Nerve pain or neuralgia can occur for various reasons and may occur on its own or be accompanied by other signs and symptoms related to the cause. This type of pain does not always indicate nerve damage and may be due to injury, pressure, inflammation, chemical irritation or infection. When the cause of the pain is experienced at a site away from the point of injury or inflammation, then this is known as referred pain.
Referred Pain in the Chest
Referred pain is an important feature of nerve pain. In these instances the pain is not due to injury or damage of the nerve itself. While the pathology may be at one site, the pain may be experienced elsewhere and prove confusing to both the patient and the doctor. A typical example is in left arm pain with no other symptoms present. This may be due to heart attack (myocardial infarction) although there is no chest pain, dizziness or sweating.
Chest Nerve Supply
Similar to other areas of the body, the chest cavity has the following types of nerves :
- Autonomic nerves that detects changes and controls the organs. This is not under voluntary control but emotions and thought can partially affect it to some extent.
- Motor nerves which send signals to the skeletal muscles and is under voluntary control.
- Sensory nerves which sends signals from distant receptor sites back to the brain and spinal cord.
Apart from nerves entering via the spinal cord, two other important nerve structures also enter the chest cavity. The first is the sympathetic trunk that lies on the sides of the spinal column at the back of the chest cavity. The other is vagus nerve which exits the brain, travels through the head and neck to innervate structures within the thoracic cavity.
There are a number of nerves innervating different structures within the thorax and isolating the pain to one of these nerves specifically is difficult without proper medical investigation. A plexus is a network of nerves that combine nerves supplying the same area or organ. These intersecting nerves are able to provide feedback and send impulses within the network and can affect more than one area, organ or function simultaneously.
Nerve-related symptoms accompanying the pain will assist with a diagnosis and may include :
- Loss of function, either complete or partial.
- Change in organ function or activity.
- Tingling and numbness, either alternating with pain, occurring after the pain completely resolves or at other sites along the course of the nerve.
- Other sensations like itching or burning.
Chest pain should always be taken seriously and investigated by a medical doctor.
Causes of Chest Nerve Pain
Before diagnosing nerve chest pain, you should first exclude possible causes of lung chest pain and/or heart chest pain as the pain due to these conditions may be life threatening. The cause of nerve chest pain is difficult to isolate if there are no other symptoms present. In these cases it is also important to consider gastrointestinal chest pain, bone chest pain and muscle chest pain.
A number of infections can cause nerve chest pain either due to infection of a nerve itself, pressure on the nerve from an abscess or as a result of referred pain from the infection at or near another site along the course of the nerve.
- Shingles (post-herpetic neuralgia)..
- Lyme disease.
- Hepatitis C.
- Coxsackie B.
Nerve impingement either at the ends of the nerve or along its course may cause nerve pain along the distribution area, only at the site or referred pain.
A current injury or previous injuries may cause pain either due to inflammation, psychological factors, scar tissue near the nerve or incomplete healing of the wound.
- Blunt force trauma.
- Stab or gunshot wounds (including old wounds).
- Crush injuries.
- Nipple piercings.
- Foreign objects like shrapnel, shard or breast implants.
Chronic conditions, particularly various types of autoimmune diseases may cause nerve pain. In some conditions, chronic inflammation of the nerve or surrounding structures may cause nerve damage.
- Multiple sclerosis (MS hug or girdle band pain).
Chemicals and Drugs
These substances may cause localized chest nerve pain or generalized pain affecting many sites.
- Metals like lead and mercury.
- Topical massage applications.
- Vitamin B6 and/or B12 deficiency.
Psychogenic chest pain may be considered as a nerve pain and is often associated with anxiety and panic attacks. Usually cardiac neuroses is a factor as the sufferer believes that the chest pain is due to a cardiac disorder like a heart attack.