sharp, stabbing, reproducible by movements or palpation) may help distinguish from cardiac causes. But further evaluation is always warranted given the risks.
Potential Mechanisms Relating Fibromyalgia to Chest Pain
The neurobiological mechanisms behind fibromyalgia itself may play a key role in linking the condition to increased chest pain:
- Central sensitization: Increased sensitivity of pain-processing pathways lowers thresholds, amplifies innocuous inputs, and causes greater chest wall pain perception[3]Staud R. Abnormal pain modulation in patients with spatially distributed chronic pain: fibromyalgia. Rheum Dis Clin North Am. 2009;35(2):263-274..
- Altered pain processing: Dysfunction in descending inhibitory and facilitatory pathways leads to increased amplification and reduced damping down of nociceptive signals.
- Autonomic dysfunction: Dysregulation of the sympathetic and parasympathetic nervous systems innervating the chest[4]Martinez-Lavin M. Biology and therapy of fibromyalgia. Stress, the stress response system, and fibromyalgia. Arthritis Res Ther. 2007;9(4):216..
Further research is needed to elucidate the precise pathophysiological mechanisms producing chest pain in the context of fibromyalgia.
Diagnostic Considerations
Since chest pain can indicate serious cardiac conditions, a thorough evaluation is required in fibromyalgia patients reporting chest pain or discomfort. Key aspects include:
- Comprehensive medical history detailing the quality, duration, location, triggering/relieving factors of pain.
- Physical exam looking for reproducible chest wall pain or tenderness on palpation.
- Cardiac testing like ECG, Holter monitoring, stress test, coronary angiography to rule out ischemic heart disease.
- Lab tests checking for inflammation markers or muskuloskeletal issues if symptoms are recurrent.
- Imaging tests like chest X-ray, CT or MRI scans to assess lung, chest wall, and spine anatomy.
This workup can identify any non-cardiac causes for chest pain and clarify whether it is linked to fibromyalgia aspects like central sensitization.
Management of Chest Pain in Fibromyalgia
Treatment approaches for chest pain associated with fibromyalgia include:
- Fibromyalgia treatment with medications, exercise, stress reduction, therapy can help reduce systemic pain amplification.
- Pain medications like NSAIDs or topicals to treat neuropathic and musculoskeletal chest wall pain.
- Manual therapies like massage, chiropractic adjustment, physiotherapy to address musculoskeletal triggers.
- Lifestyle changes including posture correction, rest, heat/cold therapy, and avoiding activities that worsen chest pain.
- Referrals to cardiology, rheumatology, physiatry or psychology if the pain persists or more specialist input is needed.
A multidisciplinary treatment approach focused on relieving the chest pain itself alongside the core fibromyalgia issues provides optimal management.
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.
References
| ↑1 | Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995;38(1):19-28. |
|---|---|
| ↑2 | Yunus MB, Inanici F, Aldag JC, Mangold RF. Fibromyalgia in men: comparison of clinical features with women. J Rheumatol. 2000;27(2):485-490. |
| ↑3 | Staud R. Abnormal pain modulation in patients with spatially distributed chronic pain: fibromyalgia. Rheum Dis Clin North Am. 2009;35(2):263-274. |
| ↑4 | Martinez-Lavin M. Biology and therapy of fibromyalgia. Stress, the stress response system, and fibromyalgia. Arthritis Res Ther. 2007;9(4):216. |