Thoracic Pain

Maarten van Kleef*, Robert Jan Stolker, Arno Lataster, José W. Geurts, Honorio T. Benzon, Nagy Mekhail

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapter

1 Scopus citations

Abstract

Approximately 5% of the patients referred to outpatient pain clinics suffer thoracic pain. Thoracic pain in this article is limited to thoracic radicular pain and pain originating from the thoracic facet joints. Thoracic radicular pain is characterized by radiating pain in the localized area of a nervus intercostalis. The diagnosis of thoracic facet pain should be considered if the patient complains of paravertebral pain that is aggravated by prolonged standing, hyperextension, or rotation of the thoracic spinal column. Based on the analyses of the results in the literature combined with experience in pain management, symptoms, assessment, differential diagnosis, and treatment possibilities of thoracic radicular pain and thoracic facet pain are described and discussed. Conservative treatment consists of medications according to the World Health Organization pain ladder. Transcutaneous electrical nerve stimulation is an option. Physical therapy is usually applied in the form of manual therapy. Interventional treatment may be considered when conservative treatment fails. For thoracic radicular pain, the available evidence on efficacy and safety supports recommendation (2 C+) of pulsed radiofrequency treatment of the ganglion spinale (DRG). If this treatment has a short-lasting effect and the pain is segmental, then radiofrequency treatment of the ganglion spinale (DRG) can be performed. Recommendation (2 C+) is applicable. However, extensive skills are required to perform this procedure above the level of Th7. This treatment should take place in specialized centers. For thoracic facet pain, radiofrequency treatment of the ramus medialis of the thoracic rami dorsales is recommended (2 C+).

Original languageEnglish (US)
Title of host publicationEvidence-Based Interventional Pain Medicine
Subtitle of host publicationAccording to Clinical Diagnoses
PublisherWiley-Blackwell
Pages62-70
Number of pages9
ISBN (Print)9780470671306
DOIs
StatePublished - Nov 1 2011

Keywords

  • Evidence-based medicine
  • Pulsed radiofrequency
  • Radiofrequency treatment
  • Thoracic facet pain
  • Thoracic radicular pain

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    van Kleef, M., Jan Stolker, R., Lataster, A., Geurts, J. W., Benzon, H. T., & Mekhail, N. (2011). Thoracic Pain. In Evidence-Based Interventional Pain Medicine: According to Clinical Diagnoses (pp. 62-70). Wiley-Blackwell. https://doi.org/10.1002/9781119968375.ch10