What is costochondritis?
Costochondritis is inflammation of the cartilage that connects a rib to the breastbone (sternum). This inflammation causes pain in the costosternal joints — the joints where your ribs meet your breastbone.
Costochondritis often causes chest pain that may be similar to the pain of a heart attack or other heart conditions. For some people, the pain of costochondritis may be due to an infection or injury — but often there’s no clear cause.
The pain typically worsens with deep breathing, coughing, sneezing or physical activity. The good news is that for most people, costochondritis goes away on its own within a few days to a few weeks. However, for some people it can last for months or even years and be quite painful. Treatment aims to relieve your pain, resolve the inflammation and prevent recurrence.
What causes costochondritis?
It’s not always clear what causes costochondritis, but it often results from:
– Injury, such as from exercise, lifting heavy objects or a motor vehicle accident. Violent coughing or even costochondritis flare-ups in the past might damage the costal cartilage.
– Joint inflammation. Rheumatoid arthritis or other types of arthritis can cause costochondritis. Ankylosing spondylitis can cause costochondral joint swelling.
– Infection. Bacterial and viral infections in bones and muscles sometimes precipitate costochondritis.
– Physical strain. Intense physical activities and sports that place excessive strain on your upper body — such as rowing, weightlifting and pole vaulting — can trigger costochondritis.
– Surgery. Any type of surgery or procedure that involves the chest wall can irritate or inflame the cartilage in your chest. Heart surgery involving the splitting of your breastbone (median sternotomy) is an example.
– Tumors. Noncancerous tumors (benign neoplasms) or cancerous tumors (malignant neoplasms) that occur in the chest wall can mimic costochondritis.
– Stress reactions. Episodes of severe stress and anxiety can cause muscle tension and chest wall pain that mimics costochondritis.
What are the symptoms of costochondritis?
The primary symptom is chest pain that might feel similar to the pain of a heart attack or angina. The pain of costochondritis is often described as:
– Sharp
– Aching
– Pressure-like
– Tender to touch
You might feel the discomfort of costochondritis in one spot or over a broader area — on the left side, right side or both sides of your sternum. The pain can range from mild to severe, and it tends to worsen with:
– Deep breathing
– Coughing
– Sneezing
– Physical activity
– Exertion
– Certain movements of your arms and upper body
For many people, the pain associated with costochondritis is fleeting. It comes and goes. For others, it’s constant. Costochondritis occurs more often in women than men. The pain also tends to be exacerbated during menstruation.
When to see a doctor
See your doctor if your chest pain:
– Is sudden, sharp and worsening
– Spreads to your arms, neck or jaw
– Is accompanied by shortness of breath, sweating, dizziness, fainting or palpitations
Chest pain can indicate a medical emergency such as a heart attack, angina, pulmonary embolism or aneurysm. Seek immediate medical care (call 911 or emergency medical services) if you experience any warning signs of a heart attack or stroke, which include:
– Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that spreads to your neck, jaw or back
– Nausea, indigestion, heartburn or abdominal pain
– Shortness of breath
– Cold sweat
– Fatigue
– Lightheadedness or sudden dizziness
Schedule a doctor’s appointment if your chest pain:
– Lasts more than a few days
– Worsens
– Spreads
– Keeps coming back after going away temporarily
– Interferes with your daily activities
– Causes concern
Make an appointment sooner if your pain is severe. Persistent chest pain with no clear cause warrants a visit to your doctor to determine the underlying reason, whether or not it’s related to your heart.
What are the best anti-inflammatory medications for costochondritis?
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first line of treatment for costochondritis. NSAIDs such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve) can help relieve the pain and inflammation of costochondritis.
Some of the most common and effective NSAIDs for costochondritis include:
Ibuprofen
Ibuprofen (Advil, Motrin IB, others) is one of the most popular NSAIDs for costochondritis and other inflammatory conditions. It can help reduce pain, swelling and inflammation.
Some key points about ibuprofen:
– Available over-the-counter in tablet, capsule and liquid form
– Typically dosed at 200-400 mg every 4-6 hours as needed
– Maximum daily dose is 3200 mg, do not exceed
– Works well for mild to moderate pain
– Helps reduce fever
– Causes fewer stomach issues than other NSAIDs
Overall, ibuprofen is very effective for costochondritis and it’s readily available without a prescription. It’s generally well tolerated if taken as directed.
