chestpain1Chest pain is a common presentation to health care practitioners, and requires careful and often urgent assessment. Although it is critical to rule out potentially life-threatening conditions, in the general practice/primary care setting, musculoskeletal conditions are the most common causes of chest pain (1). The evidence suggests a prevalence in the general practice population of from 20.6%to 46.6%. By contrast, musculoskeletal conditions were diagnosed in only 6.2% of patients presenting to the emergency department (1).  An attack of acute chest pain can have many causes, not all of which are critical.  Once serious pathology such as myocardial infarction (heart attack) has been ruled out, these patients are often discharged from the emergency department (ED) with the diagnosis of undifferentiated chest pain, i.e. chest pain of unknown origin (2). An often over-looked cause of acute undifferentiated chest pain is pain from the neck and mid back (thoracic spine), creating a sub-category of this condition often called ‘musculoskeletal chest pain’.

A recent Danish randomized controlled trial by Dr. Stochkendahl, a chiropractor and PhD clinical researcher compared chiropractic care, including spinal manipulation of the thoracic and/or cervical spine to the normal self-management program for patients presenting to a University Hospital with acute musculoskeletal chest pain (3, 4) The study results demonstrated improvement in self-perceived chest pain and less pain intensity in favor of chiropractic care. In addition, patients receiving chiropractic care reported significantly less thoracic spine and shoulder-arm pain. This study suggested that chiropractic care could help speed recovery for patients with acute musculoskeletal chest pain presenting to the emergency department.

A study that just came out in 2016 has examined the cost-effectiveness of chiropractic care versus self-management in patients with musculoskeletal chest pain (5). An interesting finding is that patients with non-specific chest pain feel equally or more disabled than patients with cardiac chest pain and are a major burden on healthcare resources. This new study found that in terms of health-related quality of life, primary care in the form of chiropractic care has similar effectiveness as self-management in patients with musculoskeletal chest pain. For patients with musculoskeletal chest pain, community-based chiropractic care is more cost-effective than self-management as it is associated with fewer hospital admissions and lower healthcare costs (5).

 

References:

1: Winzenberg T, Jones G, Callisaya M. Musculoskeletal chest wall pain. Aust Fam Physician. 2015 Aug;44(8):540-4. PubMed PMID: 26510139.

2: Donovan J, Cassidy JD, Cancelliere C, Poulsen E, Stochkendahl MJ, Kilsgaard J, Blanchette MA, Hartvigsen J. Beyond the spine: a new clinical research priority.  J Can Chiropr Assoc. 2015 Mar;59(1):6-12. PubMed PMID: 25729080; PubMed Central PMCID: PMC4319449.

3: Stochkendahl MJ, Christensen HW, Vach W, Høilund-Carlsen PF, Haghfelt T, Hartvigsen J. Chiropractic treatment vs self-management in patients with acute chest pain: a randomized controlled trial of patients without acute coronary syndrome. J Manipulative Physiol Ther. 2012 Jan;35(1):7-17. doi: 10.1016/j.jmpt.2010.11.004. Epub 2011 Dec 19. PubMed PMID: 22185955.

4: Christensen HW, Vach W, Gichangi A, Manniche C, Haghfelt T, Høilund-Carlsen PF. Manual therapy for patients with stable angina pectoris: a nonrandomized open prospective trial. J Manipulative Physiol Ther. 2005 Nov-Dec;28(9):654-61. PubMed PMID: 16326234.

5: Stochkendahl MJ, Sørensen J, Vach W, Christensen HW, Høilund-Carlsen PF, Hartvigsen J. Cost-effectiveness of chiropractic care versus self-management in patients with musculoskeletal chest pain. Open Heart. 2016 May 4;3(1):e000334. doi: 10.1136/openhrt-2015-000334. eCollection 2016. PubMed PMID: 27175285.

 

 

 

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