<s>[INST] Hi, I have a friend who has what is believed to be a pulled chest or pectoral muscle. He went to the emergency room and they took an x-ray and basically rushed him out of the door due to his lack of insurance. His symptoms are extreme pain, with no bruising or swelling. It hurts when he lays down and even when he swallows. He was prescribed Ibuprofin 800 as well as a muscle relaxer but the pain does not let up. Is there anything else he can do? [/INST] Thanks for your question on Chat Doctor. I can understand your friends situation and problem. He is having chest pain on swallowing and lying down, and not improving with painkiller (ibuprofen) so possibility of HERD related pain is more. HERD is due to laxity of gastroesophageal sphincter. Because of this the acid of the stomach tends to come up in the esophagus and cause the symptoms. Lying down position makes reflux easier. So better to keep 2-3 pillows under head in the bed to prevent reflux. Ask him to avoid painkiller Chat Doctor.  Start proton pump inhibitors (antacid).  Ask him to avoid stress and tension, avoid hot and spicy food, avoid large meals, instead take frequent small meals. Ask him to quit smoking and alcohol if he has these habits. He will mostly improve with all these. If not improving than consult gastroenterologist and get done upper GI (gastrointestinal) copy. Hope I have solved your query. Wishing good health to your friend. Thanks. </s>