🩻 Chronic Musculoskeletal Chest Wall Pain

Chest pain can be a frightening symptom — but not all chest pain is related to the heart or lungs. In fact, one of the most overlooked causes is musculoskeletal chest wall pain, which arises from the muscles, joints, tendons, or nerves of the chest wall itself.

When this pain becomes chronic (lasting more than 6–8 weeks), it can significantly impact quality of life — but the good news is, it’s rarely dangerous and often very treatable with the right approach.

🔍 What Is Chronic Musculoskeletal Chest Wall Pain?

This condition refers to long-standing pain originating from the soft tissues, bones, or joints of the chest wall. It is distinct from cardiac or pulmonary causes and is often linked to:

Costochondritis – inflammation of the cartilage joining ribs to the breastbone
Muscle tension or trigger points – especially in the pectorals or intercostal muscles
Thoracic spine or rib joint dysfunction
Postural strain – often from prolonged sitting or poor ergonomics
Intercostal neuralgia – nerve irritation between the ribs
Fibromyalgia or central sensitisation – where the nervous system becomes hypersensitive to stimuli

A thorough clinical assessment is essential to rule out serious pathology, but once that’s done, treatment can be safely focused on relieving pain and restoring function.

✅ Effective Treatments for Chronic Chest Wall Pain

1. 🧠 Reassurance & Education

Understanding that the pain is non-cardiac and non-threatening is often the first and most powerful intervention. Patients with chest wall pain often carry anxiety about their heart or lungs — reassurance reduces stress and allows the body to heal.

2. 🏃‍♂️ Physical Therapy & Movement

A tailored physiotherapy program may include:

Stretching of the chest wall, thoracic spine, and shoulder girdle
Postural correction (e.g., reversing slouched sitting habits)
Strengthening exercises for scapular stabilisers and core muscles
Diaphragmatic breathing techniques to reduce accessory muscle overuse

3. ✋ Manual Therapy

Hands-on therapies by trained clinicians can help mobilise stiff joints and release myofascial tension:

Trigger point therapy for myofascial pain
Joint mobilisation of ribs and thoracic spine
Myofascial release or dry needling in targeted areas

4. 💊 Pain Relief When Needed

Topical NSAIDs (e.g., diclofenac gel) – safe for longer-term use
Oral NSAIDs (e.g., ibuprofen) – short-term use under guidance
Paracetamol – as a baseline analgesic
Neuropathic agents – such as low-dose amitriptyline or gabapentin for nerve-related symptoms

❗ Opioids are not recommended for chronic musculoskeletal pain.

5. 💉 Interventional Therapies (if persistent)

Trigger point injections – with local anaesthetic or dry needling
Intercostal nerve blocks – for persistent nerve pain
PRP injections – an emerging option for chronic inflammation or soft tissue injury when conservative care fails

6. 🧘‍♀️ Mind-Body Approaches

Cognitive behavioural therapy (CBT) – for chronic or centrally sensitised pain
Mindfulness and yoga – to reduce muscle tension and improve movement awareness
Breathing retraining – especially in patients with shallow or apical breathing patterns

💡 The Takeaway

Chronic musculoskeletal chest wall pain can be frustrating and sometimes disabling — but it’s very often treatable and reversible with a comprehensive, non-invasive plan.

📚 References

Davies, S. J., & Silman, A. J. (2008). Musculoskeletal chest wall pain: A common and often neglected cause of chest pain. British Journal of General Practice, 58(550), 264–267. https://doi.org/10.3399/bjgp08X277311
Simons, D. G., Travell, J. G., & Simons, L. S. (1999). Travell and Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual (Vol. 1). Lippincott Williams & Wilkins.
O’Neill, T. W., & McCabe, P. S. (2020). Pain in the thoracic spine and chest wall. Best Practice & Research Clinical Rheumatology, 34(3), 101514. https://doi.org/10.1016/j.berh.2020.101514
Wang, D., Ho, K. Y., & Leong, K. W. (2017). Intercostal neuralgia: Diagnosis and treatment. Journal of Pain Research, 10, 2411–2416. https://doi.org/10.2147/JPR.S140002
van Ravesteijn, H., Lucassen, P., Bor, H., van Weel, C., & olde Hartman, T. C. (2012). Mind attribution in medically unexplained symptoms: An observational study in primary care. British Journal of General Practice, 62(601), e395–e401. https://doi.org/10.3399/bjgp12X641456
Giamberardino, M. A., & Affaitati, G. (2012). Referred pain from myofascial trigger points: A comprehensive review. Current Pain and Headache Reports, 16(5), 370–376. https://doi.org/10.1007/s11916-012-0289-5
Mehling, W. E., Hamel, K. A., Acree, M., Byl, N., & Hecht, F. M. (2005). Body awareness: A phenomenological inquiry into the common ground of mind-body therapies. Philosophy, Ethics, and Humanities in Medicine, 1(1), 1–12. https://doi.org/10.1186/1747-5341-1-6
Montagnino, A., Genung, M., Hannon, C. P., Saltzman, B. M., Cole, B. J., & Fortier, L. A. (2025). Optimizing orthobiologic therapies with exercise, diet, and supplements. PM&R, 17(3), 333–346. https://doi.org/10.1002/pmrj.13228
Sarzi-Puttini, P., Giorgi, V., Atzeni, F., & Marotto, D. (2020). Fibromyalgia: An update on clinical characteristics, aetiopathogenesis and treatment. Nature Reviews Rheumatology, 16(11), 645–660. https://doi.org/10.1038/s41584-020-00506-w
Kachalia, A., Kaufman, S. R., Boothman, R., Anderson, S., Welch, K., Saint, S., & Rogers, M. A. (2010). Liability claims and costs before and after implementation of a medical error disclosure program. Annals of Internal Medicine, 153(4), 213–221. https://doi.org/10.7326/0003-4819-153-4-201008170-00002

Tagged Musculoskeletal Medicine, Orthobiologics, Platelet-Rich Plasma, PRP, Regenerative Therapy

Chronic Musculoskeletal Chest Wall Pain