Chest Pain in Fibromyalgia

Most people associate chest pain with heart attacks — and for good reason. While not everyone who is having a heart attack experiences chest pain, it is the most common symptom. That’s why it is smart to seek medical care or call 911 if you feel pressure, pain, or fullness in the chest of your chest that lasts more than a few minutes — especially if the symptom is coupled with shortness of breath, nausea, sweating, or pain in your arm, jaw, back, or stomach.

But sometimes chest pain is not an emergency at all. It could stem from a wide range of conditions, such as anxiety, indigestion, or a pulled muscle. And if you have fibromyalgia, chest pain might also be related to a problem with how your brain interprets pain signals.

People with fibromyalgia, a chronic pain disorder, tend to report widespread pain that commonly affects  their back, shoulders, knees, and hips, but chest pain in fibro patients is also surprisingly common. Estimates vary, but anywhere from 8 to 71 percent of fibromyalgia patients seem to develop it. It is also worth noting that 85 percent of people with fibromyalgia have a tender point that is located in a specific area in the chest where a segment of cartilage connects the ribs to the breastbone.

“Fibromyalgia does cause chest pain,” says Howard L. Feinberg, DO, professor of rheumatology at Touro University California College of Osteopathic Medicine. “Patients often experience chest wall pain and tenderness, and this is most pronounced along the edges of the sternum. This is usually described as a severe, sharp pain.”

What Chest Pain in Fibro Feels Like

 The widespread pain and tenderness in fibro can differ from person to person. Some of the ways patients describe chest pain include:

  • Sharp and stabbing
  • Inflamed or burning
  • Achy
  • Tight or knotted feeling
  • Restricted breathing or shortness of breath
  • Feels worse when you move, twist, or apply pressure
  • Can come and go

Causes of Fibromyalgia Chest Pain

Of course, people with fibromyalgia can and do have heart attacks, so when in doubt it’s best to seek prompt medical assistance. But there are several other reasons why fibromyalgia patients might experience chest pain.

Pain Signaling in the Brain

For starters, it might have to do with how the brain interprets physical sensation. Experts don’t know the exact cause of fibromyalgia, but they do know that people with fibromyalgia have a much lower pain tolerance than other people. For example, even something as simple has a touch of the hand or a gentle massage could feel painful to someone with fibromyalgia. Similarly, any stress to the chest area — perhaps due to coughing, twisting the upper body, or low-level inflammation as the body tries to fight off a respiratory infection — might feel painful to someone with fibromyalgia.

Inflammation and Costochondritis

Inflammation is another possible link. Although experts have debated whether fibromyalgia is actually an inflammatory condition, some research suggests that it does in fact play a role. A recent study conducted by scientists at Massachusetts General Hospital and Karolinska Institute in Sweden found that fibromyalgia patients have substantially higher levels of inflammation in the brain, and another 2017 study from Sweden found evidence of systemic (body-wide inflammation) in people with fibromyalgia.

Widespread inflammation could very well cause inflammation of the cartilage that connects the ribs to the breastbone (costosternal bones), which is known as costochondritis. If your chest hurts more when you press on it, you might be dealing with costochondritis. This problem tends to get better on its own, but taking nonsteroidal anti-inflammatory drugs (NSAIDs) and alternating between icing the area and using moist heat might help relieve the discomfort in the meantime.

Ruling Out Other Causes of Chest Pain

It’s important to know that someone with fibromyalgia could experience chest pain that is not due to fibromyalgia, says Rajat Bhatt, MD, a rheumatologist in practice at Prime Rheumatology in Richmond, Texas. (Remember: If you have any concerns that your chest pain could be a heart attack, seek emergency medical attention.)

In some cases, fibromyalgia might have been misdiagnosed; in others, a patient might have fibromyalgia as well as another (or several other) disorders. “Coexisting conditions could be causing the chest pain, so they must be ruled out,” says Dr. Bhatt.

These chronic conditions might also be responsible for causing chest pain in people who have fibromyalgia:

Axial spondyloarthritis

 A type of arthritis that is best known for attacking the spine and sacroiliac joints, spondyloarthritis may also cause chest pain and chest wall tenderness, says Dr. Feinberg. If you are experiencing back pain, your doctor might order blood tests and/or an MRI to check for this problem. Read more about axial spondyloarthritis as well as why axSpA and fibro can be confused for each other.

Lupus

An autoimmune disorder that causes inflammation and pain throughout the body, lupus can target many of your organs, including the lungs and heart. Lupus patients are particularly susceptible to myocarditis, an inflammation of the heart muscle tissue. There’s no one way to diagnose lupus, but your doctor will likely order blood tests to check for antinuclear antibodies (ANA). Read more facts about lupus as well as why lupus and fibro can be mistaken for each other.

