What is the treatment for costochondritis?

Treatment for Costochondritis

The first-line treatment for costochondritis is NSAIDs at the maximum tolerated and approved dosage, with evaluation of treatment response after 2-4 weeks. 1

Pharmacological Management

• NSAIDs should be used at the lowest effective dose for the shortest possible period, considering the patient's risk factors for gastrointestinal, liver, and cardiorenal toxicity 1
• Acetaminophen (paracetamol) can be used as an alternative or adjunct for pain relief, especially when NSAIDs are contraindicated 1
• Topical NSAIDs should be considered before oral NSAIDs to minimize systemic side effects 1
• Short courses of oral prednisolone or intra-articular glucocorticoid injections may be considered as bridging options while awaiting the effect of other agents 1
• Long-term use of glucocorticoids should be avoided due to potential adverse effects 1

Non-Pharmacological Interventions

• Local heat or cold applications to the affected area can provide symptomatic relief 1, 2
• Patient education about the condition and its typically self-limiting nature is essential 1, 3
• Stretching exercises have shown significant improvement in pain reduction compared to control groups 4
• Manual therapy techniques including rib manipulation and soft tissue mobilization have demonstrated complete resolution of symptoms in cases of atypical costochondritis 5
• Physical therapy utilizing an impairment-based approach that includes manual therapy and therapeutic exercise may facilitate resolution of costochondritis 6
• Patients should avoid activities that produce chest muscle overuse 3

Treatment Algorithm

1. Initial Management:

   • Start with NSAIDs at maximum tolerated dose 1
   • Apply local heat or cold applications 2, 1
   • Advise rest from aggravating activities 3

2. If inadequate response after 2-4 weeks:

   • Consider adding acetaminophen 1
   • Refer for physical therapy with focus on stretching exercises and manual therapy 6, 4
   • Consider short-course glucocorticoids as a bridging treatment 1

3. For persistent cases (atypical costochondritis):

   • Implement multimodal physical therapy including manipulative therapy, instrument-assisted soft tissue mobilization, and stretching 5, 6

Important Considerations

• Costochondritis is usually self-limited and benign, but it's essential to rule out more serious causes of chest pain, particularly in patients over 35 or those with cardiac risk factors 3
• Monitor for adverse effects with prolonged NSAID use, particularly in elderly patients and those with comorbidities 1
• Infectious costochondritis, though rare, requires different management including antibiotics and possibly surgical debridement 7
• While costochondritis typically resolves in weeks to months, some cases can become persistent (atypical costochondritis), requiring more intensive physical therapy interventions 5, 6