From the Guidelines
Managing costochondritis involves a multifaceted approach that prioritizes patient education, lifestyle modifications, and targeted interventions to alleviate symptoms and improve quality of life. The most recent and highest quality study, 1, published in 2025, emphasizes the importance of providing patient education and lifestyle recommendations throughout all treatment stages.
Key Recommendations
- Consider physiotherapy as a bridging management option to help manage discomfort and improve mobility, as suggested by 1.
- A dental examination may also be beneficial to rule out any underlying dental issues that could be contributing to the costochondritis, as implied by 1.
- Local glucocorticoid injections or short courses of oral prednisolone can be considered for persistent cases, as recommended by 1.
- Gentle stretching exercises for the chest muscles and deep breathing exercises can help mobilize the rib cage and provide relief, as supported by general medical knowledge.
Additional Considerations
- Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can be used to reduce inflammation and pain, as is common practice in managing musculoskeletal pain.
- Applying heat or ice to the affected area and resting to avoid activities that worsen chest pain are also important components of management, as they can help reduce discomfort and prevent further inflammation.
- If symptoms persist beyond 2-3 weeks or are severe, consulting a healthcare provider for further evaluation and potential prescription of stronger anti-inflammatory medications or muscle relaxants is crucial, as indicated by 1.
Prioritizing Morbidity, Mortality, and Quality of Life
The primary goal in managing costochondritis is to alleviate symptoms, improve quality of life, and prevent potential complications, while also considering the patient's overall health and well-being. By prioritizing patient education, lifestyle modifications, and targeted interventions, healthcare providers can help patients manage their symptoms effectively and improve their overall quality of life, as emphasized by 1.
From the Research
Management of Costochondritis
To manage costochondritis, several approaches can be considered:
- Medication: Traditional practice is to treat with acetaminophen or anti-inflammatory medications where safe and appropriate 2.
- Avoiding Activities: Advising patients to avoid activities that produce chest muscle overuse is also recommended 2.
- Reassurance: Providing reassurance is an important aspect of management, as costochondritis is usually self-limited and benign 2.
- Stretching Exercises: Stretching exercises have been shown to be effective in reducing pain in patients with costochondritis, with a significant amelioration in pain intensity compared to the control group 3.
- External Application of Herbal Medicines: The external application of certain herbal medicines, such as Rhizoma Corydalis and borneol, has been reported to relieve pain in a young collegiate athlete with chronic costochondritis 4.
- Oral Corticosteroids: For Tietze syndrome, a rare form of chest wall costochondritis with joint swelling, the addition of short-term oral corticosteroids has been shown to improve pain and quality of life compared to non-steroidal anti-inflammatory drug (NSAID) treatment only 5.
Diagnostic Considerations
When managing costochondritis, it is essential to distinguish it from other, more serious causes of chest pain, such as coronary artery disease 2. Diagnostic tests, including electrocardiograph and chest radiograph, may be necessary, especially in patients older than 35 years or those with a history or risk of coronary artery disease 2.
Treatment of Infectious Costochondritis
In cases of infectious costochondritis, treatment with antibiotics and debridement may be necessary, as seen in a case of infectious costochondritis with sternal osteomyelitis caused by Pseudomonas aeruginosa 6. Proper determination of the extent of debridement perioperatively is crucial for effective treatment.