What is the initial treatment for costochondritis?

Initial Treatment for Costochondritis

The first-line treatment for costochondritis is nonsteroidal anti-inflammatory drugs (NSAIDs) at the maximum tolerated and approved dosage for 1-2 weeks to reduce inflammation and pain. 1

Pharmacological Management

First-Line Treatment

• NSAIDs:
  • Options include:
    • Ibuprofen (up to 1800 mg/day)
    • Naproxen (375-1100 mg/day)
    • Diclofenac (up to 150 mg/day)
    • Celecoxib (200-400 mg/day)
  • Duration: Initial trial of 1-2 weeks at maximum tolerated dosage 1
  • Monitor for gastrointestinal, renal, and cardiovascular side effects, particularly in elderly patients or those with comorbidities

Alternative Pharmacological Options

• Topical NSAIDs: Consider as an alternative with fewer systemic side effects 1
• Acetaminophen: Alternative if NSAIDs are contraindicated or ineffective 1
• Corticosteroids: A short course may be considered for severe cases not responding to NSAIDs after 2-4 weeks 1

Non-Pharmacological Management

Heat and Cold Therapy

• Local heat application: Using a heating pad for 15-20 minutes several times daily 1
• Cold therapy: Applying ice wrapped in a towel for 10-minute periods 1

Activity Modification

• Relative rest: Reduce activities that aggravate pain 1
• Avoid overuse: Particularly activities involving chest muscles 1

Physical Therapy Considerations

• Manual therapy techniques and soft tissue mobilization may be beneficial for persistent cases 2, 3
• Therapeutic exercises targeting the cervicothoracic spine and ribcage have shown positive outcomes in case studies 3

Treatment Evaluation and Follow-up

• Evaluate treatment response after 2-4 weeks to determine if modification of therapy is needed 1
• Schedule follow-up in 2-4 weeks to assess response to therapy 1
• Consider further evaluation if symptoms persist beyond 4-6 weeks despite appropriate treatment 1

Important Considerations

• Costochondritis is typically self-limiting, with most cases resolving within a few weeks to months 4
• Before diagnosing costochondritis, serious causes of chest pain should be ruled out, especially in patients over 35 years or those with cardiac risk factors 4
• Coronary artery disease can coexist in 3-6% of adult patients with chest wall tenderness 4
• Persistent or "atypical" costochondritis may benefit from referral to physical therapy if initial treatments are ineffective 2, 3

Remember that while costochondritis is typically benign, it's important to ensure serious conditions have been excluded before proceeding with symptomatic management, particularly in older adults or those with cardiac risk factors.