What can I do for persistent chest pain on my right side 5-6 weeks after an injury, given that I don't have broken ribs?

Management of Persistent Chest Wall Pain After Trauma Without Rib Fractures

For persistent chest wall pain 5-6 weeks after trauma without rib fractures, you should be treated with a 1-2 week course of NSAIDs as first-line therapy, with consideration for adding low-dose colchicine if symptoms persist, as this presentation is most consistent with costochondritis or musculoskeletal chest wall injury. 1

Understanding Your Condition

Your persistent pain at 5-6 weeks post-injury, despite no broken ribs, most likely represents:

• Costochondritis or musculoskeletal chest wall inflammation, which accounts for approximately 42% of all nontraumatic musculoskeletal chest wall pain and can persist for months after the initial injury 2, 1
• Soft tissue injury to the chest wall that may not be visible on standard imaging but causes ongoing inflammation and pain 3
• The pain is typically described as stinging or pressing, commonly retrosternal or left-sided, and often occurs more than once daily 1

Recommended Treatment Approach

First-Line Pharmacological Management

NSAIDs (Nonsteroidal Anti-Inflammatory Drugs):

• Take a 1-2 week course of NSAIDs for the inflammatory component of your chest wall pain 1
• These should be taken as standing doses (regularly scheduled) rather than as-needed for optimal anti-inflammatory effect 4
• If NSAIDs are contraindicated due to gastrointestinal issues, kidney problems, or cardiovascular risk, use acetaminophen as an alternative 1

Second-Line Options if Pain Persists

Low-dose colchicine:

• Should be added if symptoms persist despite NSAID therapy 1
• This targets the inflammatory process that may be maintaining your pain

Topical analgesics:

• Lidocaine patches applied directly to the painful area can provide localized pain relief with minimal systemic side effects 1
• These can be used in conjunction with oral medications

Non-Pharmacological Measures

Local application of heat or ice:

• Apply ice packs or heat to the affected area in conjunction with medication therapy 1
• Ice is typically more helpful in the first few weeks, while heat may be more beneficial for chronic pain

Important Considerations at 5-6 Weeks Post-Injury

Why your pain persists:

• Continuing nociceptive inputs from the initial injury can result in changes ranging from receptor function alterations to mood dysfunction, which means persistent pain can become a disease entity in its own right 5
• The transition from acute to persistent pain involves peripheral sensitization, central sensitization, and altered descending pain modulation 6, 7
• Acute pain that is inadequately treated may be an important contributing source of persistent pain 4

Red flags requiring immediate re-evaluation:

• If you develop new shortness of breath, fever, or worsening pain despite treatment, you need reassessment to rule out other potential causes such as pleural complications, pneumonia, or pneumothorax 1, 3
• If pain changes in character, becomes associated with exertion, or radiates to the arm or jaw, cardiac causes must be reconsidered 3

When to Consider Further Evaluation

If symptoms persist beyond 2-3 weeks of appropriate treatment:

• Reassessment is needed to rule out other potential causes of persistent pain 1
• Consider imaging with chest radiography as an initial test to evaluate for occult rib fractures, infection, or other conditions that may simulate chest wall pain 3
• Ultrasound can detect costochondral abnormalities not visible on radiographs with higher sensitivity than CT for detecting costochondral involvement 2

Differential diagnoses to consider if pain persists:

• Tietze syndrome: localized inflammation with visible swelling at the costochondral junction 2
• Slipping rib syndrome: pain associated with ribs subluxing from the joint, particularly affecting ribs 6 and 7 2, 1
• Occult rib fractures: may not have been visible on initial imaging but can be detected on follow-up radiographs or bone scintigraphy 3

Prognosis and Timeline

Expected recovery:

• Musculoskeletal chest wall pain can persist for more than 6 months in 55.4% of patients, so your 5-6 week timeline is within the expected range 1
• Long-term morbidity from chest wall injuries is well documented, with chronic pain, respiratory compromise, and reduced quality of life lasting up to 2 years post-injury 3
• Adequate pain control during the acute and subacute periods (which you are currently in) is critical to prevent the development of chronic pain 6, 7

The key is aggressive treatment now to prevent the transition to chronic pain, as the 5-6 week mark represents a critical window where pain can become self-perpetuating through neuroplastic changes 5, 6.