Chest wall pain: implications for musculoskeletal and respiratory health care

Chest pain remains one of the most common reasons for presentation to emergency and primary care departments. While life-threatening cardiopulmonary causes must be excluded as a priority, a substantial proportion of patients are ultimately classified as having non-cardiac or non-pulmonary chest pain, with musculoskeletal chest wall disorders representing a large subgroup of patients. This commentary examines the clinical positioning of musculoskeletal chest wall pain in contemporary healthcare systems. Epidemiological data indicate that patients discharged with non-cardiopulmonary chest pain often experience persistent symptoms, functional limitations, and psychological distress. However, coordinated follow-up pathways are often lacking. Simultaneously, thoracic spine and chest wall dysfunction influence breathing mechanics, load transfer, and pain perception, a bidirectional interaction with respiratory disease that is rarely integrated into post-rule-out care. We argue that a clearer integration of structured musculoskeletal assessment within post-rule-out care, alongside closer collaboration with respiratory and multidisciplinary services, may improve clinical coherence and patient outcomes in the future. However, the current evidence base remains limited, particularly regarding pragmatic trials, prognostic indicators, and the implementation of diagnostic and interventional models for the management of primary chest wall pain. To advance research in this field and support evidence-informed practice, it is necessary to ensure conceptual clarity, interdisciplinary dialogue, and methodologically robust research.