Respiratory Chest Pain: Diagnosis and Treatment

Medical Clinics of North America

Volumn 94, Issue 2, 2010, Pages 217-232

  Brims, Fraser J H ^a,b   Davies, Helen E ^c   Lee, Y C Gary ^b,c,d  

^a PORTSMOUTH HOSPITALS NHS TRUST   (United Kingdom)

^b SIR CHARLES GAIRDNER HOSPITAL   (Australia)

^c CHURCHILL HOSPITAL   (United Kingdom)

^d UNIVERSITY OF WESTERN AUSTRALIA   (Australia)

Author keywords

Chest pain; Pleural infection; Pneumonia; Pneumothorax; Pulmonary embolism; Respiratory

Indexed keywords

ACETYLSALICYLIC ACID; BUPIVACAINE; BUPRENORPHINE; CODEINE; CORTICOSTEROID; DIHYDROCODEINE; FENTANYL; IBUPROFEN; KETOPROFEN; LIDOCAINE; MORPHINE; OXYCODONE; PARACETAMOL;

BRAIN DEPTH STIMULATION; CANCER RADIOTHERAPY; CLINICAL FEATURE; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; COMPUTER ASSISTED TOMOGRAPHY; CONSTIPATION; CORDOTOMY; CORTICOSTEROID THERAPY; COXSACKIE VIRUS INFECTION; ECHOGRAPHY; HUMAN; INTERCOSTAL NERVE BLOCK; LUNG EMBOLISM; LUNG NON SMALL CELL CANCER; NAUSEA; NEUROPATHIC PAIN; PAINFUL BREATHING; PATHOPHYSIOLOGY; PHYSIOTHERAPY; PLEURA BIOPSY; PLEURA EFFUSION; PLEURA MESOTHELIOMA; PLEURA METASTASIS; PLEURISY; PLEURODESIS; PNEUMONIA; PNEUMOTHORAX; POSITRON EMISSION TOMOGRAPHY; POSTOPERATIVE PAIN; POSTTRAUMATIC PAIN; PRIORITY JOURNAL; PULMONARY HYPERTENSION; REVIEW; SYSTEMIC LUPUS ERYTHEMATOSUS; THORACOCENTESIS; THORACOSCOPY; THORACOTOMY; THORAX DRAINAGE; THORAX EPIDURAL ANESTHESIA; THORAX PAIN; TRACHEOBRONCHITIS;

CHEST PAIN; CONNECTIVE TISSUE DISEASES; DIAGNOSIS, DIFFERENTIAL; HUMANS; IATROGENIC DISEASE; PLEURA; PLEURAL DISEASES; PLEURAL EFFUSION; PLEURISY; PNEUMONIA; PNEUMOTHORAX; PULMONARY EMBOLISM; THORACIC WALL;

EID: 77950315649     PISSN: 00257125     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.mcna.2010.01.003     Document Type: Review

References (101)

