A very specific pain in pregnancy is making me crazy

November 1, 2012 2:16 PM

Any ideas what I can do for this chest wall pain during pregnancy?

Hello, yes yes, it's me the doctor, asking for medical advice! Well, I'm only an expert in emergencies, and this is clearly not an emergency. But it's driving me up the wall and interfering with my ability to do just about everything, so I'm asking you for help.

I'm 26 weeks pregnant (yay!) and otherwise healthy. I have been having chest wall pain for about the past 6 weeks. It is only on the right side of my chest, and it radiates from under the right breast around to my back. It's achy. Sometimes it's worse in the anterior chest and sometimes worse in the back. Initially, it was happening only on certain days, usually when I would wear certain bras and right around where the bra strap lies. Eventually, it started happening almost every day. I tried getting bra extenders, then I got fitted for fancy new bras at Nordstrom's (I went from a 34/36C to a 38D), then I started wearing the new bras with the extenders - I really cannot have the bra strap any looser than I'm wearing it or there would be no point in wearing a bra. Now I wear the new bras with the extenders every day, and I also try to lie down as much as possible because lying down is the only thing that makes it go away. When I am sitting up or standing, I often feel like I have to push in on my chest or back (i.e. "manual splinting") to try to help with the pain, but this is losing its effectiveness. Massage helps a lot but only for about 5-15 minutes and then it wears off.

To be clear, this is not because of the baby kicking me or anything - baby is not high up enough to reach my chest wall yet. The pain is constant and has no relation to breathing or eating or anything. The main baffling thing about it is that even though it has every characteristic of musculoskeletal pain, it's only on the right side. I asked my OB for ideas and her main one was 'try not wearing a bra'. I did try that and the pain is still appearing, plus it's a little rough to go braless with new D cups.

I am planning to start getting a little more liberal about the use of Tylenol, but I really don't want to be taking Tylenol all day every day for the next 3 months. At the same time, I want to work for most of the next 3 months (and am on the schedule at least until the beginning of January) and it's becoming difficult to work because of the pain. hellllp!

Is there something I could wear or do that might help more with this problem? I need to spend most of my life in the upright position!

posted by treehorn+bunny to Health & Fitness (24 answers total)

Best answer: I may be misunderstanding where your pain is, but is it costochondritis? I spent about 6 months with it thanks to reaching for something funny, and the only time I got any relief when upright was by wearing a very sturdy sports bra (so...monoboob, which might actually count as manual splinting). Possibly a foundation garment would help, something that pushes from underneath (and maybe stabilizes more firmly) rather than pulling from above?
posted by Lyn Never at 2:26 PM on November 1, 2012 [1 favorite]

Best answer: My best guess, not being a doctor, is that you have some kind of rib joint discomfort relating to relaxin somehow, like the ligaments supporting one of your ribs have loosened or something. If that's the case, I'd recommend seeing a physical therapist. My hips slipped when I was 13 weeks pregnant with my first, and my PT kept me able to walk, though not out of pain.
posted by KathrynT at 2:34 PM on November 1, 2012

Response by poster: Lyn, yes, it might be costochondritis. I was thinking about something like what I think a foundation garment is, but do you know anything more about where to find one or what sort I should look at?

tyr-r, yeah, it's definitely coming from the ribs and not the flank.
KT, physical therapist is an interesting idea. I will look into it. Thanks!
posted by treehorn+bunny at 2:39 PM on November 1, 2012

I had this pain pretty much from week26 to the end. I had to eventually stop wearing bras unless absolutely critical. It got progressively worse and I was worked up for everything-nothing was ever diagnosed. Propped in bed or in the bath were pretty much the only two positions that were not painful. Walking was better than sitting or standing. I am not sure what it was, but it was immediately better upon her delivery, so that is good. She was breech and did not move around- was breech from week 22-on, always with her head on my upper right, so maybe it was related to pressure from her head. in any case I ended up with severe pre-eclampsia and the doc didn't think they were related, so I hope that doesn't happen for you.
posted by sulaine at 2:42 PM on November 1, 2012

Also, have you tried wrapping your ribs with an ACE bandage to see if support will help?
posted by KathrynT at 2:43 PM on November 1, 2012 [1 favorite]

Best answer: A physiotherapist was very helpful for the pain that my partner had during pregnancy. Hers was also assymetrical, and was basically caused by bad lifting/sitting which wasn't an issue when she wasn't carrying a baby, but that had put her off balance. She only needed about three treatment sessions and some stretches before she started feeling better.
posted by smoke at 2:47 PM on November 1, 2012

There are pregnancy-approved licensed massage therapists, maybe that would help more than anything?
posted by emjaybee at 2:53 PM on November 1, 2012

If it's in the ribs, it makes me wonder if it's not gall stones.
posted by batmonkey at 2:57 PM on November 1, 2012

Chiming in to agree with physical therapy. I've been suffered from a muscle spasm type thing in my neck. I had pain meds, muscle relaxants and trigger point injections, but the thing that finally broke the spasm was several appointments with a physical therapist. Look for a practice that emphasizes manual therapy (basically massage on steroids) rather than just using the ultrasound/TENS type machines.
posted by SweetTeaAndABiscuit at 3:02 PM on November 1, 2012

Thirding a physical therapist as it sounds like referred pain to this (former) massage therapist. Hope you feel better soon!
posted by PorcineWithMe at 3:02 PM on November 1, 2012

I had something like this at a similar point in pregnancy which I think was rib flare, ie. the growing baby pushing the ribs out of position (also right side only, in my case). I got some relief by doing periodic stretches with the right arm over the head. It did get better in the third trimester, as well.
posted by gnimmel at 3:10 PM on November 1, 2012

I had pain like this (right side only) during pregnancy - it turned out it was my gall bladder.
posted by Daily Alice at 3:17 PM on November 1, 2012

Good ideas above. But also: do you carry your purse/briefcase on the right, or use your right side more when you drive? Those things made it worse for me in pregnancy.
posted by dpx.mfx at 3:18 PM on November 1, 2012 [1 favorite]

I had costochondritis when pregnant. Not wearing a bra helped a little, but basically it hurt every time I breathed until I had the baby and there were painkillers.

