Is stress causing my chest pain?

Dear Worried and Bird-chest in pain, 

What a pain in the chest! When it comes to chest pain, there are many potential causes, and some factors such as lifestyle, genetics, or environmental determinants that may contribute to them. The concerns you bring up, such as stress, muscle, joint, or bone injury (such as the manubriosternal joint), or other conditions could possibly be the reason. That said, the causes for chest pain can be vast and therefore the range of treatments is just as broad since each treatment corresponds with the underlying cause of pain. When it comes to seeking treatment, many health care providers and mental health professionals have sliding scales or payment plans to help those who may not have insurance. 

Unfortunately, chest pain isn’t straight forward. It may help to talk with a health care provider about what you’re experiencing, to begin to identify the cause. Depending on the cause, the pain can be characterized in many different ways, including: 

• Cardiac (heart related): caused by physical effort, strong emotion, or eating 
• Pleural (related to the space surrounding the lungs): associated with coughing or pain while breathing 
• Gastrointestinal, esophageal, or peptic ulcer: burning sensation, common at night or when laying down 
• Arthritis: local, tender, pain from movement 
• Cervical (related to neck): often due to injury, worse with physical activity or movement 
• Musculoskeletal: worse with physical activity or movement such as twisting and bending 
• Psychoneurotic: related to anxiety 

While looking at the characteristics may be helpful, it may also be useful to identify reasons for chest pain. Some of these may be conditions themselves, while other times the chest pain may be a symptom of something else like: 

• Heart conditions. Angina, heart attack, and pericarditis may all cause chest pain. Angina happens when blood has trouble flowing to the heart, and when the artery is fully blocked, a heart attack may happen. Pericarditis is the inflammation that occurs around the heart. 
• Esophagitis. This is inflammation of the esophagus, the organ that connects the throat to the stomach. 
• Gastroesophageal reflux disease (GERD). This condition is when someone experiences stomach acid going back up the esophagus (also called acid reflux) repeatedly. Acid reflux can cause heartburn. 
• Anxiety or panic disorders. Experiencing anxiety or panic may lead to chest pain, rapid heartbeats and breathing, or feeling short of breath, among other non-chest related symptoms. 
• Stress. Both physical and emotional stress may cause chest pain. The inflammation that occurs from stress may disrupt your normal bodily functions. 
• Costochondritis. This condition is characterized by pain in the chest due to inflammation of the cartilage between the ribs and sternum. 
• Pulmonary embolism (PE). PE may cause a shortness of breath and chest pain that can affect people at any age, especially if they smoke or take birth control. 

Some lifestyle factors may contribute to the conditions that cause this pain. Heartburn or esophagitis may be worsened by eating fatty meals, smoking, alcohol, or caffeine. Additionally, reducing stress may also help to reduce chest pain. 

As for the question about cancer: chest pain can be a symptom of some cancers, but it usually isn’t the only symptom. Additionally, some people with cancer have weakened immune systems, so they may be more likely to be susceptible to other illnesses that may cause chest pain. 

Treatment options for what you’re experiencing will vary based on the reason for the pain. You both mentioned speaking to a health care provider soon or in the past, which is a great start. If you decide to talk about your chest pain, describing your symptoms, what makes the pain better or worse, and what you’ve already tried may be useful in helping them to pinpoint the cause. Depending on the culprit of chest pain, they may prescribe medications, order additional tests, or recommend lifestyle changes to alleviate the pain. Additionally, you may need to seek multiple opinions since many specialists focus on just their designated area of the body. Check out the Communicating and Relating fact sheet for more strategies on how to state your concerns. Regardless, it’s wise to always get chest pain checked out as soon as possible to make sure that it isn’t due to something life-threatening.  

Take care,