Naproxen (Aleve)
Naproxen (Aleve, Naprosyn) is another common NSAID used for costochondritis inflammation and pain relief. Key points about naproxen include:
– Available over-the-counter as Aleve
– Prescription strengths available as Naprosyn
– Works for up to 12 hours with a single dose
– Anti-inflammatory and pain relieving effects
– Can cause stomach upset, ulcers and bleeding issues
Naproxen lasts longer than other NSAIDs between doses. One potential downside is it has more gastrointestinal side effects compared to ibuprofen. However, naproxen is very effective at reducing inflammation.
Diclofenac
Diclofenac (Voltaren, Cataflam) is a prescription NSAID that’s also effective for costochondritis and pain. Key points about diclofenac:
– Prescription NSAID, so not available over-the-counter
– Reduces pain, swelling and inflammation
– Increased risk of heart attack or stroke
– Can cause stomach bleeding and kidney problems
– Applied topically as a gel to avoid systemic side effects
Diclofenac is a potent NSAID, but it carries more risks compared to others. Using the topical gel minimizes systemic absorption. Diclofenac is not appropriate for people with heart disease or kidney impairment.
Aspirin
Aspirin is one of the oldest NSAID pain relievers. Key points about aspirin:
– Available over-the-counter as regular or extra strength
– Typically dosed at 325-650 mg every 4 hours as needed
– Thins the blood, so don’t combine with other blood thinners
– Can be hard on the stomach and cause bleeding issues
– Not appropriate for children or teens
Aspirin provides relief for mild costochondritis pain. However, other NSAIDs are likely safer and more effective options. Aspirin blood thinning effects might help prevent clotting issues like heart attack or stroke in some people, so occasional use can offer cardiovascular benefits.
Indomethacin
Indomethacin (Indocin) is a prescription anti-inflammatory medicine sometimes used for costochondritis pain that doesn’t respond to other treatments. Key points about indomethacin:
– Available only as a prescription medication
– Effective for pain and inflammation, but side effects common
– Can cause stomach ulcers, bleeding, kidney problems
– Not recommended for people with kidney impairment or GI issues
– Taken by mouth or used as rectal suppositories
Indomethacin is in the same NSAID drug class as the other medications, but it’s one of the most potent. It also has a high rate of side effects. Indomethacin may be helpful for severe or refractory costochondritis pain, but only when other options have failed.
Other medications
In addition to NSAIDs, other types of medications that might help relieve costochondritis pain include:
Acetaminophen
Acetaminophen (Tylenol) is often one of the first medications recommended for costochondritis pain. Key points include:
– Available over-the-counter
– Helps treat pain, but not inflammation
– Safer on stomach compared to NSAIDs
– Be sure not to exceed maximum daily dose
For mild cases of costochondritis, acetaminophen alone may be sufficient to control symptoms. It can also be combined with an NSAID for additive pain relief. It does not treat the inflammation component.
Narcotics
Prescription narcotic pain relievers are not typically used for costochondritis. However, they may be appropriate for severe unrelenting pain that doesn’t respond to other treatments. Examples include:
– Oxycodone (Oxycontin)
– Hydrocodone (Vicodin)
– Tramadol (Ultram)
Narcotics carry the risk of dependence and abuse. They are only used as a last resort for significant pain that impairs function and quality of life. Other pain medications, anti-inflammatories and alternative treatments should be tried first.
Muscle relaxants
Muscle spasms and chest wall tension can contribute to costochondritis pain. Muscle relaxant medications like cyclobenzaprine (Flexeril) or carisoprodol (Soma) may provide relief by reducing spasms and discomfort.
Steroid injections
For severe chronic costochondritis, steroid injections directly into the affected costosternal joints might reduce inflammation. However, research shows limited benefit and there are concerns about potential complications. Most doctors reserve injections only for very severe refractory cases.
Antidepressants
Certain antidepressant medications have properties that inhibit pain pathways in the central nervous system. Low doses of tricyclic antidepressants like amitriptyline are sometimes prescribed off-label to help relieve stubborn chronic pain conditions like costochondritis.
Lifestyle remedies and home treatments
In addition to medications, lifestyle remedies and home treatments that may help alleviate costochondritis pain and inflammation include:
– Apply cold or hot compresses to the sore area to relieve pain and swelling. Cold packs can ease acute flare up pain. Heat promotes blood flow and eases muscle tension. Alternate cold and heat for best results.
– Use an over-the-counter topical anti-inflammatory gel with an NSAID like diclofenac, ibuprofen or naproxen. Apply it directly to the painful costosternal joints 3-4 times per day. This targets the medication right where you need it.
