Painful cough and chest pain
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Understanding Painful Cough and Chest Pain: Causes and Management
Common Causes of Painful Cough and Chest Pain
Respiratory Infections and Inflammatory Conditions
Respiratory infections, such as viral infections, are among the most common causes of acute cough and chest pain. These infections can lead to inflammation in the airways, causing discomfort and pain during coughing1 8. Chronic inflammatory changes in the bronchi, as seen in some patients, can also result in persistent cough and chest pain2.
Chronic Conditions and Comorbidities
Chronic conditions like Chronic Obstructive Pulmonary Disease (COPD) and asthma are significant contributors to chronic cough and chest pain. These conditions often exacerbate during respiratory infections, leading to increased symptoms7 8. Additionally, chronic pain and chronic cough are interrelated, with each condition potentially exacerbating the other5.
Pleural Effusion and Lung Masses
Pleural effusion, which is the accumulation of fluid in the pleural space, can cause chest pain and cough. This condition often requires medical intervention to manage the symptoms and underlying cause2. Similarly, lung masses, such as those seen in lung cancer, can present with localized chest pain and persistent cough7.
Pneumothorax and Pneumomediastinum
Severe coughing can sometimes lead to pneumothorax (collapsed lung) and pneumomediastinum (air in the mediastinum), which are serious conditions that cause chest pain and require immediate medical attention. These conditions can be diagnosed through imaging techniques like chest X-rays and CT scans4.
Management Strategies for Painful Cough and Chest Pain
Cold Application for Post-Surgical Pain
For patients experiencing chest pain due to surgical procedures like coronary artery bypass graft surgery, cold application has been shown to significantly reduce pain associated with deep breathing and coughing exercises. This method can help improve patient comfort and reduce the risk of postoperative complications3.
Pharmacological Interventions
Antibiotics are often prescribed for bacterial infections causing cough and chest pain. However, their effectiveness can vary, and in some cases, symptoms may persist despite treatment, indicating the need for further investigation and alternative therapies2. For chronic conditions like COPD, long-acting bronchodilators and anti-inflammatory medications are commonly used to manage symptoms7.
Pain Modulation Techniques
Research suggests that pain modulation techniques, such as cold-water immersion, can reduce the urge to cough and the number of coughs in both healthy individuals and patients with refractory chronic cough. However, the effectiveness of these techniques may be reduced in patients with chronic cough, indicating a potential impairment in their endogenous inhibitory control mechanisms9.
Case Studies Highlighting Diverse Presentations
Case of a Young Male with Pneumothorax
A 20-year-old male presented with pleuritic chest pain and subcutaneous air after excessive coughing and vomiting. Imaging revealed pneumomediastinum and bilateral pneumothoraces, highlighting the potential severity of symptoms following intense coughing episodes4.
Case of a Middle-Aged Man with Chronic Symptoms
A 52-year-old man with a history of fever, cough, and chest pain was found to have chronic inflammatory changes in his bronchi. Despite antibiotic treatment, his symptoms persisted, underscoring the complexity of diagnosing and managing chronic respiratory conditions2.
Case of a Young Woman with Post-Cold Symptoms
A 27-year-old woman experienced nonproductive cough and chest pain following a common cold. Despite normal physical and laboratory findings, her symptoms persisted, illustrating the challenges in diagnosing and managing post-infectious cough and chest pain6.
Conclusion
Painful cough and chest pain are symptoms with a wide range of potential causes, from acute infections to chronic conditions and severe complications like pneumothorax. Effective management requires a comprehensive approach, including accurate diagnosis, appropriate pharmacological treatment, and supportive therapies like cold application for pain relief. Understanding the interrelatedness of chronic cough and pain can also aid in developing more effective treatment strategies for affected patients.
Sources and full results
Most relevant research papers on this topic
A 52-Year-Old Man With an 11-Month History of Fever, Cough, Chest Pain, Pleural Effusion, and Left Lung Atelectasis.
The 52-year-old man's symptoms were linked to bamboo rat meat consumption, and he was diagnosed with chronic inflammatory changes in his bronchi.
Case ReportEffect of Cold Application on Chest Incision Pain Due to Deep Breathing and Cough Exercises.
Cold application after coronary artery bypass graft surgery significantly reduces chest incision pain due to deep breathing and cough exercises.
RCTYoung male with coughing and chest pain
A 20-year-old male with coughing and chest pain was diagnosed with SARS-CoV-2 and treated conservatively, requiring no chest tube thoracostomies or antibiotics.
Case Report
Rigorous JournalThe interrelatedness of chronic cough and chronic pain
Chronic cough and chronic pain share common risk factors and/or pathophysiologic mechanisms in adult subjects, indicating potential shared risk factors and mechanisms.
Observational StudyRigorous JournalA young woman with cough and chest pain.
A 27 year old woman was admitted to our hospital with a history of a nonproductive cough and breathingdependent chest pain. The symptoms were manifested after a common cold a few weeks earlier. No fever or loss of body weight was noted. The patient’s medical history was remarkable for insulin-dependent diabetes mellitus of 6 yrs duration. She had never smoked. On physical examination, the patient had a normal heart rate and blood pressure. Chest examination revealed normal breathing sounds, and findings on cardiac examination were normal. In fact, no abnormalities were found. Laboratory evaluation, including kidney function and different serological tests, was within normal limits: angiotensin-converting enzyme (ACE) 11.6 nmol·min-1 (normal level 7–20 nmol·min-1), rheumatoid arthritis haemagglutination (RAHA) <40 (0–40), L-antistreptolysine titre (AST) 40 IE·ml-1 (normal level 0–299 IE·ml-1), negative values of antinuclear factors (ANF), anti-double-
Case ReportA 52-Year-Old Man Presented With Cough, Chest Pain, and a Mass in the Right Lung.
A large mass in the right upper lobe of the lung may be a result of a lung cancer, particularly in smokers with a history of COPD and anxiety disorder.
Case ReportClassification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report
CHEST's 2006 Cough Guidelines and management algorithms for acute, subacute, and chronic cough in adults are useful in diagnosing and treating patients globally, despite low quality evidence.
Systematic Review
Highly CitedThe effect of pain conditioning on experimentally evoked cough: evidence of impaired endogenous inhibitory control mechanisms in refractory chronic cough
Painful cold-water hand immersion has a weaker inhibitory effect on coughing in patients with refractory chronic cough, suggesting a relative deficiency in conditioned pain modulation.
RCTRigorous JournalImages in clinical medicine. Lung herniation with coughing.
A 67-year-old man was admitted to the emergency department with pain in the left side of the chest that had begun 10 days earlier after an episode of severe coughing. Computed tomography of the chest revealed lung herniation through a left lower intercostal space laterally.
Case ReportRigorous Journal