What is the treatment for costochondritis?

Treatment of Costochondritis

For costochondritis, the recommended first-line treatment is a 1-2 week course of nonsteroidal anti-inflammatory drugs (NSAIDs), which can be supplemented with local heat or cold applications as needed. 1

Pharmacological Management

• NSAIDs are the mainstay of treatment for costochondritis due to their anti-inflammatory properties and should be used for 1-2 weeks as first-line therapy 1
• For patients with pleuritic chest pain or inflammatory costochondritis, a short course of NSAIDs is reasonable, with addition of low-dose colchicine as needed for persistent symptoms 1
• Oral analgesics such as paracetamol (acetaminophen) can be used for pain relief, especially if NSAIDs are contraindicated 1
• Topical NSAIDs may be considered as an alternative to oral NSAIDs, particularly for patients with concerns about systemic side effects 1

Non-Pharmacological Approaches

• Local heat or cold applications can provide symptomatic relief and should be considered as adjunct therapy 1
• Physical therapy interventions have shown benefit in case studies and may include:
  • Stretching exercises, which have demonstrated progressive significant improvement in pain compared to control groups 2
  • Manual therapy techniques including soft tissue mobilization, which has been associated with complete symptom resolution in some cases 3, 4
  • Manipulation of thoracic spine and ribs, which may be beneficial for addressing biomechanical dysfunction contributing to costochondritis 5, 4
• Activity modification to avoid exacerbating movements while maintaining general physical activity is recommended 1
• Rest during acute painful episodes, followed by gradual return to activities as symptoms improve 1

Treatment Algorithm

1. Initial Treatment (First 1-2 weeks):

   • NSAIDs (e.g., ibuprofen, naproxen) at appropriate dosing 1
   • Local heat or cold applications for symptomatic relief 1
   • Activity modification to avoid painful movements 1

2. For Persistent Symptoms (Beyond 2 weeks):

   • Consider adding low-dose colchicine if inflammation persists 1
   • Referral to physical therapy for stretching exercises, manual therapy, and soft tissue mobilization 4, 2
   • For pain management, consider oral analgesics if NSAIDs are insufficient or contraindicated 1

3. For Chronic or Recurrent Cases (Atypical Costochondritis):

   • Comprehensive physical therapy program including manipulation techniques and instrument-assisted soft tissue mobilization 3, 4
   • Targeted exercise prescription to address any biomechanical contributors 5, 4
   • Consider interdisciplinary management if symptoms persist 3

Important Considerations and Caveats

• Costochondritis is typically a self-limiting condition that resolves within weeks to months, but atypical cases may persist longer 3, 4
• Serious causes of chest pain (cardiac, pulmonary, infectious) must be ruled out before diagnosing and treating as costochondritis 3
• Infectious costochondritis is distinct from typical costochondritis and requires antibiotic treatment and possibly surgical debridement rather than NSAIDs 6
• Monitor for NSAID side effects, particularly gastrointestinal, renal, and cardiovascular effects with prolonged use 1
• Physical therapy interventions have shown promise in case studies but larger clinical trials are needed to establish definitive evidence 3, 4

Special Populations

• In elderly patients or those with comorbidities, carefully consider the risks and benefits of NSAIDs 1
• For patients with contraindications to NSAIDs, acetaminophen and physical therapy interventions should be prioritized 1
• In patients with prolonged symptoms (atypical costochondritis), a multimodal approach focusing on physical therapy has shown benefit 3, 4