From the Guidelines
Costochondritis treatment should primarily focus on pain relief and reducing inflammation, starting with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen for 1-2 weeks, as recommended by the most recent guidelines 1.
The treatment approach for costochondritis is largely based on managing symptoms, as the condition is often self-limiting. According to the American College of Radiology Appropriateness Criteria for nontraumatic chest wall pain 1, most cases of costochondritis can be readily diagnosed by physical examination without the need for diagnostic imaging.
Key aspects of treatment include:
- Using NSAIDs such as ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily with food) to reduce pain and inflammation 1.
- Applying heat or ice to the affected area for 15-20 minutes several times daily to help manage pain.
- Resting and avoiding activities that worsen symptoms, particularly those involving chest movement or pressure.
- Considering gentle stretching exercises for the chest muscles once acute pain subsides to improve mobility and reduce stiffness.
It's essential to monitor the patient's response to treatment and adjust the approach as needed. If pain persists beyond 2-3 weeks despite treatment, or if severe chest pain, shortness of breath, or fever occurs, prompt medical attention is necessary to rule out more serious conditions 1.
From the Research
Treatment Options for Costochondritis
- The traditional practice for treating costochondritis is to use acetaminophen or anti-inflammatory medications where safe and appropriate, advise patients to avoid activities that produce chest muscle overuse, and provide reassurance 2.
- A multimodal approach, including manipulative therapy, instrument-assisted soft tissue mobilization (IASTM), and stretching, can be effective in treating atypical costochondritis, as seen in a case report where a patient experienced complete resolution of symptoms after three appointments 3.
- Oral corticosteroids have been shown to be effective in improving pain and quality of life in patients with Tietze syndrome, a rare form of chest wall costochondritis with joint swelling, with significant benefits seen at 1,2, and 3 weeks, and maintained at mid-term follow-up after treatment cessation 4.
Non-Pharmacological Interventions
- Osteopathic manipulation techniques (OMT) can be useful in the treatment of rib dysfunction, especially in atypical costochondritis 3.
- Physical therapy (PT) techniques, such as instrument-assisted soft tissue mobilization (IASTM) and stretching, can help address potential myofascial pain generators and improve symptoms 3.
Pharmacological Interventions
- Acetaminophen or anti-inflammatory medications are commonly used to treat costochondritis, but clinical trials of treatment are lacking 2.
- Oral corticosteroids, such as prednisolone, have been shown to be effective in improving pain and quality of life in patients with Tietze syndrome, with a significant drop in mean NRS pain scores and improvement in QOL using the EQ-5D-5L scoring 4.