Costochondritis: The intense chest pain that wouldn’t kill you

Oct 28, 2018 Dr Zulfikar Bux, Features / Columnists

By Dr Zulfikar Bux
Assistant Professor of Emergency Medicine

Costochondritis is a painful condition of the chest wall that causes chest pain. People who get chest pain are often frightened they have a heart or lung problem. It is a very common cause of chest pain that creates quite a bit of anxiety for patients. Fortunately, if the pain is due to costochondritis, there is no need to panic, as it is not a life-threatening condition and it usually gets better on its own with time.
The pain you get if you have costochondritis comes from the protective cage formed by your ribs, and not from the heart or lungs or blood vessels inside your chest. More specifically, it comes from one or more of the joints between your ribs and your breastbone (sternum). These joints can become inflamed and cause severe chest pains.
WHAT ARE THE COMMON CAUSES OF COSTOCHONDRITIS?
The basic problem is inflammation, but the cause of this is unknown for most people. It affects women more. There are some situations that are known to cause inflammation and they include:
• Chest infections of varying types.
• Large physical efforts, like lifting heavy objects or repeated bouts of coughing.
• Accidents which hit the chest, like falls or car accidents.
• Some types of arthritis.
WHAT ARE SYMPTOMS OF COSTOCHONDITIS?
• Costochondritis causes chest pain, felt at the front of the chest.
• It is usually sharp and stabbing in nature and can be quite severe.
• The pain is worse with movement, exertion and deep breathing.
• Pressure over the affected area also causes sharp pain.
• Some people may feel an aching pain.
• The pain is usually confined to a small area but it can spread to a wider area.
• The pain tends to wax and wane and it can settle with a change of position and quiet, shallow breathing.

The most common sites of pain are close to the breastbone, at the level of the 4th, 5th and 6th ribs. Without tenderness, the cause of the chest pain is unlikely to be costochondritis. Remember to seek medical advice if you are unsure of the cause of your symptoms

WHEN SHOULD I SEE A DOCTOR?

With chest pain, it makes sense to err on the side of caution if you are unsure.
If you feel unwell, breathless, dizzy, or sweaty, or if your chest pain is very severe or spreading to your jaw or left arm then treat it as an emergency and do not hesitate to go see a doctor.
If you have a pain in your chest which gets worse as you move your chest wall and hurts when you press on it then it is likely to be a chest wall cause, such as costochondritis. If you feel generally well, and the pain does not need painkillers, or can be managed with over-the-counter painkillers then you do not necessarily need to see a doctor. Even if you are fairly sure you have costochondritis, if the pain is severe or getting worse rather than better over time then see your doctor.
If you have other symptoms in addition to the pain then see a doctor. This would include if you have:

• A cough.
• A high temperature (fever).
• Breathlessness.
• Blood in the mucus you cough up (sputum).
• Pain which spreads to other parts of the body.
• A rash.
• A feeling of having a “thumping heart” (palpitations).
• Dizziness.

• Difficulty swallowing.
• Started to get heartburn or indigestion.
HOW IS COSTOCHONDRITIS TREATED?
Treatment is not always needed. Sometimes, it helps just to be reassured there is no serious cause for the chest pain. Worry can make the pain worse. With or without treatment, most people with costochondritis get better gradually over time. It is unusual for it to last more than two months. A course of anti-inflammatory painkillers such as diclofenac or ibuprofen usually help to alleviate the symptoms of costochondritis.
For severe cases of costochondritis not responding to painkillers and anti-inflammatory medication, injections of steroids or local anesthetic medicines may be used.
Non-medicinal measures can be tried for relief of pain in costochondritis. Examples of such techniques include:
• Heat pads.
• Ice application.
• Acupuncture.
• Gentle stretching exercises.
• Avoidance of sports or activities that worsen the pain.
• Physiotherapy or chiropractic therapy.

While the chest pains from costochondritis can be nagging and intense, it’s not life-threatening. However, if you are not sure, it’s better to go see your doctor.