What is the recommended treatment for costochondritis?

Management of Costochondritis

NSAIDs are the first-line treatment for costochondritis, with a recommended 1-2 week course at maximum tolerated dosage to reduce inflammation and pain. 1

Pharmacological Management

First-Line Treatment

• Oral NSAIDs (ibuprofen, naproxen) at maximum tolerated dosage for 1-2 weeks 1
  • Monitor for gastrointestinal, renal, and cardiovascular side effects, particularly in elderly patients or those with comorbidities
  • Long-term NSAID use should be avoided due to potential risks

Alternative Pharmacological Options

• Topical NSAIDs can be considered as an alternative with fewer systemic side effects 1
• Acetaminophen if NSAIDs are ineffective or contraindicated 1
• Small doses of non-acetylated salicylates if both NSAIDs and acetaminophen are ineffective 1

For Persistent Pain (2-4 weeks with insufficient response)

• Short course of oral corticosteroids as a bridging option 1
• Local corticosteroid injections for persistent pain unresponsive to other measures 1

Non-Pharmacological Interventions

Physical Measures

• Local heat or cold application 1
  • Heat: Apply heating pad for 15-20 minutes several times daily
  • Cold: Apply ice wrapped in a towel for 10-minute periods

Activity Modification

• Relative rest and reduced activity that aggravates pain 1
• Avoid activities that involve chest muscle overuse 1

Physical Therapy

• Stretching exercises have shown significant improvement in pain compared to conventional treatment alone 2
  • These can be particularly beneficial for patients with persistent symptoms

Manual Therapy Options

• For atypical or persistent costochondritis, consider referral for:
  • Manipulative therapy to address rib dysfunction 3
  • Instrument-assisted soft tissue mobilization to target myofascial pain generators 3

Monitoring and Follow-up

• Evaluate treatment response after 2-4 weeks 1
• Schedule follow-up in 2-4 weeks to assess response to therapy 1
• Consider further evaluation to rule out other causes of chest pain if symptoms persist beyond 4-6 weeks despite appropriate treatment 1

Important Considerations

• Costochondritis is typically self-limited but can become chronic in some cases 4
• In patients older than 35 years or with cardiac risk factors, rule out cardiac causes before confirming diagnosis 4
• Infectious costochondritis is rare but should be considered if there are signs of infection (swelling, purulent discharge) 5

Treatment Algorithm

1. Start with NSAIDs for 1-2 weeks
2. If ineffective, try topical NSAIDs or acetaminophen
3. For persistent symptoms (2-4 weeks), consider corticosteroids (oral or injection)
4. Incorporate stretching exercises and activity modification throughout treatment
5. For chronic cases, consider referral for manual therapy techniques