– Take a break from exercise and strenuous physical activity that worsens your pain. Limit use of the affected area of your chest. Once the acute pain resolves, gradually resume activity.
– Improve your posture, especially if you have a sedentary job. Slouching and poor posture strain the chest.
– Use relaxation techniques to lower stress. Anxiety and tension can worsen chest wall pain. Try meditation, yoga, deep breathing, massage or listening to calming music.
– Quit smoking to ease coughing. Coughing exacerbates pain. Smoking impairs healing.
– Apply capsaicin cream to numb the pain receptors. Capsaicin is derived from chili peppers and offers temporary relief.
– Consider acupuncture treatments which may reduce chest wall pain. Acupuncture improves circulation and releases natural painkillers.
– Use a CBD pain relief cream containing cannabidiol, which has anti-inflammatory properties. However, research is still limited on the efficacy of CBD products.
– Wear comfortable, loose clothing that does not constrict the chest. Tight bras or tops can increase discomfort.
– Get enough rest. Fatigue and poor sleep quality can lower your pain threshold.
– Maintain a healthy weight. Excess weight puts added strain on the chest.
– Ensure proper posture during sleep. Sleeping in certain positions can aggravate pain. A cervical pillow aligns the neck and shoulders properly. Sleeping upright or propped up can also help.
When to see your doctor
In most cases, over-the-counter NSAID medication and home remedies can alleviate costochondritis flare ups. However, see your doctor if:
– Pain persists longer than 1-2 weeks
– Symptoms are severe or worsening
– Pain interferes with daily activities
– Breathing becomes difficult
– You have risk factors for heart or lung disease
– You experience fatigue, fever or other concerning symptoms
Seek prompt medical care if chest pain is sudden, sharp, or accompanied by shortness of breath, sweating, dizziness or pain radiating down the arms. These may indicate a possible heart attack, pulmonary embolism, pneumonia or other emergency.
Prevention
There’s no guaranteed way to prevent costochondritis, but you can reduce your risk by:
– Using proper lifting techniques and ergonomics at work
– Building up intensity and duration of exercise routines gradually
– Avoiding excessive straining and heavy lifting
– Maintaining good posture
Treating underlying conditions like arthritis or injuries can also help prevent flare ups of chest wall inflammation. Stopping smoking helps minimize coughing. Getting prompt care for respiratory infections prevents prolonged bouts of deep coughing.
Long term outlook and complications
For most people, rest and anti-inflammatory medication will resolve an episode of acute costochondritis within a few days to a few weeks. However, for some, costochondritis can become a chronic recurring problem lasting months or longer.
Potential complications of costochondritis include:
– Repeated long term use of NSAIDs can increase gastrointestinal bleeding risks or cause kidney impairment. Use the lowest effective dose.
– Ongoing flare ups can disrupt daily activities and quality of life. Chronic pain may lead to depression and disability.
– Severe bouts of violent coughing can actually cause the ribs to separate from the sternum. This creates a flail chest injury requiring emergency medical treatment.
– It’s important to rule out cardiac conditions that can resemble costochondritis. Seek prompt medical evaluation for any severe or persistent chest pain.
When to seek a specialist
If you have frequent recurrences of debilitating costochondritis that do not resolve with rest and medication, seeing a specialist may help determine any underlying condition contributing to your chest wall inflammation.
Types of doctors who treat costochondritis include:
– Primary care provider – Your regular doctor can prescribe anti-inflammatory meds and rule out cardiac causes.
– Rheumatologist – If autoimmune arthritis is the suspected trigger, a rheumatologist can provide specific treatments to reduce joint inflammation.
– Orthopedist – An orthopedic specialist can detect any subtle structural chest wall anomalies contributing to costochondritis susceptibility.
– Physical medicine and rehabilitation – These specialists address muscle spasms and poor posture aggravating costochondritis. They can provide tailored exercise routines to stabilize and strengthen the chest.
– Pain management – For chronic unremitting pain not controlled with other therapies, a pain specialist has access to interventional procedures and alternative treatments.
Talk to your doctor
The bottom line is that you should talk to your doctor if you have persistent soreness and pain in your chest wall. Costochondritis is often easily treated with rest, OTC medication, home remedies and lifestyle changes. But more evaluation is needed if symptoms are severe or keep recurring. Be sure to rule out any heart, lung or bone diseases causing chest wall inflammation. Together you and your doctor can find the appropriate treatment to relieve your costochondritis.