<s>[INST] i have been having pain in the middle of my chest off and on for a few months now. over the past week or so i am having worse chest pains that last most of the day off and on. sometimes it is sharp pain today it is dull and achy and my back is sore too [/INST] Hello. Thank you for your question and welcome to Chat Doctor. I understand your concern. Well, I am going to try and explain the differences between various origins of the pain which can arise from the rib cage. There is angina. It is described more like mid-chest heaviness or squeezing sensation, that is triggered by exercise and relieved by rest, which radiates to the both sides of the chest, to the jaw and left arm and shoulder. It is indicative of a blockage within one or more coronary arteries and reflects the lowering of blood supply to the heart muscle. An EKG obtained in the moment of chest pain, if it fills this description, would be helpful. Then there is pleuritic chest pain. This kind of pain is sharp, stabbing pain that can happen in any part of the chest area. No radiation like in anginal pain. It arises from acute or chronic inflammation of the linings that are within the rib cage: pleura (lining of the lungs) or pericardium (lining of the heart) or both. In this regard, I would recommend a chest X-ray for pleural inflammation or effusion. In case of pericardial pain and anginal pain, echocardiogram is helpful, by evaluating the size, motility and function of heart muscle and valves, and also by assessing the pericardium and whether there is fluid build-up within it, or not. Other causes of chest pain are related to the locomotion system of the rib cage: muscle soreness, bone and cartilage-related pain. In the end, stress can also cause chest pain. I hope I was helpful with my answer. Best regards,  </s>