eMedicine Specialties > Pediatrics: General Medicine > Rheumatology
Costochondritis: Treatment & Medication
Updated: Nov 8, 2007
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
- Reassure patients diagnosed with costochondritis that the cause of their chest pain is neither cardiac nor malignant in origin.
- Treatment involves conservative local care with judicious use of nonsteroidal anti-inflammatory drugs (NSAIDs) or analgesics, as necessary. Cough suppressants may be beneficial if cough is an aggravating factor.
- Liberal use of ice is recommended for 20-minute intervals.
- Advise relative rest for the patient's upper extremities and avoidance of possible precipitating or exacerbating activities.
Consultations
Occasional refractory cases may require consultation with the following specialists:
- Primary care sports medicine physician
- Rheumatologist
Activity
- Activity restrictions include relative rest. Instruct the patient to avoid activities that exacerbate symptoms. Collision or contact sports may be limited until the patient can perform activity-specific movements without pain.
- Applying ice after activity usually helps alleviate a significant amount of pain or discomfort.
- Resumption of aggravating activities prior to resolution may cause relapse.
Medication
NSAIDs provide analgesia for mild-to-moderate chest pain and may modulate the presumed inflammatory process. Purely analgesic drugs (eg, acetaminophen, tramadol hydrochloride) may suffice.
Nonsteroidal anti-inflammatory drugs
These provide analgesia and may play a role in controlling inflammation.
Ibuprofen (Motrin, Advil, Ibuprin)
Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Adult
400-800 mg PO q6-8h prn
Pediatric
5-10 mg/kg PO q6-8h prn
Avoid concomitant use of aspirin; may increase bleeding with anticoagulants, increase toxicity of methotrexate, and increase serum lithium levels; may decrease effects of furosemide or thiazide diuretics
Documented hypersensitivity, known hypersensitivity to aspirin or other NSAIDs; active GI bleeding, active ulcer
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
History of upper GI disease, peptic ulcer, gastric ulcer; impaired renal or hepatic function; edema, hypertension; bleeding disorder; diabetes; dehydration; pregnancy category D at third trimester
Naproxen (Aleve)
Available as OTC preparation and in prescription form; OTC preparation has faster onset of action, though limited duration of action. Prescription form is available in both pill and elixir forms and has a convenient bid-dosing schedule.
Adult
200-500 mg PO bid prn
Pediatric
<2 years: Not established
>2 years: 2.5-5 mg/kg PO q8-12h prn; not to exceed 20 mg/kg/d or 1 g/d
Avoid concomitant aspirin; may potentiate protein-bound drugs (eg, hydantoins, sulfonamides, sulfonylureas); monitor PO anticoagulants; may antagonize diuretics, beta-blockers, other antihypertensives; increased renal toxicity with ACE inhibitors; reduces methotrexate excretion; increases serum lithium levels
Documented hypersensitivity, known hypersensitivity to aspirin or other NSAIDs; active GI bleeding, active ulcer
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Active peptic ulcer; history of GI disease; impaired renal or hepatic function; heart failure; edema; hypertension; monitor blood, hepatic, renal, and ocular function with long-term use; pregnancy category D at third trimester
Analgesics
These may be used to relieve mild-to-moderate pain.
Acetaminophen (Tylenol)
May be used to relieve mild-to-moderate pain. Inhibits prostaglandin synthetase in the CNS by inhibiting cyclooxygenase.
Adult
650-1000 mg PO q6-8h prn; not to exceed 4 g/d
Pediatric
10-15 mg/kg PO q6-8h prn; not to exceed 2.6 g/d
Rifampin can interact to reduce analgesic effects; conversely, barbiturates, carbamazepine, hydantoins, isoniazid, may increase hepatotoxicity
Documented hypersensitivity; G-6-PD deficiency
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Hepatotoxicity reported with high or chronic dosing; severe or recurrent pain or high or continued fever may indicate a serious illness; contained in many OTC products and combined use with these products may result in cumulative doses exceeding recommended maximum dose
Tramadol hydrochloride (Ultram)
Inhibits ascending pain pathways, altering perception of and response to pain. Also inhibits reuptake of norepinephrine and serotonin.
Adult
Gradually titrate upward over 3 d to 50-100 mg PO q4-6h; not to exceed 400 mg/d
Pediatric
<16 years: Not recommended
>16 years: Administer as in adults
Do not use concomitantly with MAOIs; may potentiate seizure risk with use of MAOIs, SSRIs, tricyclics, neuroleptics, and opioids; use caution when administering with other depressants; may potentiate digoxin activity; may be potentiated with concomitant use of CYP2D6 inhibitors (eg, quinidine, fluoxetine, paroxetine, amitriptyline)
Documented hypersensitivity; acute intoxication with alcohol; hypnotics, analgesics, opioids, or psychotropic drugs dependence
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Initiate dose gradually to minimize nausea and vomiting; can cause dizziness, nausea, constipation, sweating, pruritus; additive sedation with alcohol and TCAs; abrupt discontinuation can precipitate opioid withdrawal symptoms; adjust dose in liver disease, myxedema, hypothyroidism, hypoadrenalism; pregnancy, breastfeeding; seizure; development of tolerance or dependency with extended use
More on Costochondritis |
| Overview: Costochondritis |
| Differential Diagnoses & Workup: Costochondritis |
 Treatment & Medication: Costochondritis |
| Follow-up: Costochondritis |
| References |
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References
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Further Reading
Keywords
chest wall syndrome, costochondral syndrome, costosternal chondrodynia, Tietze syndrome, chest pain, costal chondritis, costochondral joint, costochondritis, costochondral cartilage, crepitus
