What treats costochondritis?

Treatment of Costochondritis

For costochondritis, first-line treatment includes NSAIDs such as ibuprofen or naproxen, along with rest, ice application, and physical therapy focusing on stretching exercises. 1

Pharmacological Management

First-Line Treatments

• NSAIDs: The cornerstone of treatment for inflammatory costochondritis
  • Options include ibuprofen, naproxen, or other available NSAIDs
  • Typically used for 1-2 weeks for acute episodes 1
  • Monitor for gastrointestinal side effects, especially in older patients or those with comorbidities 1

Second-Line Treatments

• Topical NSAIDs: Can be applied directly to the affected area 3-4 times daily 2

  • Provides localized pain relief with fewer systemic effects
  • Particularly useful for patients who cannot tolerate oral NSAIDs

• Acetaminophen/Paracetamol: May be considered as an alternative when NSAIDs are contraindicated

  • Maximum dose of 3 grams daily in divided doses 2
  • Requires monitoring for hepatotoxicity with prolonged use

For Refractory Cases

• Corticosteroid injections: For persistent pain unresponsive to other treatments 1

  • Local injection into the costochondral junction
  • Should be used cautiously due to potential side effects including tissue atrophy

• Low-dose colchicine: May be considered in cases of recurrent or persistent inflammation 1

  • Not first-line therapy but can be effective in certain cases

Non-Pharmacological Management

Physical Interventions

• Rest and activity modification: Avoid activities that exacerbate symptoms 3

  • Temporary rest from aggravating activities (heavy lifting, intense exercise)
  • Gradual return to activities as symptoms improve

• Ice/cold packs: Apply to the affected area for 15-20 minutes several times daily 1

  • Particularly effective during acute flares
  • Can be alternated with heat for some patients

• Physical therapy: Shown to be highly effective in case studies 3

  • Stretching exercises targeting the chest wall and thoracic spine 4
  • Manual therapy techniques including soft tissue mobilization 5, 3
  • Postural correction exercises to address contributing factors

Supportive Measures

• Breathing exercises: Diaphragmatic breathing to reduce strain on the costal cartilages

  • Particularly helpful during recovery phase

• Posture correction: Address any contributing postural factors

  • Especially important for patients who spend long periods sitting

Treatment Algorithm

1. Acute phase (first 1-2 weeks):

   • NSAIDs (oral or topical)
   • Rest from aggravating activities
   • Ice application 3-4 times daily
   • Begin gentle stretching exercises

2. If symptoms persist beyond 2 weeks:

   • Continue NSAIDs if effective and tolerated
   • Initiate formal physical therapy with focus on manual techniques and stretching 3
   • Consider local corticosteroid injection for severe cases

3. For chronic cases (>3 months):

   • Comprehensive physical therapy program 3
   • Consider referral to pain specialist if symptoms remain refractory
   • Evaluate for other potential causes or contributing factors

Special Considerations

• Infectious costochondritis: Rare but requires antibiotic treatment and possibly surgical debridement 6

  • Look for signs of infection: fever, purulent discharge, significant swelling
  • Requires different management approach than non-infectious costochondritis

• Atypical costochondritis: May require more intensive physical therapy interventions 5

  • Manipulative therapy and instrument-assisted soft tissue mobilization have shown promise

Monitoring and Follow-up

• Reassess after 2-3 weeks of initial treatment
• If symptoms persist beyond 3 months despite appropriate treatment, consider additional diagnostic evaluation
• Most cases resolve within several weeks to months with appropriate management

Remember that costochondritis is typically self-limiting, but appropriate treatment can significantly reduce the duration and severity of symptoms.