How do you manage moderate chest wall pain after breast radiation if imaging studies are normal?

Pain in the breast or chest wall due to RT-induced myositis or fibrosis is generally mild and responds to nonsteroidal anti-inflammatory agents and stretching exercises. However, one should first determine whether there is a cause of pain separate from RT effects. One of the common sources of such complaints is costochondritis. This may be exacerbated by RT. I have seen a few patients with very severe chest wall pain that was due to pectoralis muscle tears (diagnosed by chest wall MRI), but that is very unusual. Persistent and increasing pain can also represent recurrence in the ribs or soft tissue of the chest wall or breast, but again this is low on my differential. Many (if not most) patients worry this is the cause of their pain; fortun...

Moderate pain in the chest wall is not rare, but fortunately not that common either.

1. Understanding the character of the pain (e.g., pleuritic vs. not), history of trauma, and associated symptoms (e.g., shortness of breath).
   1. One always wants to worry about common things that are unrelated to the RT (e.g., pulmonary embolus with SOB and pleuritic pain), or angina. Cancer can increase the risk of DVT and PE.
2. I have seen a few cases of pleural pain (maybe 3), without SOB or cough, that I think were RT-induced pleural inflammation. I have used NSAIDs and pain meds, and that seemed to help-- or at least the pain subsided. I cannot think of a patient with chronic moderate/severe chest wall pain.
3. I have seen a few rib fractures. One I remember w...