What are the treatment options for costochondritis?

From the Guidelines

Costochondritis treatment primarily involves managing pain and inflammation until the condition resolves on its own, with the most effective approach being the use of nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line treatment, as recommended for similar inflammatory conditions 1. The treatment options for costochondritis can be broken down into several key areas:

• Pain management: Over-the-counter NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily) for 1-2 weeks to reduce inflammation and pain, considering the potential gastrointestinal, liver, and cardiorenal toxicity risks 1.
• Adjunct non-pharmacological treatments: Applying heat or ice to the affected area for 15-20 minutes several times daily, rest, avoiding activities that worsen pain, gentle stretching exercises for the chest muscles, and considering other therapies like local heat or cold applications, and manipulation and stretching 1.
• Lifestyle modifications: Deep breathing exercises, good posture, and avoiding heavy lifting or chest movements to reduce strain on the chest wall.
• Severe cases: Prescription of stronger pain medications or administration of a local corticosteroid injection directly into the affected cartilage area by a doctor. It is essential to note that while costochondritis shares some similarities with other conditions like osteoarthritis, the primary approach to treatment remains focused on managing pain and inflammation, with NSAIDs being a cornerstone of treatment, as seen in the management of ankylosing spondylitis 1. If pain is severe, worsening, or accompanied by other concerning symptoms, seeking medical attention is crucial to rule out more serious conditions.

From the Research

Treatment Options for Costochondritis

• Conservative management, including manipulation and exercise prescription, may be beneficial in the treatment of benign costochondritis 2
• Traditional practice is to treat with acetaminophen or anti-inflammatory medications where safe and appropriate, advise patients to avoid activities that produce chest muscle overuse, and provide reassurance 3
• Impairment-based examination and treatment approach, including manual therapy and therapeutic exercise, may facilitate the resolution of costochondritis 4
• External application of herbal medicines, such as Rhizoma Corydalis and borneol, may be effective in relieving pain and improving range of motion in patients with costochondritis 5
• Stretching exercises have been shown to be effective in reducing pain and improving symptoms in patients with costochondritis, and may be a useful addition to traditional treatment 6

Non-Pharmacological Interventions

• Manual therapy, including high-velocity low-amplitude thrust manipulation, acupuncture, ischemic compression, and cross fibre friction massage techniques, may be beneficial in the treatment of costochondritis 2, 4
• Exercise prescription, including specific exercises to improve range of motion and strengthen the muscles of the chest wall, may be effective in reducing pain and improving function in patients with costochondritis 2, 4
• Cryotherapy may be used to reduce pain and inflammation in patients with costochondritis 2

Pharmacological Interventions

• Acetaminophen or anti-inflammatory medications may be used to reduce pain and inflammation in patients with costochondritis, where safe and appropriate 3
• Local injection of anaesthetic or steroid may be used to reduce pain and inflammation in patients with costochondritis, although the effectiveness of these treatments may be limited 6