Xiphodynia

Xiphodynia, also called xiphoidalgia, is pain that comes from the xiphoid process, the small tip at the bottom of the breastbone, or from the tissues attached to it. The pain can spread to the chest, upper abdomen, throat, arms and even the back (Simpson & Hawken, 2007; Noor et al., 2022). There are no reliable figures on how common it is; most authors describe it as uncommon.

Why chest pain has to be checked first

Xiphodynia can mimic cardiac chest pain and upper abdominal pain, and can come with nausea. It has been reported alongside angina, heart attack and pericarditis (Simpson & Hawken, 2007). In one case, a 52-year-old woman’s obvious xiphodynia delayed recognition of an impending heart attack, and the authors advised treating it as a diagnosis to consider only after dangerous conditions have been ruled out (Koren & Shahar, 1998).

Chest wall pain in general is common and usually benign. In a Swiss primary care study of 672 people with chest pain, 44.6% had chest wall syndrome; the outlook at a year was good, though it came back in half, and in 19 people it existed alongside coronary heart disease (Verdon et al., 2007).

How is xiphodynia recognised?

The diagnosis rests on reproducing the person’s symptoms, fully or partly, with moderate pressure on the xiphoid and the tissues around it (Simpson & Hawken, 2007). Reported triggers include a blow to the chest, sudden acceleration and deceleration injuries, unaccustomed heavy lifting and aerobics, although it often starts for no clear reason.

Desk work isn’t a known cause, but pressure on the area can provoke it in people who have it. One of the cases described was a student who had learnt to avoid sitting close to a table while studying, because pressure on her upper abdomen set off her pain (Simpson & Hawken, 2007). If a desk edge presses on the same spot for you, look at how close and how high you sit; see office chair setup. Another had pain felt between the shoulder blades; pain in that area has many more common causes, covered in pain between the shoulder blades.

What helps xiphodynia?

No trials have tested treatments, so what is known comes from case reports and reviews. Approaches described include reassurance, painkillers, heat or cold, injection of local anaesthetic and steroid, and, for severe pain that doesn’t settle, surgical removal of the xiphoid (Noor et al., 2022). Injections carry risks, including a punctured lung (pneumothorax) and infection, and there is no evidence yet on whether physical therapies help (Simpson & Hawken, 2007).

When to see a doctor

Call 999 if you have sudden chest pain or pressure that doesn’t go away, pain that spreads to your arms, neck, jaw, stomach or back, or chest pain with sweating, feeling sick, light-headedness or shortness of breath. See a GP if chest pain comes and goes, or goes quickly but you’re still worried (NHS). These are among the red flags that should never wait.