What patient education should be provided for a patient diagnosed with costochondritis?

Patient Education for Costochondritis

Patients with costochondritis should be educated that this is a benign, self-limiting condition causing chest wall pain that typically resolves within weeks to months with conservative treatment, but requires initial reassurance that serious cardiac causes have been ruled out. 1, 2

Understanding the Condition

What is costochondritis:

• An inflammation of the cartilage connecting your ribs to your breastbone (costochondral joints), accounting for approximately 42% of nontraumatic musculoskeletal chest wall pain 2
• The pain is typically sharp, stabbing, or pressing in nature, most commonly felt on the left side or behind the breastbone 1, 2
• Pain worsens with deep breathing, coughing, or physical activity and is reproducible when pressing on the affected rib joints 1, 2

Expected course:

• Most cases resolve within 1-2 weeks with appropriate treatment 1
• Some patients experience symptoms lasting more than 6 months (approximately 55% in reported series), which is considered atypical costochondritis 2, 3
• Symptoms often occur more than once daily in the majority of patients 2

Pain Management Strategies

Medication use:

• Take NSAIDs (like ibuprofen or naproxen) for 1-2 weeks as your first-line treatment 1, 2
• If you cannot take NSAIDs due to stomach problems, kidney disease, or other contraindications, use acetaminophen instead 1, 2
• If pain persists despite NSAIDs, your doctor may add low-dose colchicine 1, 2
• Topical lidocaine patches can be applied directly to the painful area for localized relief with minimal side effects 1, 2

Non-medication approaches:

• Apply ice packs or heat to the affected area for 15-20 minutes several times daily 1, 2
• Avoid activities that worsen your pain, particularly heavy lifting, pushing, or pulling motions 4
• Avoid repetitive movements and chest muscle overuse until symptoms improve 4

Activity Modification

What to avoid temporarily:

• Heavy lifting or carrying objects 4
• Repetitive upper body exercises or movements 4
• Activities that require forceful pushing or pulling 4
• Exercises that involve twisting the torso 5

Safe activities:

• Gentle stretching exercises as recommended by your healthcare provider 5
• Light walking and lower body exercises that don't stress the chest wall 5
• Gradual return to normal activities as pain improves 5

When to Seek Immediate Medical Attention

Critical warning signs that require emergency evaluation:

• New or worsening chest pain that feels like pressure, squeezing, or heaviness rather than sharp stabbing pain 2, 6
• Chest pain accompanied by shortness of breath, sweating, nausea, or pain radiating to the arm or jaw 2, 6
• Sudden severe chest pain with difficulty breathing 2, 6
• Fever, chills, or drainage from the chest wall (suggests possible infection) 7

Important caveat: Relief of your pain with nitroglycerin does not necessarily mean you have heart disease, as nitroglycerin can relieve both cardiac and non-cardiac chest pain 2

Follow-Up Care

When to contact your provider:

• Pain persists beyond 2-3 weeks despite treatment 2
• Pain progressively worsens rather than improves 2
• New symptoms develop, such as fever or skin changes 7
• You develop limitations in daily activities or work that persist beyond expected recovery time 5

Expected recovery timeline:

• Most patients experience significant improvement within 1-2 weeks of starting treatment 1
• Complete resolution typically occurs within several weeks to a few months 4, 3
• If symptoms persist beyond 6 months, reassessment is needed to rule out other causes 2, 3

Special Considerations

For patients with cardiac risk factors:

• If you are over 35 years old or have risk factors for heart disease (diabetes, high blood pressure, high cholesterol, smoking, family history), your provider needed to rule out cardiac causes before diagnosing costochondritis 2, 6
• The presence of reproducible chest wall tenderness does not completely exclude heart disease, as 3-6% of adults with chest wall tenderness also have coronary artery disease 4

For patients with chronic symptoms:

• Physical therapy focusing on the cervicothoracic spine and ribcage may be beneficial if symptoms persist beyond several months 5
• Manual therapy techniques and specific exercises can facilitate resolution in cases lasting 6 months or longer 5
• Consider evaluation for underlying inflammatory conditions if you have other joint symptoms, as anterior chest wall pain can be the first manifestation of axial spondyloarthritis in some patients 1, 2