The commonest causes of chest pain in general practice are musculoskeletal (chest wall and spine) pains and psychogenic chest pain, often inter-linked.
Strains of the intercostal, pectoral, back and shoulder muscles are extremely common but may worry patients unduly, especially if not immediately associated with a remembered injury. Overuse strains may not become painful for 24-48 hours. Sharp, short-lasting pains may be caused by spasms in these muscles at times when unexpected similar to to the way leg cramps occur when the muscle is not in use.
Pain and tightness in the chest also occur due to tension as with headache and so good history-taking is essential to reveal anxiety, stress and depression which may be the cause. When this can be confidently diagnosed, the patient can be saved from unnecessary investigations or even an unwarranted emergency admission.
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