From the Guidelines
Rib pain management should prioritize a multimodal approach, including rest, over-the-counter pain medications like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or NSAIDs like ibuprofen (400-600mg every 6-8 hours with food), and consideration of thoracic epidural and paravertebral blocks for severe pain, especially in elderly patients with rib fractures, as recommended by the 2023 WSES guidelines 1.
Causes of Rib Pain
Rib pain can result from various causes, including:
- Trauma (fractures, bruises)
- Inflammation (costochondritis)
- Muscle strain
- Underlying conditions like pleurisy or pneumonia
Management of Rib Pain
Management typically begins with:
- Rest
- Over-the-counter pain medications such as acetaminophen or NSAIDs like ibuprofen
- Applying ice for 15-20 minutes several times daily during the first 48 hours to reduce inflammation, then switching to heat therapy
- Gentle stretching and deep breathing exercises to maintain lung function and prevent complications
- Supporting the painful area with pillows and avoiding lying on the affected side for sleeping comfort
When to Seek Medical Attention
Seek medical attention if pain is:
- Severe
- Follows significant trauma
- Accompanied by difficulty breathing
- Accompanied by fever
- Persists beyond 1-2 weeks
Expected Recovery Time
Most rib pain improves within 3-6 weeks as the body's natural healing processes resolve the underlying issue, though rib fractures may take 6-8 weeks to heal completely.
Activities to Avoid
Avoid activities that worsen pain and gradually return to normal activities as symptoms improve, as suggested by the management guidelines for trauma patients 1.
From the Research
Rib Pain Causes
- Costochondritis: a self-limiting, poorly described, and benign condition that usually manifests as non-cardiac chest pain 2
- Stress fractures: can cause rib pain, especially in athletes or individuals with osteoporosis 3
- Slipping rib syndrome: a condition where the ribs slip out of place, causing pain and discomfort 3
- Chest wall muscle injuries: can cause rib pain, especially after trauma or overuse 3
- Fibromyalgia: a chronic condition that can cause widespread muscle pain, including rib pain 3
- Herpes zoster: a viral infection that can cause rib pain, especially if it affects the nerves that supply the ribs 3
Rib Pain Management
- Osteopathic manipulation techniques (OMT): can be useful in the treatment of rib dysfunction, especially in atypical costochondritis 2
- Instrument-assisted soft tissue mobilization (IASTM): can help address myofascial pain generators and improve rib mobility 2
- Stretching and exercises: can help improve rib mobility and reduce pain 3
- Manual therapy: can help diagnose and treat musculoskeletal causes of chest pain, including rib pain 3
- Pharmacologic management: can include pain medications, such as acetaminophen or ibuprofen, to help manage rib pain 4
- Epidural anesthesia: can be used to manage severe rib pain, especially in patients with multiple rib fractures 4
- Rib plating: a surgical procedure that can be used to stabilize and repair rib fractures 4
Diagnostic Imaging
- One-view chest radiograph: can provide sufficient information for the clinical management of ambulatory patients with rib pain 5
- Rib series: may not be necessary for all patients with rib pain, especially if a one-view chest radiograph is sufficient 5