Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Angina and Other Chest Pain


You may feel worried if you have chest pain, whether it happens just once, or often. Chest pain can range from mild and harmless to severe and life-threatening, depending on its cause. For example, mild chest pain can be caused by indigestion. 

If you have a type of chest pain called angina, your heart isn’t getting enough blood flow and oxygen. Most angina is caused by coronary artery disease (CAD). If coronary arteries become completely blocked, a heart attack can occur. 

For men, angina usually feels like pressure or squeezing in the chest. For women, the pain may feel stabbing or pulsating. 

Usually, angina isn’t a health emergency. The pain often goes away when you rest. Treatment and lifestyle changes can reduce your symptoms and protect your heart’s health.

Call 911 immediately or get someone to take you to the nearest hospital if you have severe, intense chest pain, or chest pain with these symptoms:

  • Headache
  • Nausea or vomiting
  • Difficulty breathing
  • Lightheadedness (feeling faint) 

Learning about chest pain can help you take care of yourself or a loved one. Be sure to check with your doctor if you have chest pain or risks for heart disease.


Many different health problems can cause chest pain. 

Coronary artery disease (CAD) is the main cause of angina, one type of chest pain. Plaques (cholesterol and calcium deposits) can build up in your heart’s blood vessels. Blocked arteries prevent blood flow and oxygen from getting to the heart. 

Less commonly, angina can be caused by coronary artery spasm, in which the artery suddenly contracts.

Chest pain can be a symptom of an illness or condition that isn’t an emergency, but still needs medical care. You may have one of these conditions:

  • Pneumonia
  • Blood clot in the lungs (pulmonary embolism)
  • Collapsed lung
  • Asthma
  • Panic or anxiety attack
  • Acid reflux problems, such as GERD or heartburn
  • Gallbladder or pancreas disease

Injury of the chest muscles or cartilage can also cause chest pain. 

Milder chest pain can be caused by something temporary and harmless, such as indigestion. 


If your chest pain is caused by CAD or other heart problems, you may also have:

  • Shortness of breath
  • Radiating pain from the chest into the left arm or the jaw
  • Worsening pain during exercise or other exertion
  • Nausea or vomiting
  • Fainting
  • Extreme sweating

For women, sensations in the chest can feel like stabbing or pulsing. Men often feel pressure or squeezing sensations.

Call 911 immediately or have someone take you to the nearest hospital if you have severe chest pain, or chest pain and these symptoms:

  • Headache 
  • Nausea
  • Difficulty breathing
  • Lightheadedness (feeling faint)

Do not drive yourself to the hospital. You could endanger yourself or those around you. 

Risk Factors

These are the main risk factors for heart-related chest pain:

  • High cholesterol
  • High blood pressure (hypertension) 
  • Smoking 
  • Obesity or overweight 
  • Diabetes or insulin resistance 
  • Congestive heart failure
  • Family history of coronary artery disease

We’ll talk with you about these factors and may test you for specific risks. 

An inactive lifestyle, with too much sitting and too little exercise, can cause some risk factors or make them worse.


We will ask you:

  • To describe your chest pain and other symptoms. 
  • About your family history.

We’ll give you a physical exam and may recommend tests.

If you have severe chest pain, you may need to be assessed and treated in the Emergency Room. 


We may recommend one or more of these tests, to help us pinpoint what’s causing your chest pain. 

Electrocardiogram (ECG/EKG) checks your heart’s electrical activity. 

Echocardiogram uses sound waves to produce an image of your heart muscle. It may reveal heart problems or tissue damage.

Blood tests check for increased levels of enzymes that indicate a heart attack.

Exercise stress test, myocardial perfusion imaging, or stress echocardiography measures how well your heart works under physical stress. 

CT scan or MRI imaging tests of the chest and heart area may reveal cardiac problems. 

Chest X-rays can reveal heart or lung problems.

Endoscopy produces images of your stomach and esophagus. They may reveal problems such as gastroesophageal reflux disorder (GERD). 


We will treat the condition or problem that’s causing your chest pain. 

If you have angina due to CAD, we may prescribe one or a combination of these medications. 

Nitrates improve blood flow by relaxing the blood vessels. We usually prescribe nitroglycerin to treat angina.

Beta blockers lower heart rate and blood pressure. This reduces the heart’s workload and can help prevent sudden death. Beta blockers include metoprolol (Lopressor, Toprol XL) and atenolol (Tenormin).

Calcium channel blockers relax the blood vessels, lower blood pressure, and improve blood flow to the heart. These drugs include: amlodipine (Norvasc), nifedipine (Procardia), and diltiazem (Cardizem).

Statins help lower cholesterol and fight CAD. Medications include simvastatin (Zocor), atorvastatin (Lipitor), and lovastatin (Mevacor).

Aspirin helps prevent blood clots and reduce heart attack risk.

Angiotensin-converting enzyme (ACE) inhibitors reduce the production of angiotensin, which causes blood vessels to contract and raises blood pressure. ACE inhibitors include lisinopril (Prinivil) and captopril (Capoten).

If your chest pain is caused by:

  • Pneumonia, we’ll prescribe antibiotics and pain medication.  
  • Asthma and coughing, we may recommend asthma or antiallergy medications.

Other Treatments

If your heart problem is severe, we may recommend blood thinners given intravenously (IV). Or you may need one of these procedures, or surgery.

Cardiac catheterization or angiogram. We use this procedure to check for coronary artery blockages. We will:

  • Insert a long, thin tube (catheter) into an artery, usually in the upper thigh. 
  • Inject a contrast solution (iodine) into the heart arteries.
  • Use imaging to look for blockages.

Coronary angioplasty (also called percutaneous coronary intervention, or PCI). We use this to widen a narrow artery and improve blood flow to the heart. We will:

  • Insert a long, thin tube (catheter) into an artery, usually in the upper thigh.
  • Guide the catheter, which carries a small balloon, into your narrowed coronary artery.
  • Expand the balloon within the artery to widen it.

Usually, we also place a small wire-mesh tube (stent) in the artery to keep it open. This is called coronary artery stenting.

Coronary artery bypass graft (CABG) surgery. If other angina treatments haven’t worked for you, we may consider this surgery. We create a new pathway (bypass) for blood to flow around the narrow or blocked part of an artery. We will:

  • Take a healthier blood vessel from another part of the body.
  • Attach (graft) the healthy vessel onto the artery. 

Lifestyle Recommendations

If you have frequent chest pain, see your doctor regularly for checkups, regardless of the cause of your pain. Also, always take your medications as prescribed.

If you have angina or other heart-related chest pain, your doctor and care team will help you make a heart-healthy living plan. We can connect you with health coaches, classes, and other resources.

Your plan will include these keys to heart health.

Exercise and keep active. Walking is the best exercise. Avoid intense exercise or physical work. Ask for help with home tasks like carrying boxes or yard work. 

Maintain a healthy weight. Lose weight, if needed.

Eat healthily and enjoy your food. Include fresh fruits and vegetables, whole grains, legumes, and lean meats. You can also use these tips:

  • Avoid high-fat and fried foods. 
  • Eat enough to feel satisfied, but don’t overeat. 
  • Take a brief rest after each meal.

Keep your blood sugar within your normal range, if you have diabetes or insulin resistance. 

Quit smoking or don’t start. This includes smoking tobacco or marijuana. Let us know if you want help with quitting.

Practice relaxation and stress reduction methods, such as mindfulness meditation.

Get treatment for depression or anxiety, if needed.

Related Health Tools:

Classes and Coaching
Interactive Programs
Prepare for Your Procedure

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.