What is the treatment for costochondritis?

Treatment for Costochondritis

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

Pharmacological Management

First-Line Treatment

• Start with NSAIDs at the lowest effective dose for the shortest possible period to minimize risks 1
• Consider topical NSAIDs to minimize systemic side effects, particularly useful for localized pain 1
• Regular dosing of acetaminophen (paracetamol) may be used as an alternative or adjunct when NSAIDs are insufficient, contraindicated, or poorly tolerated 1

Second-Line Treatment

• If inadequate response after 2-4 weeks, consider switching to a different NSAID or adding acetaminophen 1
• For persistent focal areas of tenderness, consider local corticosteroid injections directed to the site of inflammation 1
• Short courses of oral prednisolone may be considered as a bridging option while awaiting the effect of other agents 1

Important Cautions

• Monitor for gastrointestinal, liver, and cardiorenal toxicity with prolonged NSAID use, particularly in elderly patients and those with comorbidities 1
• Avoid long-term use of systemic glucocorticoids due to potential adverse effects 1
• For patients with increased gastrointestinal risk, use non-selective NSAIDs plus a gastroprotective agent, or a selective COX-2 inhibitor 1

Non-Pharmacological Interventions

Physical Modalities

• Apply local heat or cold applications to the affected area for symptomatic relief 1
• Regular exercise and physical therapy should be considered as part of a comprehensive treatment plan 1
• Stretching exercises have shown promising results in reducing pain in costochondritis patients 2
• Manual therapy and soft tissue mobilization techniques may be beneficial, especially in cases that don't respond to conventional treatment 3, 4

Patient Education

• Provide education about the condition and reassurance about its typically benign and self-limiting nature 1, 5
• Advise patients to avoid activities that produce chest muscle overuse 5

Special Considerations

Atypical or Persistent Cases

• For costochondritis that doesn't resolve within the expected timeframe (typically several weeks), consider referral to physical therapy for impairment-based examination and treatment 4
• Physical therapy approaches including manual therapy to the cervicothoracic spine and ribcage, combined with therapeutic exercise, may facilitate resolution of persistent costochondritis 4

Differential Diagnosis

• Rule out more serious causes of chest pain, particularly in patients older than 35 years or those with risk factors for coronary artery disease 5
• Be aware that coronary artery disease can be present in 3-6% of adult patients with chest wall tenderness 5
• Infectious costochondritis is rare but should be considered in cases with purulent discharge, systemic symptoms, or failure to respond to standard treatment 6

Remember that while costochondritis is usually self-limited and benign, proper diagnosis and appropriate treatment can significantly reduce pain and improve quality of life for affected patients.