Upper Back/chest Pain

[Pat]

I have POTS and I get this pain that is upper back/chest basically where your bra would go. Does any one else get this? It doesn't hurt all the time but I do get it several times a day and it is a severe pain. Heat seems to soothe it some. I appreciate any and all comments. Thanks

[erikainorlando]

Yes!!!

Terrible pain in my back .... thought it was my lungs for a long time. Pain in my chest too and up my throat. Severe when I have done too much. Today I just woke up with it tho...go figure. I have POTS too. I don't have the BP thing tho. I think this pain is called "coat hanger" pain. I am new to this but I am sure someone with more knowledge will have a more scientific explaination.

Glad I am not alone.

Erika

[Sunfish]

"coat-hanger pain" describes pain/ tension/ pressure in & around the neck & across the shoulders & upper back; picture an actual hanger super-imposed on one's back (hook would be where your head is, hanger then covers neck & upper shoulders & back). sometimes a corresponding headache is considered to be part of the coat-hanger "constellation" of symptoms as well.

i'm not sure if what one &/or both of you are describing/ experiencing fits this description? of course individual physiology could account for a bit of variation but more internal &/or centrally or lower localized chest pain wouldn't likely fit under the "coat-hanger pain" description/ heading...not that the particularly terminology is necessarily the most important thing when you're hurting but having seen the coat-hanger terminology several places on the forum as i've been reading today i just wanted to clarify what it is (& isn't).

speaking of which....as for what "coat-hanger pain" actually IS, i believe that the prevailing belief/ understanding amongst the autonomic specialists is that its related to orthostatic hypotension &/or a lack of sufficient circulatory perfusion (aka blood flow) in the area of &/or around the discomfort/ pain/ pressure - the head, neck & shoulders - which goes along with why/ how many of us may experience concurrent "brain fog"/ cognitive trouble (or an increased degree of it), though this isn't always the case.

for those who do in fact have the classic "coat-hanger pain" laying down or reclining should help the situation...not in a way that it will necessarily stop immediately/ instantaneously- but that if reclined/ laying down it will gradually improve whereas remaining upright often brings with it increasing degrees of the pain/ discomfort. for many (perhaps most?) "typical" meds to treat headaches &/or joint or muscle pain/ discomfort will do little or nothing to help; conversely some do find that meds to increase blood pressure or blood volume &/or facilitate vasoconstriction/ better cerebral perfusion (blood flow to the brain) DO in fact help.

i know this is DEFINITELY the case for me; NOTHING helps when i get the "coat-hanger pain" other than laying flat (or reclining darn close to it). essentially it acts as a warning for me that my "upright time" (when seated) is quickly drawing to a close; i don't get it from standing/ walking b/c i can't stay up that long without fainting but during my "better" days/ times with my maximum meds in my system (to up my BP) it's my most prevalent orthostatic symptom from a seated position....almost as if the meds allow me to push & stay seated without actually faintin but eventually my body still konks out halfway - thus the coathanger pain - but still doesn't actually lose consciousness as it would when standing or without meds. in some ways the "coat-hanger pain" almost seems to replace my dizziness/ fainting when SEATED when i'm on my meds.

hope this helps,

melissa

[juliegee]

Hi Guys-

I agree with Melissa. iIdon't think you two are describing the same thing. Unfortunately, I've had both. Pat, that's exactly the pain I had before I got my gallbladder out. It got really intense (multiple hospital stays) before the surgery. Run, don't walk, to your doc for a HIDA scan. That shows whether or not your gallbladder is functioning. They always order ultrasounds first that showed nothing for me. I had NO stones, etc. but my gallbladder was in awful shape when it came out- wrapped in layers and layers of adhesions. The pain radiated to between my shoulder pains- ouch! If it's worse after eating, that's a classic clue.

Erika, Melissa's done a great job of describing the coat hanger pain- also awful. I've had flares of that one off and on for years. It gets particularly bad for me when my blood sugar/hypoglycemia acts up. Sounds crazy, but I have periods where I get awful low blood sugar, and whenever that happens that awful pain in my upper shoulders and neck reoccurs- so debilitating. It's kind of like my glucose reserves have runout and I don't even have the strength to hold my head up Lying down does resolve it and my autonomic stuff gets bad during those periods too. Drink lots of fluid, take lots of salt (if your BP allows) and eat frequent high protein, complex carb snacks.

Hugs-

Julie

[mkoven]

Any new chest pain should be checked out urgently. If it goes away when you lie down, that tells you it's probably ans-related. But if it's new, get it looked at. We get so many symptoms that sound like something life-threatening, and typically aren't. But we shouldn't assume everything is ans. If you have a good ans doc, I'd put in a call/page. If you can't get through, to be safe, go to the ER--even if it ends up being nothing dangerous, better safe...

[Sunfish]

while the point to not uniformly dismiss anything & everything as ALWAYS being ANS-related is very well taken (and a somewhat tricky balancing act that we all must do our best to continually make sense of) i think that it may be jumping to the other extreme to urge anyone & everyone with any/every type of chest pain to head to an ER immediately. i certainly know what & why you gave the recommendation but at the same time think that your definition of "any chest pain" is more specific than what others may be describing as pain in & around the their chest. it is very likely the case that what you classify as "chest pain" of new onset would be cause for a ER trip, on the basis of a number of posts i've read this afternoon & evening i'm pretty certain that some people are using the phrase "chest pain" (or other similar things) to describe a MUCH wider/ broader collection of aches & pains than that which would necessitate immediate/ urgent evaluation & intervention.

