Control of Chest Pain

Abstract

Pain involving the chest causes the patient to seek medical attention with an urgency that is second only to that following hemoptysis. There is frequently anxiety accompanying this pain and the insistence of the patient on relief is completely out of proportion to the degree of pain. The result has been that over the years the physician has yielded to this demand and has directed his treatment toward the relief of the symptom, frequently without regard to the necessities of the underlying conditions and the possible deleterious effects that the treatment may have. Cupping and leeches were standard procedure in former days and while they may not have improved the underlying pathology, the pain was frequently relieved and no side effects occurred. Later the use of analgesic and sedative medicines superseded these measures. Opium, morphine and its derivatives were found to be effective, both in relieving the pain and the anxiety of the patient and in abolishing the cough which frequently was part of the picture and was responsible for severe painful spasms. Another method which became popular was immobilizing of the chest by binders and adhesive tape strapping, With greater and increasing knowledge of pulmonary physiology and recognition of the changes which accompany various types of pathology, it has become clear that not all methods of relieving pain are desirable and that these methods of treating the pain may aggravate the underlying pathological condition. A second fact which must be remembered is that pathology may be extended or even produced by therapeutic measures which interfere with normal lung function. An approach to the treatment of chest pain must consider In what way this symptom is related to .the underlying pathology and how the pain or the pathology affects respiratory function.