FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

TIME IS THE BEST HEALER FOR THE CHEST PAIN OF COSTOCHONDRITIS

Question: I'm having a terrible time with chest pain. My doctor says I have costochondritis, and he has recommended that I take aspirin. It helps my pain, but it hurts my stomach enough that I can't continue to take it. What causes costochondritis, and what can I do for it since I can't take aspirin?

Answer: Chest pain from various causes is a common symptom. Males will often assume they are having a heart problem and females may think they have breast cancer. These are normal reactions, and it's always a good idea to get unidentified chest pain checked out promptly. If you are found to have costochondritis, like our reader, you are fortunate. Though it can make you mightily uncomfortable, it is not life threatening and is what we doctors call a “self-limiting” condition.

In short, costochondritis is a painful inflammation of the junctions where the ribs join with the cartilage that holds them to the breastbone. If the pain is accompanied by swelling, it's referred to as Tietze syndrome.

Let me explain this a little more clearly with a brief anatomy lesson. Our ribs are an important part of the human body. They form a protective cage around the vital organs within the chest. In addition to their protective role, the ribs also must move -- sort of like the sides of a bellows -- to help force air into and out of the lungs. Accommodating these two roles poses some mechanical dilemmas. The best protective rib cage would be rigid, while the best "bellows" action requires movement. Creatures with a bony skeleton, including humans, are designed solve this problem in a similar way.

Ribs are rigid because they are bone, and this rigidity provides an excellent protective cage as well as a firm structure for the attachment of muscles. Each rib is attached to the vertebra of the backbone with a type of joint that allows a gliding motion. The situation is a little different in the front of the chest where most ribs are attached to the breastbone with a section of flexible cartilage that bends to accommodate rib motion instead of gliding as most joints do. Only the 11th and 12th rib pairs are not attached to the breastbone in this manner.

Costochondritis occurs most often to the cartilage that connects the second and third ribs to the breastbone -- either on one or on both sides of the chest. Ribs move with respiration, particularly with the deep breathing of exercise, and are also attached to some of the muscles that move the neck and shoulder. As you might assume from this arrangement, costochondritis can turn simple activities like taking a deep breath or reaching to retrieve a can from the pantry shelf into difficult and painful experiences.

The symptoms of costochondritis usually clear up without treatment in a few months, but that probably seems like a long time to wait for the pain to go away. There is no specific medication or treatment that works best for this problem, and we have found no treatment that shortens the length of the illness. Pain medication, anti-inflammatory drugs including aspirin, and heat can ease the discomfort and make it more bearable while you wait until your body and time can do the healing. That’s why I recommend that you talk to your doctor about an anti-inflammatory medication that is less irritating to your stomach than aspirin.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.