What is the treatment for costochondritis?

Treatment of Costochondritis

The first-line treatment for costochondritis is a 1-2 week course of nonsteroidal anti-inflammatory drugs (NSAIDs), supplemented with local heat or cold applications as needed. 1

Pharmacological Management

• NSAIDs (e.g., ibuprofen, naproxen) are recommended as first-line therapy for 1-2 weeks to reduce inflammation and pain 1, 2
• Oral analgesics such as acetaminophen (paracetamol) can be used for pain relief, especially when NSAIDs are contraindicated 1
• Topical NSAIDs may be considered as an alternative to oral NSAIDs for patients concerned about systemic side effects 1
• For persistent symptoms with inflammatory features, low-dose colchicine may be added to the treatment regimen 1

Non-Pharmacological Approaches

• Local heat or cold applications provide symptomatic relief and should be used as adjunct therapy 1, 2
• Activity modification to avoid exacerbating movements while maintaining general physical activity is essential for recovery 1, 2
• Rest during acute painful episodes, followed by gradual return to activities as symptoms improve 1
• Stretching exercises have shown significant improvement in pain reduction compared to conventional treatment alone 3
• Manual therapy techniques including soft tissue mobilization and rib manipulation have demonstrated effectiveness in cases of atypical costochondritis that don't respond to conventional treatment 4, 5

Treatment Algorithm

1. Initial treatment (1-2 weeks):

   • NSAIDs at appropriate dosing (e.g., ibuprofen 400-600mg three times daily) 1, 2
   • Local heat or cold applications for symptomatic relief 1
   • Activity modification to avoid painful movements 1

2. For persistent symptoms (beyond 2 weeks):

   • Continue NSAIDs if effective and well-tolerated 1
   • Consider adding stretching exercises targeting the chest wall and thoracic spine 3
   • For pain management, consider acetaminophen if NSAIDs are insufficient or contraindicated 1

3. For refractory cases (beyond 4-6 weeks):

   • Consider referral to physical therapy for manual therapy techniques and targeted exercises 5
   • Physical therapy interventions including manual therapy to the cervicothoracic spine and ribcage have shown effectiveness in chronic cases 5

Important Considerations and Caveats

• Monitor for NSAID side effects, particularly gastrointestinal, renal, and cardiovascular effects with prolonged use 1
• Costochondritis is typically self-limiting but can persist for several weeks to months 2
• In patients older than 35 years or those with cardiac risk factors, cardiac causes of chest pain should be ruled out before confirming the diagnosis of costochondritis 2
• Infectious costochondritis is rare but should be considered in patients with fever, localized swelling, or purulent discharge 6

Special Populations

• In elderly patients or those with comorbidities, carefully weigh the risks and benefits of NSAIDs 1
• For patients with contraindications to NSAIDs, acetaminophen and physical therapy interventions should be prioritized 1
• In cases of atypical or persistent costochondritis (lasting more than 3 months), a multimodal approach including physical therapy has shown complete resolution of symptoms 4, 5