10. Thoracic pain

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+).