What is the treatment for costochondritis (inflammation of the cartilage that connects the ribs to the sternum)?

From the Guidelines

Treatment for costochondritis typically involves managing pain and inflammation until the condition resolves on its own, with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen being the first-line treatment. The goal is to reduce pain and inflammation, and NSAIDs are effective in achieving this, as seen in the management of similar conditions 1.

Key Treatment Components

• Over-the-counter NSAIDs such as ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily) for 1-2 weeks
• Rest and avoiding activities that worsen chest pain
• Applying heat or ice to the affected area for 15-20 minutes several times daily
• Gentle stretching exercises for the chest muscles, introduced gradually

Additional Considerations

For severe cases, a doctor might prescribe stronger pain medications or administer a local corticosteroid injection directly into the affected cartilage area. Physical therapy focusing on posture improvement and strengthening exercises can be beneficial for persistent cases. While the provided evidence does not directly address costochondritis treatment, the principles of managing pain and inflammation are applicable, as noted in guidelines for other conditions 1. Costochondritis occurs when the cartilage connecting the ribs to the breastbone becomes inflamed, often due to physical strain, repetitive movements, or respiratory infections. Most cases improve within a few weeks with conservative treatment, though some may take several months to resolve completely.

From the Research

Treatment Options for Costochondritis

• The goal of therapy for costochondritis is to reduce inflammation and pain 2
• Traditional treatment options include:
  • Acetaminophen or anti-inflammatory medications where safe and appropriate 3
  • Avoiding activities that produce chest muscle overuse 3
  • Providing reassurance 3
• Stretching exercises have been shown to be effective in reducing pain in patients with costochondritis, with a progressive significant amelioration in patients treated with stretching exercises compared to the control group (p<0.001) 2
• NSAIDs, local injection of anaesthetic or steroid have insufficient effectiveness in treating costochondritis 2
• Ultrasound-guided corticosteroid injection may be a useful treatment option for patients with Tietze syndrome combined with costochondral joint swelling, with one case report showing complete resolution of symptoms after three injections 4
• There is a lack of clinical trials on the treatment of costochondritis, and further research is needed in this area 5

Pharmacologic Therapy for Acute Pain

• Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain 6
• Topical NSAIDs are recommended for non-low back, musculoskeletal injuries 6
• Adjunctive medications may be added as appropriate for specific conditions if the recommended dose and schedule of first-line agents are inadequate 6
• Opioids may be necessary for short-term use in patients with severe acute pain, but their use should be minimized due to the risk of opioid use disorder 6