1. Pitts S.R., Niska R.W., Xu J., et al. National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary (2008), National Center for Health Statistics, Hyattsville (MD) Contract No.: Document Number
2. Albert R. Chest pain. In: Albert R.K., Spiro S.G., and Jett J.R. (Eds). Clinical pulmonary medicine. 3rd edition (2008), Elsevier, Philadelphia 317-324
3. Gray H. Gray's anatomy. 15th edition. In: Pick T.P., Howden R., et al. (Eds) (1988), Crown Publishers Inc, New York 969-970
4. Montes J.F., Garcia-Valero J., and Ferrer J. Evidence of innervation in talc-induced pleural adhesions. Chest 130 3 (2006) 702-709
5. Murray J., and Gebhart G. Chest pain. In: Murray J., Nadel J., Mason R., et al. (Eds). Textbook of respiratory diseases. 4th edition (2005), WB Saunders & Co, Philadelphia 848-865
6. Marel M., Zrustova M., Stasny B., et al. The incidence of pleural effusion in a well-defined region. Epidemiologic study in central Bohemia. Chest 104 5 (1993) 1486-1489
7. Lee Y.C.G., and Light R. Pleural effusion: overview. In: Laurent G., and Shapiro S. (Eds). Encyclopedia of respiratory diseases (2006), Elservier, Oxford (UK) 353-358
8. Wilson N.A., Mutsaers S., and Lee Y.C.G. Immunology in pleural diseases. In: Light R., and Lee Y.C.G. (Eds). Textbook of pleural diseases. 2nd edition (2008), Arnold, London 71-100
9. Gleeson F.V., and Lee Y.C.G. Practical imaging in pleural sepsis. In: Desai S., Franquet T., Hartman T., and Wells A. (Eds). Pulmonary imaging (2008), Taylor & Francis Book Ltd, London 99-105
10. Antunes G., Neville E., Duffy J., et al. BTS guidelines for the management of malignant pleural effusions. Thorax 58 Suppl 2 (2003) ii29-ii38
11. Light RW, Lee YCG. Pneumothorax, chylothorax, hemothorax and fibrothorax. In: Murray J, Nadel J, Mason R, et al, editors. Textbook of respiratory diseases. 5th edition. Philadelphia: WB Saunders & Co, in press.
12. World Health Organization. WHO's pain ladder. 2009. [updated 2009; cited December 2009]; Available at (2009). http://www.who.int/cancer/palliative/painladder/en/index.html Accessed December 1, 2009
13. Oxford league table of analgesic efficacy (2007), Bandolier Evidence Based Healthcare, Oxford. http://www.medicine.ox.ac.uk/bandolier/booth/painpag/Acutrev/Analgesics/Leagtab.html Accessed December 1, 2009
14. Barden J., Derry S., McQuay H.J., et al. Single dose oral ketoprofen and dexketoprofen for acute postoperative pain in adults. Cochrane Database Syst Rev 4 (2009) CD007355
15. Collins S.L., Moore R.A., McQuay H.J., et al. Single dose oral ibuprofen and diclofenac for postoperative pain. Cochrane Database Syst Rev 2 (2000) CD001548
16. Collins S.L., Moore R.A., McQuay H.J., et al. Oral ibuprofen and diclofenac in post-operative pain: a quantitative systematic review. Eur J Pain 2 4 (1998) 285-291
17. McQuay H.J., Carroll D., and Moore R.A. Injected morphine in postoperative pain: a quantitative systematic review. J Pain Symptom Manage 17 3 (1999) 164-174
18. Dworkin R.H., Backonja M., Rowbotham M.C., et al. Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Arch Neurol 60 11 (2003) 1524-1534
19. Tetik O., Islamoglu F., Ayan E., et al. Intermittent infusion of 0.25% bupivacaine through an intrapleural catheter for post-thoracotomy pain relief. Ann Thorac Surg 77 1 (2004) 284-288
20. Aykac B., Erolcay H., Dikmen Y., et al. Comparison of intrapleural versus intravenous morphine for postthoracotomy pain management. J Cardiothorac Vasc Anesth 9 5 (1995) 538-540
21. Raffin L., Fletcher D., Sperandio M., et al. Interpleural infusion of 2% lidocaine with 1:200,000 epinephrine for postthoracotomy analgesia. Anesth Analg 79 2 (1994) 328-334
22. Miguel R., and Hubbell D. Pain management and spirometry following thoracotomy: a prospective, randomized study of four techniques. J Cardiothorac Vasc Anesth 7 5 (1993) 529-534
23. Elman A., Debaene B., Magny-Metrot C., et al. Interpleural analgesia with bupivacaine following thoracotomy: ineffective results of a controlled study and pharmacokinetics. J Clin Anesth 5 2 (1993) 118-121
