DEAR DOCTOR,

I have had an on and off pain in my chest for some time. After several check-ups, doctors say it is nothing to worry about and that I should work on getting enough rest. Could there be more to this?

JAMES

DEAR JAMES, 

What is your current age? How does the pain feel like, burning or a pressure put on chest? Does your work or exercise schedule involve pushing or pulling  heavy weights?

In a young person, mental stress or anxiety can cause pain in the upper middle part. In fact, touching upper mid portion of chest is often painful, a condition called costochondritis. This condition is diagnosed by excluding other causes of chest pain by suitable investigations. It is relieved by pain killers and relaxation.

Functional dyspepsia, is a very common underlying cause for chest pain in young and middle aged persons alike. The pain typically occurs in middle of chest and or upper abdomen, feels like burning sensation, may be aggravated or relieved by meals, depending on site affected, whether stomach or first part of small intestine. There may be associated nausea and or vomitting. Taking heavy fatty meals, constipation, use of alcohol, very hot, spicy food are common causes of dyspepsia. Sometimes, it may be caused by Heliobacter pylori infection, which is detected by simple blood test and is treatable by drugs. It can be prevented by small frequent meals, avoiding heavy meal, particularly late in the evening, avoiding alcohol and very spicy food, taking high fiber food including plenty of fresh vegetables and fruits. Cure is available by means of medicines that reduce excess acid production in stomach by different mechanisms.

One should also avoid taking excess of tea or coffee, as that also causes and aggravates pre existing dyspepsia.

Exposure to cold weather can result in chest pain, which is usually generalised.  It improves after providing some warmth to chest by warm clothes. Similarly muscular pain can occur over chest, by doing  unaccustomed strenuous work like pushing or lifting heavy weights. Many young adults do heavy push ups in gyms or lift/push weights, in a bid to build muscles and mostly suffer from chest pain. Therefore it is advised to start any physical exercise, including weight lifting, push ups in a small measure and then increase slowly, as per one’s stamina. Some simple warm up exercises before starting actual physical exercise or activity is useful. Such pain can be cured by rest and pain killers.

Heart attacks, lung infection, lung cancer are sinister medical causes for chest pain. But these are usually associated with other features as well. Any one of this condition if present, can be detected by suitable investigations. In your case, as you have mentioned, no cause has been found, hence these conditions are excluded. Just relax and make small  changes in your diet and life style.

Dr Rachna Pande is a specialist in internal medicine 

E-mail rachna212002@yahoo.co.uk