Pleurodynia is an infectious illness characterized by the sudden onset of severe, spasmodic pain in the muscles of the chest and upper abdomen. This condition is an acute inflammation of the striated muscles, specifically those between the ribs and the diaphragm. The intense, recurrent pain is the defining feature of this self-limiting disease. Historically, the condition has been referred to by names such as Bornholm disease, epidemic myalgia, or colloquially as “devil’s grip”.
Viral Origins of the Condition
Pleurodynia is caused by infection with an enterovirus, most commonly Coxsackievirus B. Other related viruses, such as Coxsackievirus A and certain echoviruses, can also cause the syndrome. These viruses target the skeletal muscle tissue, leading to the inflammation that causes the intense muscle aches.
Transmission occurs primarily through the fecal-oral route, but it can also spread via respiratory droplets. Direct contact with contaminated surfaces or objects can also facilitate the spread of the virus. Infections are highly contagious and tend to occur in clusters or small epidemics, particularly during the late summer and early fall in temperate climates.
Recognizing the Distinctive Symptoms
The hallmark symptom of pleurodynia is an excruciating, knife-like pain, typically localized to one side of the lower chest or upper abdominal wall. This pain is not constant; rather, it comes in intense spasms or waves that can last anywhere from 15 to 30 minutes at a time. Between these severe bouts, the affected area may feel persistently tender or experience a dull ache.
The pain is often aggravated by movements that engage the chest muscles, such as deep breathing, coughing, sneezing, or sudden turns. Patients may experience associated symptoms like sweating and a rapid heart rate during the spasms. Flu-like symptoms also accompany the muscle pain, including a fever, headache, malaise, and body aches.
In children, the pain is more frequently concentrated in the upper abdomen, where it can be so severe that it sometimes mimics an acute surgical condition like appendicitis. Involvement of the diaphragm muscle can lead to shallow breathing, as the body attempts to minimize the painful muscle contractions. The muscles may become noticeably swollen and tender to the touch.
Diagnosis and Exclusion of Other Issues
Diagnosis relies on clinical assessment, including reviewing the patient’s history and physical examination. A health care provider will look for the characteristic presentation of spasmodic chest or abdominal pain, especially if the illness occurs during a known local outbreak. Since there is no single, rapid test to confirm the viral infection, the main goal of the diagnostic process is to exclude other, more serious conditions.
A physician may order tests such as a chest X-ray or an electrocardiogram (ECG) to rule out cardiac events, pulmonary embolism, or bacterial pneumonia. Blood work may show an elevated serum creatine kinase level, a specific marker indicating injury to the striated muscles affected by the virus. The diagnosis is made by recognizing the classic clinical picture after ruling out life-threatening causes of acute pain.
Managing Pain and Recovery
Treatment for pleurodynia is supportive and generally self-limiting, as the illness is caused by a virus. The primary focus is managing the severe muscle pain until the body’s immune system clears the infection. Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, are typically recommended to help control the aches and fever.
Aspirin should not be given to children with pleurodynia due to the potential risk of Reye’s syndrome, a serious complication associated with certain viral illnesses. Applying heat or warm compresses to the painful areas of the chest or abdomen can help soothe the muscle spasms. The prognosis is favorable, with the intense symptoms usually subsiding completely within a week, although some cases may take up to three weeks to fully resolve.