From the Guidelines
To treat lower rib pain, prioritize rest, avoid activities that worsen the pain, and consider surgical stabilization of rib fractures (SSRF) if indicated, as it has been shown to improve outcomes in patients with severe chest wall injuries 1. When managing lower rib pain, it is essential to consider the underlying cause, as it can range from muscle strain to rib fractures.
- For mild cases, over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours with food) or acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) can be effective in reducing pain and inflammation.
- Applying ice for 15-20 minutes every 2-3 hours during the first 48-72 hours, then switching to heat therapy using a heating pad for 15-20 minutes several times daily, can also help alleviate pain.
- Gentle stretching and deep breathing exercises can help maintain mobility and prevent stiffness. However, for patients with severe chest wall injuries, including flail chest or multiple and displaced rib fractures, surgical stabilization of rib fractures (SSRF) should be considered as a treatment option, as it has been shown to reduce morbidity, mortality, and improve quality of life 1. In addition, thoracic epidural analgesia may be considered for patients with traumatic rib fractures, as it has been suggested to provide effective pain relief 1. It is crucial to seek medical attention if pain is severe or persists beyond 1-2 weeks, as it could indicate a rib fracture, costochondritis, or other conditions requiring specific treatment.
- Prescription muscle relaxants or stronger pain medications might be necessary in some cases, and IV opioids can be considered as the first-line drug class of choice to treat non-neuropathic pain in critically ill patients 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Carefully consider the potential benefits and risks of ibuprofen tablets and other treatment options before deciding to use ibuprofen tablets. Mild to moderate pain: 400 mg every 4 to 6 hours as necessary for relief of pain.
The treatment option for lower rib pain (costal margin pain) using ibuprofen is 400 mg every 4 to 6 hours as necessary for relief of pain.
- The dose can be adjusted based on individual patient needs and response to therapy.
- It is essential to use the lowest effective dose for the shortest duration consistent with individual patient treatment goals. 2
From the Research
Treatment Options for Lower Rib Pain
The treatment options for lower rib pain, also known as costal margin pain, can be divided into several categories, including:
- Pharmacologic approaches:
- Interventional approaches:
- Thoracic epidural steroid injections have been used to manage rib fracture pain, with promising results 3
- Regional anesthesia techniques, such as thoracic epidural analgesia (TEA) and paravertebral block (PVB), have been favored options in pain management for rib fractures 5
- Serratus anterior plane blocks (SAPB) and erector spinae blocks (ESPB) are practical alternatives to TEA or PVB, with lower incidences of adverse effects and similar levels of analgesia 5
- Nonpharmacological therapeutic interventions:
- Physiotherapy techniques, such as deep breathing exercises and chest physiotherapy, can help improve respiratory function and reduce pain 6, 7
- Acupuncture, transcutaneous electrical nerve stimulation (TENS), and noninvasive ventilation (NIV) modalities have been shown to be effective in reducing pain and improving respiratory function 7
- Multidisciplinary care pathways, which combine pharmacological and nonpharmacological interventions, are important management strategies and can reduce the risk of developing pneumonia 7
Considerations for Treatment
When choosing a treatment option, it is essential to consider the patient's individual case and the team's preferences 5. The goal of treatment is to control pain, prevent complications, and improve respiratory function. A multidisciplinary approach, which combines pharmacological and nonpharmacological interventions, may be the most effective way to manage lower rib pain.