it's obviously better to be safe than sorry if & when truly concerned or in doubt; i just don't want new folks or those coming across a post by way of search in the future thinking that any new pain that's anywhere close to the chest area merits a trip to the ER. per conversation & an understanding with one's doctor this may very well be the standard for some but on the other hand there are a variety of pains/ discomforts that might occur in & around the chest/ back/ abdomen that, however uncomfortable, are okay to leave until morning (so to speak).

i am certainly NOT telling anyone to stay away from an ER if there's an indication or inkling or feeling that it might be a good idea. but having been the recipient of many a PM or email from (often newly or not yet diagnosed) members who are in a panic about a well-intended (and generally in its own right correct) line from a post on the forum i did feel the need to add my own two cents.

bottom line: the decision to go to the ER (or not) is ALWAYS an individual decision that only an individual &/or those around him or her can make; the "criteria" may vary greatly from person to person & may even be different for an individual over time but no matter what is never & never should be based on any guideline or suggestion here on the forum (or anywhere else online for that matter...)

again i am definitely NOT trying to start an argument; what i AM trying to do is quell any undue panic.

cheers,

melissa

[mkoven]

Point well taken, Melissa. I've spent far too many hours in the ER or hospital being worked up for chest pain. And the frustrating thing is being worked up for it by doctors who aren't familiar with ans symptoms.

At this point, I seem to get two types of chest pain. One is definitely ans-related, and has improved with ans meds and treatments.

But the other seems to be coronary vasospasm or prinzmetal angina. This is quite serious and the treatments/dangers quite different. It feels quite different from my ans chest pain. and I know that if I get a bout of it, and I can't reach my cardiologist, I have to go to the ER, because it can cause damage to the heart.

I'm not saying that is a likely scenario for most people here, though I think there are a couple others here with both conditions. And now that I know my different types of chest pain, I mostly know what to do. And many of us know the frustration of the ER--they are there to keep people from losing life and limb, not a place that is able to diagnose or manage complex syndromes.

But I do think any NEW chest pain should be discussed with a doctor. Ideally, we would all have quick access by phone to a doctor who knows us, knows ans issues and how to distinguish them from other causes of chest pain. I'm very lucky this year as I'm on sabbatical in a place with a great cardiologist whom I can page if I'm having a bout and not sure what to do. She has returned my calls promptly and we have discussed whether I need to be seen. And she has kept me out of the ER by properly recognizing and treating the two different issues I have going on. (I take a calcium-channel blocker now to prevent arterial spasm, in addition to florinef and midodrine. it's an odd combo, but seems to work for me, for now). But she also is ready to tell me when I need to go in. I'm happy because I can't tell you how many er trips I had until I started working with her, and now I haven't been since October.

My rule of thumb, for MYSELF, is that if my chest pain improves by lying down, fluids/salt, compression, etc., and it feels like it did in the past, I stay home. I know I''m not saying anything particularly new, but there are lots of causes of chest pain--some pretty benign and some pretty serious.

[Csmith3]

On the assumption that the pain is nothing sinister, I'm going to make a further suggestion.

I get coathanger pain and also pain around the bra line. I don't think they are the same thing in my case, but I wonder if the mid-back pain is a consequence of the coathanger pain, maybe from tensing up. Anyway, I had an osteopath look at it whilst I was there for something else. She commented my back was very stiff at that point and I had some massage and manipulation. Since then it has been much, much better.

I have also propped up the foot of my bed which really helps my coathanger pain and helps me to sleep. Other things that help me are applying heat and using a thera-band to do exercises that stretch the shoulder muscles.

[ajw4790]

Hi,

When I first read your post I was thinking costochondritis. Google it to see if it sounds like a possibility. You can also do a search here on the forum, because that has been discussed some before. I don't personally have that pain, so I am not of much help. Sorry.

[Pat]

Yes!!!

Terrible pain in my back .... thought it was my lungs for a long time. Pain in my chest too and up my throat. Severe when I have done too much. Today I just woke up with it tho...go figure. I have POTS too. I don't have the BP thing tho. I think this pain is called "coat hanger" pain. I am new to this but I am sure someone with more knowledge will have a more scientific explaination.

Glad I am not alone.

Erika

I am going to research into this "coat hanger" pain, I have never heard of it before thanks!

[Pat]

Hi Guys-

I agree with Melissa. iIdon't think you two are describing the same thing. Unfortunately, I've had both. Pat, that's exactly the pain I had before I got my gallbladder out. It got really intense (multiple hospital stays) before the surgery. Run, don't walk, to your doc for a HIDA scan. That shows whether or not your gallbladder is functioning. They always order ultrasounds first that showed nothing for me. I had NO stones, etc. but my gallbladder was in awful shape when it came out- wrapped in layers and layers of adhesions. The pain radiated to between my shoulder pains- ouch! If it's worse after eating, that's a classic clue.

Erika, Melissa's done a great job of describing the coat hanger pain- also awful. I've had flares of that one off and on for years. It gets particularly bad for me when my blood sugar/hypoglycemia acts up. Sounds crazy, but I have periods where I get awful low blood sugar, and whenever that happens that awful pain in my upper shoulders and neck reoccurs- so debilitating. It's kind of like my glucose reserves have runout and I don't even have the strength to hold my head up Lying down does resolve it and my autonomic stuff gets bad during those periods too. Drink lots of fluid, take lots of salt (if your BP allows) and eat frequent high protein, complex carb snacks.

Hugs-

Julie

Thanks, Julie for your input I had my gall bladder removed in 92 so I know it is not that. You know it would be great if there was a POTS handbook with all the symptoms in it that you could look up and get answers out of, but unfortunately this crazy disease/disorder is different for each person. You all have given me good new information that I can research on. At least I have a starting place. Thanks so much.