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Year : 2020  |  Volume : 6  |  Issue : 1  |  Page : 39-40

Chest pain–cardiac origin or myofascial origin: A case report

1 Department of Pain Medicine, Dr. Kuber's SSDCM hospital, Chandrapur, Maharashtra, India
2 Department of Pain Medicine, Daradia Pain Hospital, Kolkata, West Bengal, India
3 Department of Anaesthesiology, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
4 Department of Pain Medicine, Dr. Kasture's Advance Pain Management Center, Yavatmal, Maharashtra, India

Correspondence Address:
Jeshnu P Tople
Department of Anaesthesiology, Jawaharlal Nehru Medical College, Wardha, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.5005/jp-journals-10046-0155

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Background: Myofascial pain is one of the common clinical findings in patients who present with musculoskeletal pain. The main symptom of chronic myofascial pain is ongoing or longer lasting muscle pain in areas such as the low back, neck, shoulders, and chest. You might feel the pain or the pain may get worse when you press on a trigger point. The muscle may be swollen or hard and you may hear it called a “taut band” in the muscle. Sometimes it may associate with interspinous ligaments or other systems. Case description: A 65-year-old female patient came with complaint of severe axial and left-sided chest and back pain since 2 years, which was mixed in character and of aching, burning, stabbing type, with numeric rating scale (NRS) of 8/10 and the score on pain detect tool was 18. On examination the patient had normal skin and had no scar or redness of the overlying skin. On palpation, the patient had tenderness over midline at T3-4 vertebral level and also had myofascial trigger point over left trapezius. The pain aggravated on flexion of the neck. Systemic examination was normal. Based on these findings, our provisional diagnosis was interspinous ligament sprain with myofascial trigger point. Subsequently trigger point injection of left trapezius with 1 mL lignocaine hydrochloride 2% along with injection of platelet-rich plasma 0.5 mL for T3-4 interspinous sprain was administered. Interventional procedure was done after withholding the anticoagulants (tab aspirin 75 mg and clopidogrel 75 mg) for 7 days. On follow-up visit after 1 month, the patient reported excellent pain relief with an NRS score of 1 to 2. Conclusion: Trigger point over back can cause burning numbness and tingling if it entraps a nerve and can lead to pain that emulates like pain due to cardiac problems. So a proper clinical examination must be done for every chest pain. As every chest pain is not originated from the heart, it may be myofascial in origin.

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