Cervical spinal stenosis

Some patients who are incorrectly diagnosed with fibromyalgia actually have cervical spinal stenosis, and pain from the neck and upper back can radiate to the chest. This condition, a narrowing of the spinal canal in the neck that occurs when intervertebral discs bulge out or cartilage wears away, can be diagnosed with imaging tests (like MRIs).

Pericarditis

Heart inflammation can cause chest pain. One type of is pericarditis — an inflammation of the tissue that forms a sac around the heart. Pericarditis is often caused by a viral or bacterial infection. You may need a chest X-ray, EKG, or ultrasound of the heart to find out if you have this problem.

Depression and anxiety

Mental health issues can also cause physical symptoms, including chest pain, says Dr. Bhatt. While the discomfort is often harmless, it shouldn’t be ignored because people with anxiety and depression tend to have higher rates of heart attacks. You may need to see a mental health professional (in addition to your primary care provider or a cardiologist) to sort it out.

How Chest Pain in Fibromyalgia Is Treated

Once other problems — including heart issues — have been ruled out, treating chest pain in someone with fibromyalgia comes down to addressing the underlying fibromyalgia, says Dr. Feinberg.

Medications

A wide variety of drugs may be used to treat fibromyalgia. Some, like pregabalin (Lyrica, an anti-convulsant) and duloxetine (Cymbalta, an antidepressant), are specifically FDA-approved to treat fibromyalgia, but other drugs such as muscle relaxers and NSAIDs are often used “off-label.” If you’re having chest pain or other symptoms, talk to your doctor about tweaking your current regimen. Read more here about fibro treatment options.

Exercise

Though it may sound counterintuitive to get moving when you are in pain, gentle exercise like walking or swimming should gradually help ease your symptoms over time. Yoga and tai chi may also be good options. If you need help putting together a routine, ask your doctor to recommend a physical therapist.

Cognitive behavioral therapy

This type of talk therapy has been proven to help fibromyalgia patients and others with chronic pain cope better with the discomfort. It can also help by teaching you to manage stress more effectively.

Sleep hygiene 

Fatigue and insomnia are major problems for most people with fibromyalgia, and lack of sleep can make pain worse. Your doctor might prescribe medication to help you sleep, but you should also practice good sleep hygiene habits: That includes waking up and going to bed at the same time every day, limiting daytime naps, and giving yourself adequate time to wind down before bed.

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Keep Reading

Albrecht DS, et al. Brain glial activation in fibromyalgia – A multi-site positron emission tomography investigation. Brain, Behavior, and Immunity. January 2019. doi: https://doi.org/10.1016/j.bbi.2018.09.018.

Almansa C, et al. Noncardiac Chest Pain and Fibromyalgia. Medical Clinics of North America. March 2010. doi: https://doi.org/10.1016/j.mcna.2010.01.002.

An In-Depth Overview of Fibromyalgia. Hospital for Special Surgery. https://www.hss.edu/conditions_in-depth-overview-fibromyalgia.asp#Treatment.

Bäckryd E, et al. Evidence of both systemic inflammation and neuroinflammation in fibromyalgia patients, as assessed by a multiplex protein panel applied to the cerebrospinal fluid and to plasma. Journal of Pain Research. March 2017. doi: http://dx.doi.org/10.2147/JPR.S128508.

Cervical Spinal Stenosis. University of Michigan. https://www.uofmhealth.org/health-library/uh2003spec.

Costochondritis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/costochondritis/symptoms-causes/syc-20371175.

Diagnosis and differential diagnosis of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults. UpToDate. https://www.uptodate.com/contents/diagnosis-and-differential-diagnosis-of-axial-spondyloarthritis-ankylosing-spondylitis-and-nonradiographic-axial-spondyloarthritis-in-adults.

Fibromyalgia. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/fibromyalgia/diagnosis-treatment/drc-20354785.

Heart Inflammation. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/heart-inflammation.

How Does Depression Affect the Heart? American Heart Association. https://www.heart.org/en/healthy-living/healthy-lifestyle/mental-health-and-wellbeing/how-does-depression-affect-the-heart.

How lupus affects the heart and circulation. Lupus Foundation of America. https://www.lupus.org/resources/how-lupus-affects-the-heart-and-circulation.

Interview with Howard L. Feinberg, DO, professor of rheumatology at Touro University California College of Osteopathic Medicine

Interview with Rajat Bhatt, MD, rheumatologist in practice at Prime Rheumatology in Richmond, Texas

Lupus. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/lupus/symptoms-causes/syc-20365789.

Major causes of musculoskeletal chest pain in adults. UpToDate. https://www.uptodate.com/contents/major-causes-of-musculoskeletal-chest-pain-in-adults.

Warning Signs of a Heart Attack. American Heart Association. https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack.