Costochondritis
Costochondritis is treated with symptomatic management, including analgesia, rest, and reassurance, after exclusion of serious cardiopulmonary and infectious causes of chest pain. [1] Most patients improve with conservative therapy over days to weeks. [2]
Diagnostic Exclusion Before Symptomatic Treatment
Chest pain should be assessed for coronary artery disease, infection, and other serious conditions before costochondritis is treated as the primary diagnosis. [1] Electrocardiography and chest radiography are recommended when costochondritis is suspected and the patient is older than 35 years or when there are signs or symptoms concerning for coronary artery disease or infection or other serious conditions. [1]
First-Line Symptomatic Management
Analgesia is recommended using nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen for pain control. [1] Rest and reassurance are recommended as core components of initial therapy. [1]
Medication Selection
NSAID therapy is recommended for pain relief in costochondritis. [1] Acetaminophen is an alternative for analgesia when NSAIDs are not appropriate. [2]
Nonpharmacologic Treatment
Rest is recommended to reduce mechanical irritation of the costosternal joints. [1] Physical therapy is recommended as a conservative option for persistent symptoms. [2]
Initiation Thresholds and Duration
Conservative therapy is appropriate when the clinical picture supports costochondritis and serious etiologies have been excluded. [1] If symptoms persist or worsen, escalation of evaluation is indicated, including consideration of alternative diagnoses and further workup. [1]
Evidence Base for Conservative Therapy
No high-quality studies have examined the effectiveness of specific treatment options for costochondritis. [3] A large observational study reported that 91% of patients with new-onset costochondritis had resolution of pain after three weeks of rest and NSAIDs. [3]
Common Pitfalls to Avoid
Failure to exclude coronary artery disease, infection, and other serious causes of chest pain delays appropriate management. [1] Assuming costochondritis management directly treats systemic inflammatory or infectious disorders without reassessment when atypical features are present is inappropriate. [1]
Treatment Goals
The treatment goal is pain relief with return to normal activity using conservative measures after exclusion of dangerous causes. [1]