Chest pain in patients with COPD: the fascia’s subtle silence

Abstract

COPD is a progressive condition that leads to a pathological degeneration of the respiratory system. It represents one of the most important causes of mortality and morbidity in the world, and it is characterized by the presence of many associated comorbidities. Recent studies emphasize the thoracic area as one of the areas of the body concerned by the presence of pain with percentages between 22% and 54% in patients with COPD. This article analyzes the possible causes of mediastinal pain, including those less frequently taken into consideration, which concern the role of the fascial system of the mediastinum. The latter can be a source of pain especially when a chronic pathology is altering the structure of the connective tissue. We conclude that to consider the fascia in daily clinical activity may improve the therapeutic approach toward the patient.

Lymphatic Pump Manipulation in Patients with Chronic Obstructive Pulmonary Disease

“…The movement of lymphatic fluid from the parietal pleura depends upon the active movement of the diaphragm and also the heartbeat. The parietal pleura is closely connected with the endothoracic fascia/adipose tissue of the mediastinal cavity, the fascia of which is attached to the epimysium of the deepest intercostal musculature and in a superior manner, to the diaphragm [7]. The endothoracic fascia is rich in lymphatic vessels which receive lymph from the intercostal nodes.…”

“…This technique aims to reduce the levels of pro-inflammatory substances, thus stimulating lymphatic drainage of the lungs. However, the literature relating to this technique is contradictory [7]. We do know that lymphatic flow is facilitated by the movement of the diaphragm and contraction of the heart, not only at the mediastinal level but also at the systemic level [8][9].…”

The Fascial Breath

“…C-fibres can activate the brain areas involved in emotional expression (insular cortex); the mechanical deformation to which a muscle is subjected stimulates these afferents, which reach the insula [10]. The fascia can influence health status, altering the mechanometabolic environment, causing clinical pictures of pain, inflammation and possible tumour formation [11][12][13][14][15][16][17]. A chronic deformation of the myofascial system causes the mechanoreceptors to turn into nociceptors, for example in the thoracolumbar fascia, simulating an idiopathic back pain syndrome [15].…”

“…The lateral pillars attach themselves to the twelfth rib with the epimysium and merge with the epimysium of the large psoas and quadratus lumborum muscle [26][27]. The muscular body of the diaphragm merges with the epimysium at the endothoracic costal fascia, which last covers the entire upper portion of the diaphragm [12]. The lower portion of the diaphragm is covered by the transversalis fascia, continuation of the endothoracic fascia [12].…”

“…The muscular body of the diaphragm merges with the epimysium at the endothoracic costal fascia, which last covers the entire upper portion of the diaphragm [12]. The lower portion of the diaphragm is covered by the transversalis fascia, continuation of the endothoracic fascia [12]. The posterior diaphragmatic area is covered by the thoracolumbar fascia [13,15].…”