Transitory benign chest wall pain (TBCWP) is a common condition especially among children, adolescents or young adults. While TBCWP may be a symptom of heart disease, it is frequently benign and not related to a serious condition.

TBCWP is typically a sharp pain that occurs suddenly in the chest.  However, the pain does not come from the heart or other organs and does not pose any threat to a person’s life. Individuals who experience this kind of pain do not need medication or other forms of treatment. Instead, the individual and family members are urged to learn how such a painful and often alarming sensation is most likely a normal sensation and not the sign of a disease. Since TBWCP most commonly occurs in children and adolescents, it is important for adults to reassure the child that the pain is harmless and does not pose a threat to their well-being.

Transitory benign chest wall pain (TBCWP) is chest pain that occurs in the chest wall area, but is unrelated to any heart or lung condition. It is not actually a disease, nor is it dangerous. TBCWP is not life-threatening nor does it create any complications. It also does not create any reason to limit physical exercise or restrict activities.

TBCWP usually occurs in children, adolescents and young adults and can be unsettling. When experiencing this pain, children will frequently grab their chest and express fear about what they consider as “heart” pain. However, this particular type of pain does not come from the heart or lungs or other organs within the chest.

In many cases, TBCWP is thought to be related to a momentary irritation of the pleura, a membrane that covers the lung and lines the chest wall. The pleural membrane has two layers, with lubricating fluid between them. During lung expansion, the two pleural layers slide against each other painlessly. Any irritation of the pleural surfaces could cause them to rub together painfully for a few breaths until the situation corrects itself. Other possible explanations for TBCWP include a spasm of muscle in the chest wall that causes the pain. Overall, researchers agree that the condition is harmless.

TBCWP is relatively common. Researchers estimate that one-third to one-half of the healthy population has experienced TBCWP. Many normal, healthy individuals during childhood, adolescence and even adulthood feel a sharp chest pain from time to time that subsequently proves to be unrelated to any disease or abnormality.

However, patients or parents may wish to consult a physician if the chest pain has any of the following characteristics:

• Persists over fifteen minutes, particularly if it is accompanied by shortness of breath, weakness or lightheadedness
  
  
• Is unrelieved by rest or a change in position and spreads or radiates through the upper body to the arms, neck, shoulders or jaw
  
  
• Pressure or squeezing sensation that may be either constant or intermittent
  

Depending on the symptoms, a physician may order some diagnostic tests to rule out the presence of other conditions that affect the chest, heart and the blood vessels. These tests can include a chest x-ray, CT scan and echocardiogram

If there is a clinical suspicion of heart disease due to risk factors or the presence of EKG abnormalities, the physician may request a stress test to assess the presence of coronary artery disease.

The symptoms of transitory benign chest wall pain (TBCWP) are fairly characteristic, but only a physician can determine whether or not someone’s chest pain is serious. Even if someone has all the classic symptoms of TBCWP, a physician may still need to perform tests to determine whether or not the chest pain is serious 

Symptoms of TBCWP vary according to the person’s natural ability to withstand pain. In addition, the individual’s state of mind when the pain occurs (e.g., anxiety factors or fear of a heart condition), and personality can influence reaction to the TBCWP. Generally, the symptoms of TBCWP have the following characteristics:

• The pain occurs suddenly and is not related to exercise or a specific activity.
  
  
• The pain is sharp, often stabbing. Younger children may have difficulty accurately expressing the type or severity of the pain.
  
  
• The pain usually lasts only a few seconds or a minute, but can reappear for an hour or more, After the pain has passed, the individual is able to return to his or her normal activities.
  
  
• The pain may recur in a variety of ways, from daily to weekly. In some cases, it may not appear for months and the individual will forget about the occurrence.  
  
  
• The individual is able to identify a specific spot where the pain occurs in the chest. In many cases, it is in the same area each time.
  
  
• Individuals may describe the pain as a “catch” or “jolt” that prevents them from taking a deep breath. Also, breathing deeply may cause the sensation to become more severe.
  

Although a physician is the only one who can determine whether or not chest pain is serious, there are some signs and symptoms that indicate the condition may not be transitory benign chest wall pain (TBCWP). Another condition may be responsible if patients experience chest pain that:

• Consistently occurs with strenuous exercise.
  
  
• Always develops beneath the breastbone and is not localized to a specific, small area.
  
  
• Lasts longer than a few seconds or remains constant during the day.
  
  
• Is accompanied by weakness, fatigue or a faint feeling.
  
  
• Occurs in individuals with known heart disease or abnormal heart rhythm (arrhythmia).
  
  
• Is accompanied by tenderness and/or swelling in the chest area at the site of the pain.

Patients with chest pain associated with the above symptoms should consult a physician. These symptoms may be related to many conditions other than TBCWP.

If the physician has determined that the pain is not related to a serious condition, there are several methods that could help these individuals. First, when a bout of pain develops or recurs, it is not necessary that the person lie down or rest and individuals should not stay home from school or work. For the most part, it is better if the person continues with everyday chores and activities, including exercise and sports. This is particularly important for children, who take cues from adults on how to manage the pain.

Other suggestions for dealing with TBCWP include:

• Do not give aspirin or other pain reliever for the pain. Giving a drug to relieve the pain is unnecessary as the pain typically lasts only a short time.
  
  
• Do not inflate the importance of a generally harmless condition by asking about the pain or treating people like they are sick.
  
  
• Follow any recommendations provided by the patient’s physician. Do not contact the physician every time an event occurs unless advised to do so by the doctor.

If a child has been diagnosed with transitory benign chest wall pain (TBCWP), family members are generally encouraged to:

• Believe that the child’s pain is real. Although harmless, TBCWP is real and can sometimes cause a child to cry – partly from fear and partly from pain. Adults who have experienced this pain agree that it is not at all imaginary, but a definite sensation that occurs for no apparent reason. In rare instances, a young child may imitate someone they know who has chest pain. However, in general, this type of chest pain is not caused by psychological factors or an attempt to avoid school or work. A child who experiences TBCWP may be frustrated if told that the pain is only in the mind or made up to get out of some chore or school work.
  
  
• Explain to the child that that even though the pain is present, it is harmless. TBCWP occurs in many normal, healthy people and does not require medical attention. If the condition occurs, the child should understand that it will pass but may recur. No matter how often it recurs, it does not cause any medical problems and they should do their best to carry on normally.  The child will be relieved to hear this, especially if the pain has occurred several times and continually causes concerns.
  
  
• Listen to the child if he or she wants to express feelings about the pain. However, do not encourage the child to dwell on the condition. Continue to offer reassurances about its harmlessness.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients or parents may wish to ask their doctor the following questions related to transitory benign chest wall pain (TBCWP):

1. How do you know that the pain is from TBCWP and not a heart condition?
   
   
2. Are there any tests that can verify the cause of the pain?
   
   
3. Is there anything that could bring on TBCWP?
   
   
4. Should I see a specialist about this condition?
   
   
5. What can be done to reduce the events in my child?
   
   
6. Will TBCWP become less frequent as my child gets older?
   
   
7. If I experienced TBCWP as a child, does my child have a greater chance of developing the condition?
   
   
8. Can psychological counseling help reduce TBWCP?
   
   
9. How will I know if the pain events need medical attention?
   
   
10. What should I do if my child insists on receiving treatment?