Control of Chest Pain

¹ The Medical Department of the Edgewater Hospital, Chicago, Illinois.

The review of the major group of the conditions causing pain which has just been presented illustrates one major point. While the elimination of the pain will depend on the removal or successful treatment of the pathology which has caused it, this pain is a symptom and as such can be safely treated regardless of what its origin may be. It is impossible to overemphasize the undesirability of narcotics or of chest immobilization in any case of bronchial or pulmonary pathology. The same contra-indication obviously exists in the absence of such pathology since it will be conducive to, if not directly responsible for initiating new disease. Successful treatment of chest pain can be accomplished without any such hazard. The procedures outlined which have been proved effective and safe are the injection of intercostal nerves, anaesthesia of trigger areas and the use of analgesic rubs. It is important to remember the hazard of intercostal injection, not from the drug used, but from the point of the needle, itself, and such injection employed only in suitable cases. In most cases, the anaesthetizing of the trigger area by the method of Trevell, using procain or ethyl chloride will cause immediate relief. Since this relief is relatively transient this procedure should always be followed by an application of the analgesic rub in the manner recommended. In a great many cases—in fact, in almost all of the cases falling into the category of muscle and bone injury, inflammation, pleuritis, or pain referred from inflammatory diseases, the symptom can be completely relieved by the proper application of a suitable analgesic rub following the application of heat. We have not found equal effectiveness in all substances tried. Some of the ointments which advertise their properties as mighty pain killers were found to be relatively ineffective. Much more work needs to be done to determine whether it is absorption of substances through the skin which produces the relief or whether it is some particular action on the nerve endings in the skin. No toxic effects or any other untoward reactions were observed in any of the patients who have been treated by this means during the past three years. There would seem to be no reason to fear any such complications and it appears that such an approach to the management of chest pain would eliminate rather than cause complications. It is a technique that is easily applicable and requires no special training in its use.

In this day when we are placing so much emphasis on silent pathology it would not seem necessary to issue an additional warning. Because of certain observed cases, I feel that this must be done. It is the warning that in relieving pain, it is only a symptom that has been removed. The ease of elimination of this symptom does not relieve the physician of the responsibility of following through the necessary steps for adequate diagnosis of underlying pathology. It is important that this be done regardless of the wishes of the patient who frequently believes that once he feels better nothing more is necessary. Cases of bronchogenic carcinoma, tuberculosis, and other types of chest pathology have been found in patients who submitted to x-ray and work-up only on the insistence of the physician, despite their own statement that they felt perfectly well and needed no additional treatment.