24. Schneider R.F., Villamena P.C., Harvey J., et al. Lack of efficacy of intrapleural bupivacaine for postoperative analgesia following thoracotomy. Chest 103 2 (1993) 414-416
25. Inderbitzi R., Flueckiger K., and Ris H.B. Pain relief and respiratory mechanics during continuous intrapleural bupivacaine administration after thoracotomy. Thorac Cardiovasc Surg 40 2 (1992) 87-89
26. Symreng T., Gomez M.N., and Rossi N. Intrapleural bupivacaine v saline after thoracotomy-effects on pain and lung function-a double-blind study. J Cardiothorac Anesth 3 2 (1989) 144-149
27. Mann L.J., Young G.R., Williams J.K., et al. Intrapleural bupivacaine in the control of postthoracotomy pain. Ann Thorac Surg 53 3 (1992) 449-453 [discussion: 53-4]
28. Gaeta R.R., Macario A., Brodsky J.B., et al. Pain outcomes after thoracotomy: lumbar epidural hydromorphone versus intrapleural bupivacaine. J Cardiothorac Vasc Anesth 9 5 (1995) 534-537
29. Assalia A., Kopelman D., Markovits R., et al. Intrapleural analgesia following thoracoscopic sympathectomy for palmar hyperhidrosis: a prospective, randomized trial. Surg Endosc 17 6 (2003) 921-922
30. Knottenbelt J.D., James M.F., and Bloomfield M. Intrapleural bupivacaine analgesia in chest trauma: a randomized double-blind controlled trial. Injury 22 2 (1991) 114-116
31. Short K., Scheeres D., Mlakar J., et al. Evaluation of intrapleural analgesia in the management of blunt traumatic chest wall pain: a clinical trial. Am Surg 62 6 (1996) 488-493
32. Engdahl O., Boe J., and Sandstedt S. Interpleural bupivacaine for analgesia during chest drainage treatment for pneumothorax. A randomized double-blind study. Acta Anaesthesiol Scand 37 2 (1993) 149-153
33. Waite K., and Gilligan D. The role of radiotherapy in the treatment of malignant pleural mesothelioma. Clin Oncol (R Coll Radiol) 19 3 (2007) 182-187
34. Bissett D., Macbeth F.R., and Cram I. The role of palliative radiotherapy in malignant mesothelioma. Clin Oncol (R Coll Radiol) 3 6 (1991) 315-317
35. McQuay H.J., Carroll D., and Moore R.A. Radiotherapy for painful bone metastases: a systematic review. Clin Oncol 9 3 (1997) 150-154
36. Price P., Hoskin P.J., Easton D., et al. Prospective randomised trial of single and multifraction radiotherapy schedules in the treatment of painful bony metastases. Radiother Oncol 6 4 (1986) 247-255
37. Mithal N.P., Needham P.R., and Hoskin P.J. Retreatment with radiotherapy for painful bone metastases. Int J Radiat Oncol Biol Phys 29 5 (1994) 1011-1014
38. Eason M.J., and Wyatt R. Paravertebral thoracic block-a reappraisal. Anaesthesia 34 7 (1979) 638-642
39. Karmakar M.K. Thoracic paravertebral block. Anesthesiology 95 3 (2001) 771-780
40. Joshi G.P., Bonnet F., Shah R., et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg 107 3 (2008) 1026-1040
41. Jackson M.B., Pounder D., Price C., et al. Percutaneous cervical cordotomy for the control of pain in patients with pleural mesothelioma. Thorax 54 3 (1999) 238-241
42. Lipton S. Percutaneous cervical cordotomy. Proc R Soc Med 66 7 (1973) 607-609
43. Kuperman A.S., Krieger A.J., and Rosomoff H.L. Respiratory function after cervical cordotomy. Chest 59 2 (1971) 128-132
44. Bittar R.G., Kar-Purkayastha I., Owen S.L., et al. Deep brain stimulation for pain relief: a meta-analysis. J Clin Neurosci 12 5 (2005) 515-519
45. Yen C.P., Kung S.S., Su Y.F., et al. Stereotactic bilateral anterior cingulotomy for intractable pain. J Clin Neurosci 12 8 (2005) 886-890
46. Fallon M., Hanks G., and Cherny N. Principles of control of cancer pain. BMJ 332 7548 (2006) 1022-1024
47. Jemal A., Siegel R., Ward E., et al. Cancer statistics, 2008. CA Cancer J Clin 58 2 (2008) 71-96
48. Peto J., Decarli A., La Vecchia C., et al. The European mesothelioma epidemic. Br J Cancer 79 3-4 (1999) 666-672
49. Yang H., Testa J.R., and Carbone M. Mesothelioma epidemiology, carcinogenesis, and pathogenesis. Curr Treat Options Oncol 9 2-3 (2008) 147-157
50. Robinson B.W., and Lake R.A. Advances in malignant mesothelioma. N Engl J Med 353 15 (2005) 1591-1603
51. Curran D., Sahmoud T., Therasse P., et al. Prognostic factors in patients with pleural mesothelioma: the European Organization for Research and Treatment of Cancer experience. J Clin Oncol 16 1 (1998) 145-152
52. Ribak J., Lilis R., Suzuki Y., et al. Malignant mesothelioma in a cohort of asbestos insulation workers: clinical presentation, diagnosis, and causes of death. Br J Ind Med 45 3 (1988) 182-187
53. West S.D., and Lee Y.C. Management of malignant pleural mesothelioma. Clin Chest Med 27 2 (2006) 335-354
54. Mishra E., Davies H.E., and Lee Y.C. Malignant pleural disease in primary lung cancer. In: Spiro S., Janes S., and Huber R. (Eds). Thoracic malignancies. 3rd edition (2009), European Respiratory Society Journals Ltd, European respiratory monograph. 3rd edition. Sheffield (UK) 318-355
55. Heit J.A., Silverstein M.D., Mohr D.N., et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 160 6 (2000) 809-815
56. Anderson Jr. F.A., and Spencer F.A. Risk factors for venous thromboembolism. Circulation 107 23 Suppl 1 (2003) I9-16
57. Stein P.D., Terrin M.L., Hales C.A., et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest 100 3 (1991) 598-603
58. Worsley D.F., and Alavi A. Comprehensive analysis of the results of the PIOPED Study. Prospective Investigation of Pulmonary Embolism Diagnosis Study. J Nucl Med 36 12 (1995) 2380-2387
59. Rizkallah J., Man S.F., and Sin D.D. Prevalence of pulmonary embolism in acute exacerbations of COPD: a systematic review and metaanalysis. Chest 135 3 (2009) 786-793
60. Rubin L.J. Pathology and pathophysiology of primary pulmonary hypertension. Am J Cardiol 75 3 (1995) 51A-54A
61. Yap E., Anderson G., Donald J., et al. Pleural effusion in patients with pulmonary embolism. Respirology 13 6 (2008) 832-836
62. Porcel J.M., Madronero A.B., Pardina M., et al. Analysis of pleural effusions in acute pulmonary embolism: radiological and pleural fluid data from 230 patients. Respirology 12 2 (2007) 234-239
63. Kearon C., Kahn S.R., Agnelli G., et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians evidence-based clinical practice guidelines. (8th edition). Chest 133 Suppl 6 (2008) 454S-545S
64. Jokinen C., Heiskanen L., Juvonen H., et al. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol 137 9 (1993) 977-988
65. Foy H.M., Cooney M.K., Allan I., et al. Rates of pneumonia during influenza epidemics in Seattle, 1964 to 1975. JAMA 241 3 (1979) 253-258
66. Lave J.R., Fine M.J., Sankey S.S., et al. Hospitalized pneumonia. Outcomes, treatment patterns, and costs in urban and rural areas. J Gen Intern Med 11 7 (1996) 415-421
67. Community-acquired pneumonia in adults in British hospitals in 1982-1983: a survey of aetiology, mortality, prognostic factors and outcome. The British Thoracic Society and the Public Health Laboratory Service. Q J Med 62 239 (1987) 195-220
68. Fine M.J., Stone R.A., Singer D.E., et al. Processes and outcomes of care for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team (PORT) cohort study. Arch Intern Med 159 9 (1999) 970-980
69. Brandenburg J.A., Marrie T.J., Coley C.M., et al. Clinical presentation, processes and outcomes of care for patients with pneumococcal pneumonia. J Gen Intern Med 15 9 (2000) 638-646
70. Perez-Padilla R., de la Rosa-Zamboni D., Ponce de Leon S., et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med 361 7 (2009) 680-689
71. Lim W.S., Baudouin S.V., George R.C., et al. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 64 Suppl III (2009) iii1-iii55
72. Koegelenberg C.F., Diaconi A.H., and Bolligeri C.T. Parapneumonic pleural effusion and empyema. Respiration 75 3 (2008) 241-250
73. American Thoracic Society. Available at: (Accessed December 1, 2009). www.thoracic.org/sections/publications/statements/index.html
74. Seremetis M.G. The management of spontaneous pneumothorax. Chest 57 1 (1970) 65-68
75. Wilcox D.T., Glick P.L., Karamanoukian H.L., et al. Spontaneous pneumothorax: a single-institution, 12-year experience in patients under 16 years of age. J Pediatr Surg 30 10 (1995) 1452-1454
76. Kalomenidis I., Moschos C., Kollintza A., et al. Pneumothorax-associated pleural eosinophilia is tumour necrosis factor-alpha-dependent and attenuated by steroids. Respirology 13 1 (2008) 73-78
77. Kalomenidis I., Guo Y., Peebles R.S., et al. Pneumothorax-associated pleural eosinophilia in mice is interleukin-5 but not interleukin-13 dependent. Chest 128 4 (2005) 2978-2983
78. Iyer V.N., Joshi A.Y., and Ryu J.H. Spontaneous pneumomediastinum: analysis of 62 consecutive adult patients. Mayo Clin Proc 84 5 (2009) 417-421
79. Davies H.E., and Lee Y.C.G. Pleural effusion, empyema and pneumothorax. In: Albert R.K., Spiro S., and Jett J. (Eds). Clinical pulmonary medicine. 3rd edition (2008), Elsevier, Philadelphia 853-867
80. Farber H.W., and Loscalzo J. Pulmonary arterial hypertension. N Engl J Med 351 16 (2004) 1655-1665
81. Stuckey D. Cardiac pain in association with mitral stenosis and congenital heart disease. Br Heart J 17 3 (1955) 397-408
82. Mukherjee S., de Klerk N., Palmer L.J., et al. Chest pain in asbestos-exposed individuals with benign pleural and parenchymal disease. Am J Respir Crit Care Med 162 5 (2000) 1807-1811
83. Mahajan V.K., Simon M., and Huber G.L. Reexpansion pulmonary edema. Chest 75 2 (1979) 192-194
84. Trapnell D.H., and Thurston J.G. Unilateral pulmonary oedema after pleural aspiration. Lancet 1 7661 (1970) 1367-1369
85. Fox V., Gould D., Davies N., et al. Patients' experiences of having an underwater seal chest drain: a replication study. J Clin Nurs 8 6 (1999) 684-692
86. Owen S., and Gould D. Underwater seal chest drains: the patient's experience. J Clin Nurs 6 3 (1997) 215-225
87. Luketich J.D., Kiss M., Hershey J., et al. Chest tube insertion: a prospective evaluation of pain management. Clin J Pain 14 2 (1998) 152-154
88. Lee Y.C., Baumann M.H., Maskell N.A., et al. Pleurodesis practice for malignant pleural effusions in five English-speaking countries: survey of pulmonologists. Chest 124 6 (2003) 2229-2238
89. Clementsen P., Evald T., Grode G., et al. Treatment of malignant pleural effusion: pleurodesis using a small percutaneous catheter. A prospective randomized study. Respir Med 92 3 (1998) 593-596
90. Musani A.I., Haas A.R., Seijo L., et al. Outpatient management of malignant pleural effusions with small-bore, tunneled pleural catheters. Respiration 71 6 (2004) 559-566
91. Furrer M., Rechsteiner R., Eigenmann V., et al. Thoracotomy and thoracoscopy: postoperative pulmonary function, pain and chest wall complaints. Eur J Cardiothorac Surg 12 1 (1997) 82-87
92. Dajczman E., Gordon A., Kreisman H., et al. Long-term postthoracotomy pain. Chest 99 2 (1991) 270-274
93. Kalso E., Perttunen K., and Kaasinen S. Pain after thoracic surgery. Acta Anaesthesiol Scand 36 1 (1992) 96-100
94. Passlick B., Born C., Sienel W., et al. Incidence of chronic pain after minimal-invasive surgery for spontaneous pneumothorax. Eur J Cardiothorac Surg 19 3 (2001) 355-358 [discussion: 8-9]
95. Sedrakyan A., van der Meulen J., Lewsey J., et al. Video assisted thoracic surgery for treatment of pneumothorax and lung resections: systematic review of randomised clinical trials. BMJ 329 7473 (2004) 1008
96. Davies H.E., and Lee Y.C.G. Pleurodesis. In: Light R., and Lee Y.C.G. (Eds). Textbook of pleural diseases (2008), Arnold Press, London 569-582
97. Pulsiripunya C., Youngchaiyud P., Pushpakom R., et al. The efficacy of doxycycline as a pleural sclerosing agent in malignant pleural effusion: a prospective study. Respirology 1 1 (1996) 69-72
98. McNicol E., Horowicz-Mehler N., Fisk R.A., et al. Management of opioid side effects in cancer-related and chronic noncancer pain: a systematic review. J Pain 4 5 (2003) 231-256
99. Wilder-Smith C.H. Pain treatment in multimorbid patients, the older population and other high-risk groups. The clinical challenge of reducing toxicity. Drug Saf 18 6 (1998) 457-472
100. Teixeira L.R., Vargas F.S., Acencio M.M., et al. Influence of antiinflammatory drugs (methylprednisolone and diclofenac sodium) on experimental pleurodesis induced by silver nitrate or talc. Chest 128 6 (2005) 4041-4045
101. Lardinois D., Vogt P., Yang L., et al. Non-steroidal anti-inflammatory drugs decrease the quality of pleurodesis after mechanical pleural abrasion. Eur J Cardiothorac Surg 25 5 (2004) 865-871