Aleve has been the most effective after pregnancy (can take a year for the costochondritis to heal) but I wasn't allowed that during pregnancy.

On the one hand that would be a good thing to have because it's totally harmless. On the other hand it's really painful and not very treatable. :(
posted by Eyebrows McGee at 3:23 PM on November 1, 2012

I had two episodes of costochondritis in my pregnancy, the first in the first trimester, brought on by all the throwing up, and the second in the last six weeks, brought by all the coughing from a nasty cold. For the second episode, the pain came on so strongly in the middle of the night that I actually paged my midwife and she advised me to head to the hospital! As the WebMD entry on costonchronditis mentions, checking for pain when putting pressure on the ribs seemed to be key in the costochronditis diagnosis with my doctors.

For me, both episodes started with an acute phase, where the pain was really intense and sharp and almost constant for 2-3 days, followed by 5-7 days of gradually lessening pain turning in to more general soreness.

I found some relief with a heating pad-- I tucked it up under the elastic of a nursing bra and slept that way.

Good luck-- hope you feel better soon!
posted by kittydelsol at 3:56 PM on November 1, 2012

Just realized I linked to the Mayo Clinic, not WebMD as I'd intended.
posted by kittydelsol at 4:12 PM on November 1, 2012

Response by poster: Perhaps I should reiterate - when I push on my ribs, the pain gets BETTER. In fact I spend most of the day pushing on my own ribs to relieve the pain. So, it's possible it could be costochondritis but I think it's unlikely. And that also makes it very unlikely to be my gallbladder.

My question is not "what is causing this pain?" exactly. I'm already confident that it's a benign musculoskeletal condition. My question is - how do I deal with it?

Thanks to those who have provided answers thus far!
posted by treehorn+bunny at 4:38 PM on November 1, 2012

Best answer: This sounds like what I had during pregnancy, including the feeling of relief from applying pressure to my ribs! It was painful and maddening. I got a referral to PT, because I had pain related to diastasis recti. I saw a physical therapist who was very experienced in treating pregnant women. She determined that not only did I have the diastasis, I also had a rib that she described as "stuck." It was subtle, but basically it didn't really fully move in concordance with the other ribs. PT helped quite a bit - she spent a lot of time manipulating/massaging (in a very gentle manner) the ribs to get it to move a little more easily. She also used athletic tape -- the fancy coloured tape that made such a splash at the London Olympics -- to support my ribs, but I don't think it helped as much as the massage. Floating in the tub also helped, but I think I should have gone for gentle swims in the pool, too.

My recommendation:
PT with someone experienced in pregnancy-related conditions
Massage
Floating/swimming
Maybe the tape? Get a fun colour.
posted by stowaway at 5:04 PM on November 1, 2012

I found that shiatsu massage made a huge difference with pregnancy caused sciatica - might help with this as well. This sort of thing is miserable - sorry you're going through it.
posted by leslies at 5:06 PM on November 1, 2012

Oh! I also got one of those pregnancy-support belts, but it exacerbated the diastasis pain so I didn't help me that much overall.
posted by stowaway at 5:07 PM on November 1, 2012

Here's a suggestion if pressure helps: you can make something to apply pressure for you by using "belting" from a fabric store. Sew velcro on it (really well, outline the velcro completely - nobody cares how it looks) such that you can wrap the belting around yourself and it applies pressure appropriately. If you have velcro connections in two locations per circumference, then you'll find you can add a little more pressure when you mate the second connection.

You can also put a rolled-up sock under the belting. For super bonus points, you could also put something warm in the sock.

Since you're wearing a larger-than-usual bra band, maybe constant pressure isn't what you want, but I thought I'd throw this out there just in case it helps.

I have no idea of the medical implications of this, so you might want to be careful not to apply too much pressure. You're a doctor, though, so whatever.
posted by amtho at 6:14 PM on November 1, 2012

I also suffer from costochondritis (it's actually surprisingly common in women in their 20s and 30s, even of the non-pregnant variety) and the only relief I've gotten is from Advil (ibuprofen), which was my doctor's suggestion. He also suggested taking it on a regular schedule, instead of just when needed for pain. Advil works better than Tylenol because costochondritis is a inflammation of the cartilage, and ibuprofen is an anti-inflammatory. I'm assuming you don't want to be taking Advil any more than you want to take Tylenol, but if you do go down that route i'd suggest choosing the Advil instead.
posted by cgg at 8:15 PM on November 1, 2012

I had something similar with pregnancy. What help for me was a foam roller. I would lay on my side with the foam roller under the side of my rib cage. Generally I could find the spot that hurt fairly quickly and I would hold the foam roller there until the spot didn't hurt as much. Cursing was sometimes involved. But once I was done it greatly reduced the pain (at least for a little while).
posted by statsgirl at 4:00 AM on November 2, 2012

Only thing that's helped me for costochondritis is lowering my stress load, stretching regularly (pulling chest apart by moving shoulder blades together), and naproxen when it hurts
posted by MangyCarface at 10:07 AM on November 2, 2012