Pleuritis is a pain in the chest which comes from inflammation of the pleurae, which are membranes that surround the lungs and chest wall. It is also known as pleurisy and pleuritic chest pain.
When people breathe, pleurae rub against each other and this is safe and natural. However, when the pleurae are inflamed or infected, they become swollen and they cause strong stabbing pain. The pain is usually sharp and acute, but in some cases it is more persistent.
Pleuritis used to be very dangerous and relatively common. However, antibiotics have made it less present and, when it does occur, far less dangerous. It remains a problem for people who can’t take anti-inflammatory and anti-infections medication and a painfully unpleasant condition for everyone.
What Are the Symptoms of Pleuritis
The pain is the most noticeable symptom and it is always present. It can cover one side of the chest and even spread to shoulders, head, joints and back.
However, there are other symptoms as well. These include fever, coughing, shortness of breath and even weight loss.
Many patients also experience buildup of fluid in the lungs. It increases pressure on the lungs and hampers their operation. This accumulation of fluid is called pleural effusion and in the beginning of its buildup it can actually relieve the pain, since it can reduce the friction between the pleurae. However, as the amount of fluid builds up, the patients have a much shortened breath, fever and cough.
What Are the Causes of Pleuritis?
Viral infection is the most common cause, but pleuritis can also come from lung cancer, pulmonary embolism, tuberculosis, bronchitis, any form of obstruction of the lymph channels, liver cirrhosis, spleen damage, gallbladder disease, lupus, rheumatoid arthritis, breast cancer, sarcoma, mesothelioma (the previous two are kinds of pleural tumors) pneumonia and various autoimmune disorders. It can also come after pancreatitis, asbestosis and various forms of chest trauma, including rib fractures and heart surgery.
Furthermore, bacteria, fungi and parasites can also cause pleuritis.
The cause of pleurisy can also be inhaled. Most often it is the case with cleaning chemicals such as ammonia.
Diagnosis of Pleuritis
The pain is the first hint for diagnosis as it is very distinctive. It is very sharp and it is worsened by breathing. The first step in diagnosis is examination of the chest using a stethoscope. This way the doctors can hear the rubbing of the pleurae while the patient breathes. In case there is water in the lungs, the rubbing sound is not as audible, but the chest then has a dull sound.
Blood tests can give information about the possibility of infection, its cause or some kind of immune system disorder.
Chest X-ray is used to assess if there is any fluid in the pleural space. The patient needs to stand or lie on the side during this examination. Ultrasound can also be used to detect chest fluid.
CT scan will be more efficient in discovering smaller amounts of fluid. It also helps assess the tissue.
If there is fluid, a part of it needs to be taken using a syringe. This is done in order to determine the cause of the condition, since analysis of the fluid gives the necessary information. The liquid can either be high in protein, LDH enzyme, white cells and low in sugar, or normal in these terms. The former kind is a sign of diseases such as pneumonia, cancer, lupus, rheumatoid arthritis and tuberculosis, while the latter is a sign of liver, kidneys and heart issues.
Treatment Options for Pleuritis
Pleurisy treatment at home is possible in case the condition is not severe and the underlying disease allows it.
Since pleuritis is painful, most patients take pain medication. However, for proper elimination of pleuritis, the underlying condition needs to be treated. Pain is also relieved by removing the fluid and it also does away with the shortness of breath.
If pleural space has pus, there are several options. The first option is done under local anesthesia and it involves a chest drainage tube. More severe cases which include more pus and adhesions require decortication. Decortication requires general anesthesia and includes removal of pus and scar tissue by thoracoscope. The highest level of difficulty requires thoracotomy – a surgical procedure.
Pleural effusion treatment for cases that stem from cancer usually involves a procedure called pleurodesis in order to prevent the reaccumulation of fluid. During this procedure an irritant is inserted in order to cause inflammation, which is supposed to remove the space between pleurae and in this way remove any possibility of reaccumulation.
NSAIDs are used for pain and inflammation. Only in the case when the doctors wish to create inflammation to fend off recurring accumulation of fluid in the pleural space are the inflammation drugs excluded.
However, NSAIDs come with a variety of side effects and their prolonged usage can cause tolerance development. This is why PEA is a better option.
It is a medical food consisted only of palmitoylethanolamide, an endogenous substance created by the body to help cells recover and relieve pain and inflammation.
Its pain-relieving properties come from inhibition of COX-2 an iNOS and its anti-inflammatory properties from its effects on the immune system cells, including neutrophils, macrophages, B cells, mast and glia cells and hematopoietic cells.
This means that PEA relieves both pain and inflammation in the safest way possible. It has no issues with overdosing, no side effects, no tolerance development and no negative interactions. It is incredibly efficient, but it does take a few days to show its benefits. However, this is resolved since you can take PEA together with NSAIDs until it builds up in the body and takes over the pain and inflammation management, because there are no negative interactions between NSAIDs and PEA.
Having in mind its amazing anti-inflammatory and pain-relieving properties, as well as its safety and completely natural mechanism of operation, PEA should be an indispensible part of pleuritis treatment.