Costochondritis: Chest Wall Pain with Arthritis and Fibromyalgia

What is Costochondritis?

Oh, Costochondritis! This is easily one of the worst and most painful symptoms of life with Spondylitis and Fibromyalgia. Before I knew what it was, I honestly thought I was having a heart attack!

Thankfully, my FB group for Fibromyalgia and Ankylosing Spondylitis in Women was there to assist and reassure me when it first happened. I’m endlessly thankful for support groups and patient groups that pool resources so we can learn from each other.

The first time I had a costochrondritis attack was August 2014, but it wasn’t until December 2015 that it got bad enough to not only leave me bedbound and in agony, but it also felt life-threatening as the chest pain I was experiencing was a sharp pain and the pressure was intense. I really thought I was having a cardiac incident.

Today’s post answers the basics about living with costochondritis. It happened several times before I knew the signs of costochondritis, and that is why I’m sharing this with you today.


Disclaimer: I am not a medical professional! Don’t mess around with chest wall pain. If you’ve never experienced a costochondritis attack, please go to the hospital and get it checked it out! The most important part of receiving a costochondritis diagnosis is ruling out other causes of chest wall pain, which include ‘acute coronary syndrome, pneumothorax, pneumonia, aortic dissection, pulmonary embolism, or an esophageal perforation.


What is Costochondritis?

Costochondritis is caused by inflammation of your sternum and ribs. Your costosternal joints, which are rubbery pieces of cartilage that attach the ribs to the breastbone, become inflamed. When costo attacks, it feels like my chest is being pulled down and inward, sort of like my chest is collapsing. Pressure builds in your chest until you feel the need to ‘pop’ your sternum. I work on opening my chest to relieve the pressure by doing gentle stretches and chest opening exercises.

Veteran patients who experience costochondritis regularly will all tell you that it can take a long time to pop and get some relief.

Studies suggest that as much as 50% of all chest pain is caused by musculoskelatal disorders.

Acute chest pain is a major health problem all over the western world. Active approaches are directed towards diagnosis and treatment of potentially life threatening conditions, especially acute coronary syndrome/ischemic heart disease. However, according to the literature, chest pain may also be due to a variety of extra-cardiac disorders including dysfunction of muscles and joints of the chest wall or the cervical and thoracic part of the spine. The diagnostic approaches and treatment options for this group of patients are scarce and formal clinical studies addressing the effect of various treatments are lacking.

Diagnosis and treatment of musculoskeletal chest pain: design of a multi-purpose trial
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2315652/

Worse of all, the pain of costchondritis mimics cardiac problems, such as a heart attack. So you never really know what you’re dealing with when it starts. Over time, I’ve learned the signs of a costochrondritis attack, which is what I’m sharing with you today.

One great tip to learning if you’re having a costo attack is that if your chest is painful to touch, you can be almost certain it’s not a heart attack. That said, let your doctor do the investigating if this is your first time experiencing chest wall pain.

What Causes Costochrondritis?

Sometimes costochondritis is a result of some sort of mechanical stress, such as physically straining yourself or perhaps coughing too hard.

Costochondritis is also known to affect patients who suffer from fibromyalgia, axial spondyloarthritis, rheumatoid arthritis, psoriatic arthritis, and other rheumatic conditions. Inflammation from inflammatory arthritis can also cause damage to rib cartilage.

Costochondritis can also be triggered by viral and bacterial infections. It can also develop after surgery and even with pregnancy since a woman’s ribcage is stretched during the third trimester.

Costochondritis Symptoms: Sharp Pain and Pressure

The hallmark symptom of costochondritis is intense chest wall pain that can be described as sharp, aching and full of pressure. Most certainly, I’ve experienced that the pain gets worse with breathing deeply or moving my upper body. This is because costochondritis attacks the joints that flex when you inhale. It can also feel like someone has stuck a knife in you. It really does take your breath away.

I remember once incident in 2015 that left me writhing in agony in my rheumatologist’s clinic in Taiwan and he never once suggested a link between Axial Spondyloarthritis and fibromyalgia. He didn’t even know what to call it, but he tried corticosteroid injections to try and get the inflammation to come down. Since I had visible inflammation present in all my major joints that summer, that was our only treatment option at the time. That particular costochondritis attack lasted for three months. I’m not kidding you. I was bedbound that whole summer and moving was terrible. I spent my time breathing shallowly, trying not to move, and reading or listening to classical music.

The symptoms are intense, especially if you’ve never experienced it before. Costochondritis is not life-threatening, but as I’ve mentioned, if you’ve never experienced it before, make sure you head to ER to rule out other life threatening problems.

With costochondritis, typically the second to fifth costochondral joints of the ribs are affected, especially your third and fourth ribs, but it can impact any of the seven rib junctions. Pain can happen in several places, but it’s almost always on one side of the body. For me, it presents on the left side every time it hits.

I’ve learned I need to wait it out. Sometimes it can last weeks to months, as I stated above with my summer from hell in 2015. Some patients have lived with it as long as a year. Thus it’s important for patients to understand what costochrondritis is and know that it will eventually go away.

