Medicine for chest pain
Pro Research Analysisby 
Searched over 200M research papers
Consensus Meter
Effective Medications for Chest Pain: A Comprehensive Review
Pre-Hospital Treatment of Chest Pain in Acute Coronary Syndrome
Narcotic Analgesics and Nitrates
In the pre-hospital setting, managing chest pain effectively is crucial, especially for patients with suspected acute coronary syndrome (ACS). Narcotic analgesics, such as morphine, are commonly used for pain relief, although they come with side effects. Alfentanil, another narcotic, has been noted for its rapid pain relief properties. Nitrates are also effective in alleviating chest pain with minimal side effects.
Beta-Blockers and Benzodiazepines
Beta-blockers, when combined with morphine, have shown increased efficacy in pain relief, although this combination can lead to more side effects. Benzodiazepines, while not extensively studied, are used to manage anxiety associated with chest pain, potentially reducing overall discomfort.
Treatment of Non-Cardiac Chest Pain (NCCP)
Proton Pump Inhibitors (PPIs)
For non-cardiac chest pain, particularly when gastroesophageal reflux disease (GERD) is suspected, proton pump inhibitors (PPIs) like omeprazole, lansoprazole, and rabeprazole are effective . High-dose PPI treatment is particularly beneficial for patients with GERD-related chest pain.
Antidepressants and Cognitive Behavioral Therapy
Antidepressants, including imipramine, sertraline, trazodone, and venlafaxine, have shown efficacy in treating esophageal and functional chest pain . Cognitive behavioral therapy (CBT) is another effective treatment modality for NCCP, addressing the psychological components of pain .
Smooth Muscle Relaxants and Anti-Spasmodics
For esophageal motility disorders, smooth muscle relaxants such as calcium channel blockers, nitrates, and phosphodiesterase inhibitors are recommended. Anti-spasmodics and botulinum toxin injections are also viable options for managing spastic motility disorders.
Specific Medications for Chest Pain
Buprenorphine vs. Diamorphine
A randomized trial comparing buprenorphine and diamorphine for chest pain relief in suspected myocardial infarction found both drugs to be equally effective. However, buprenorphine had a slightly slower onset of action but is not a controlled substance, making it a practical option in various medical settings.
Aspirin Administration Timing
Early administration of aspirin (within two hours of chest pain onset) significantly improves survival rates compared to later administration (in-hospital). This highlights the importance of timely intervention in acute coronary events.
Traditional Medicine: Saikanto
In cases of chest pain associated with mild to moderate COVID-19, the traditional Japanese medicine saikanto has been effective, especially when conventional analgesics fail. This treatment option may offer anti-inflammatory and analgesic benefits.
Conclusion
Effective management of chest pain requires a tailored approach based on the underlying cause. For acute coronary syndrome, narcotic analgesics, nitrates, and beta-blockers are commonly used, while benzodiazepines can help manage associated anxiety. Non-cardiac chest pain often benefits from PPIs, antidepressants, and cognitive behavioral therapy. Early administration of aspirin is crucial for improving survival in myocardial infarction cases. Additionally, traditional medicines like saikanto may provide relief in specific scenarios, such as COVID-19-related chest pain. Further research and large randomized clinical trials are needed to optimize treatment protocols for various types of chest pain.
Sources and full results
Most relevant research papers on this topic