What is the treatment for costochondritis?

Treatment for Costochondritis

For costochondritis, a short-term course of nonsteroidal anti-inflammatory drugs (NSAIDs) for 1-2 weeks is the first-line treatment, with the addition of low-dose colchicine as needed for persistent symptoms. 1

First-Line Pharmacological Treatment

• NSAIDs:

  • Initial treatment of choice for 1-2 weeks 1, 2
  • Options include ibuprofen (400-800 mg three times daily), naproxen (250-500 mg twice daily), or other available NSAIDs
  • Use the lowest effective dose for the shortest duration to minimize side effects

• Acetaminophen (Paracetamol):

  • Alternative for patients who cannot tolerate NSAIDs 2
  • Dosing: 1000 mg 3-4 times daily (maximum 4g/day) 3

Second-Line or Adjunctive Treatments

• Colchicine:

  • May be added to NSAIDs for persistent inflammatory symptoms 1
  • Low-dose regimen (0.5-1.0 mg daily)

• Topical Analgesics:

  • Topical NSAIDs can provide localized pain relief with fewer systemic effects 3
  • Apply to affected area 3-4 times daily

Non-Pharmacological Approaches

• Activity Modification:

  • Avoid activities that exacerbate symptoms 2
  • Rest from activities that involve chest muscle overuse

• Stretching Exercises:

  • Progressive stretching exercises have shown significant improvement in pain compared to conventional treatment alone 4
  • Focus on gentle stretching of chest wall muscles and improving thoracic mobility

• Manual Therapy:

  • Manipulative therapy and soft tissue mobilization may be beneficial for persistent cases 5
  • Instrument-assisted soft tissue mobilization has shown promise in atypical costochondritis

• Heat Application:

  • Local heat application can help reduce pain and muscle tension 4

Treatment Algorithm

1. Initial Presentation:

   • Rule out serious causes of chest pain (cardiac, pulmonary, etc.)
   • Confirm diagnosis through reproduction of pain with palpation of costochondral junctions

2. First 1-2 Weeks:

   • Start NSAIDs (if no contraindications)
   • Advise activity modification and rest
   • Apply local heat

3. If Inadequate Response After 2 Weeks:

   • Consider adding low-dose colchicine
   • Implement stretching exercises
   • Consider referral for manual therapy techniques

4. For Persistent Cases (>4-6 Weeks):

   • Re-evaluate diagnosis
   • Consider physical therapy referral for specialized manual techniques and exercise prescription
   • Evaluate for atypical costochondritis

Special Considerations

• Infectious Costochondritis:

  • Rare but requires different management with antibiotics and possible surgical debridement 6
  • Suspect if fever, purulent discharge, or systemic symptoms are present

• Elderly Patients or Those with Cardiovascular Risk Factors:

  • Cardiac causes must be ruled out before diagnosing costochondritis 2
  • ECG and possibly chest radiograph should be obtained in patients >35 years or with cardiovascular risk factors

Prognosis

Most cases of costochondritis are self-limiting and resolve within weeks to months with appropriate treatment. Atypical cases that persist beyond this timeframe may benefit from specialized physical therapy interventions 5.

The key to successful management is early appropriate treatment with anti-inflammatory medications, activity modification, and progressive introduction of stretching exercises as symptoms improve.