Treating chronic chest pain with an everyday DC practice

Panic disorder is one of the more common types of anxiety disorders, affecting an estimated 6 million American adults, usually in early adulthood (often between the ages of 20 and 24).^1,2

It is twice as common in women than in men, with anywhere from 2 percent to 3 percent of adults reporting having had a panic attack within the previous year.

Many people think that anxiety only manifests as mental difficulties, such as thoughts of low self-esteem or worry. In fact, anxiety disorders can often also manifest as dizziness, sweating, feeling faint or lightheaded, rapidly elevated pulse, shortness of breath, and chronic chest pain.¹ This can be very frustrating not only for sufferers, but for their doctors, as such symptoms are also often associated with any number of cardiac or pulmonary disorders.

In fact, patients with anxiety disorders that manifest as symptoms of cardiopulmonary disease, such as chronic chest pain, may end up being subjected to treatments and medications that may have serious risks and adverse side effects. Of course, they also end up even more anxious because they have yet to get a definitive diagnosis, which only makes their symptoms that much worse.

Attempting to treat patients with physical symptoms in response to mental disorders can be very frustrating for DCs. On the one hand, you want to relieve those symptoms, yet at the same time, you also need to address their root psychological cause. In fact, chiropractic care can provide the best of both worlds for these patients. Not only can it relieve their physical symptoms, but it can do so without the risk of adverse side effects.

There has been research into the use of manual chiropractic adjustment to treat these symptoms, particularly chest pain due to panic disorder.³ However, there has been some interesting research into the effectiveness of instrument adjusting in such cases as well.⁴

Taking a thorough medical history

When doing an initial exam for a patient complaining of chronic pain, it is very important to rule out the possibility of any cardiopulmonary issues before doing any adjustments. Take a thorough medical history, including current and past medications, as well as a mental health screening to assess if there may be a history of any anxiety disorders. Include vitals such as blood pressure and pulse rate in your intake exam.

Instrument adjusting for chest pain

In a 2003 article in the Journal of Manipulative and Physiological Therapeutics, Polkinghorn and Colloca discussed the case of a male patient with chronic chest pain and shortness of breath as the result of ongoing panic disorder that had affected his employment and social life.⁴ Other attempts to treat his physical symptoms had been to no avail.

The patient underwent 14 weeks of instrument assisted chiropractic adjustments to both the thoracic spine and the costo-sternal articulations, in order to open up the space between the joints, which allowed the patient to be able to breathe more freely without chest pain. He reported being free from main immediately following the 14-week treatment session and at a nine-month follow-up session.

In this instance, the use of an adjustment instrument allows for getting into the small spaces around the costo-sternal articulations, which can be more difficult to access with a manual adjustment.

When your patients manifest physical symptoms in response to psychological issues, there’s no question that it is a frustrating ordeal, both for them and for you. The important thing is to focus first on relieving the physical symptoms. Once those have been relieved, you will often find that you have cleared the way to help your patients then address the underlying psychological causes for their distress.

References

1. Panic attack symptoms. Accessed 3/23/2017.
2. Frequently asked questions about panic disorder. Accessed 3/23/2017.
3. Haneline MT. Chest pain in chiropractic practice. Journal of Manipulative and Physiological Therapeutics. 2000 8:84-8.
4. Polkinghorn BS, Colloca CJ. Chiropractic management of chronic chest pain using mechanical force, manually assisted short-lever adjusting procedures. Journal of Manipulative and Physiological Therapeutics. 2003 Feb;26(2):108-115.