Diagnosing Costochondritis and Treatment Protocol

X-rays don’t show soft tissue well and there’s no blood test for it, so costochondritis is typically diagnosed by a doctor through a physical exam. Older adults experiencing these symptoms may need to get an EKG to rule out the possibility of cardiac problems.

As I mentioned earlier, I’m always certain it’s costochondritis when I push on my chest gently and it’s extremely painful.

If you’re heading to ER, you can count on a physical exam being conducted by the doctor to see if tenderness to palpation of the costochrondal joints reproduces more pain. Any time this has happened with me, the pain intensifies and starts hitting several sites on the same side of my chest and torso.

Your doctor might suggest pain relievers such as:

  • Tylenol (acetaminophen) 
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Local anesthetic injections or steroid injections
  • Ice or heating pads can help
  • Epsom salt baths and magnesium rich baths help to reduce symptoms
  • Your doctor might give you a cough suppressant to reduce discomfort
  • Try some GENTLE stretching
  • Minimize your activity

Honestly, though, the best treatment is rest!

There’s also no real way of knowing how long the pain will last, though the American Family Physician report says that it can last from weeks to months, though for some it may last for a year. “Patients with costochondritis should be educated and reassured that this is a benign condition that will eventually resolve itself,” the journal states, sometimes without any treatment at all.

American Family Physician

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Post Author: Carrie Kellenberger

I'm a chronically ill Canadian who has been living in Asia since 2003. I moved from China to Taiwan in 2006. I'm an experienced businesswoman and have worked in many leadership positions in Asia. In addition to my own work, I've been writing professionally about Asia, travel and health advocacy since 2007, providing regular content to publishing companies and travel publications in Asia and North America. I started writing about my health journey in 2009 after being diagnosed with Ankylosing Spondylitis. In 2014, I was diagnosed with Fibromyalgia and ME/CFS, which came with other massive health issues. These diagnoses were the start of my journey as a health advocate and patient leader. Since then, My Several Worlds has been recognized worldwide as a top site for AS, fibromyalgia, and chronic illness by WEGO Health and Healthline.

12 thoughts on “Costochondritis: Chest Wall Pain with Arthritis and Fibromyalgia

    Lucy

    (August 4, 2021 - 2:06 am)

    This is such a detailed post about Costochondritis , which will help raise awareness and be so helpful to people who are also struggling. Researching our conditions and treatment options can be so time and energy consuming, which is hard when our energy levels are limited. Thank you for your efforts in putting this post together.

      Carrie Kellenberger

      (August 5, 2021 - 9:29 am)

      Thank you so much, Lucy! Costo attacks are the worst and they hit me hard every summer. It’s good to know this might help other patients.

    Sheryl

    (August 6, 2021 - 12:33 pm)

    This is super interesting, because I’m actually sitting here right now with similar pains as to what you described. I have an NSAID plaster stuck onto my chest for days, and have been on painkillers. Not so much because of the pain in itself, but the difficulty with lying down and breathing. I wonder if it’s costochondritis?! Never knew there was a term for it except that doctors say it’s muscle strain or inflammation.

    It also mimics blood clots/PEs/DVTs, but like you, I’ve learned to tell the differences over time. In the beginning, I used to rush to the A&E for such pain all the time only to learn there were no clots. It can be tricky for a newly diagnosed person to differentiate!

      Carrie Kellenberger

      (August 9, 2021 - 12:39 pm)

      Oh wow! Yes, I know that feeling of having plasters stuck all over my chest and back! Painkiller use goes up with this and in many cases, I’ve gone to ER for further pain intervention. It’s exceptionally painful. With my worst bout in 2015, I couldn’t even sit up in bed. It took months for it to go down and that feeling of needing to pop my chest for relief was so intense. I’m suffering through another bout of it now and have learned that the best remedy is rest and not moving! Even corticosteroid injections in my chest/ribs didn’t help. I can literally trace the band of inflammation across my chest and down my rib cage. It swells up something awful. Hope you get an answer and that it doesn’t last long, Sheryl! Take good care. Summer in Asia is never good for costo!

    Holly B

    (August 7, 2021 - 9:57 pm)

    Thank you.. Thank you! For years I have suffered from what my doctors called a MS hug, and I would say it’s the worst hug of my life.when you have multiple chronic illnesses you have multiple doctors sometimes doctors make it another doctors problem! This will help me explain to my doctors what is going on! I pinned it!

      Carrie Kellenberger

      (August 9, 2021 - 12:40 pm)

      Yes, I completely agree! I’ve never heard of an MS hug, but hugs got really hard for me in my early 20s. Someone actually fractured my ribs hugging me when I was in my second year of university. At the time, I didn’t realize it was related to AS or fibro, and I had no diagnoses then so doctors didn’t believe me when I told them what I was going through. I’m so glad it helps you!

      Sheryl

      (August 9, 2021 - 8:46 pm)

      I will definitely ask my doctor about it when I see him. I didn’t even think there might be a term for it and just attributed it to ‘symptoms of Sjogrens or Lupus’!

        Carrie Kellenberger

        (August 16, 2021 - 12:41 pm)

        It’s amazing what we learn from each other and not from our doctors, isn’t it? The only reason I know about it myself is because of all the women who suffer from it in my fibro and AS group. After approaching my doctor about it, he said, ‘Oh yes. That makes sense with your blood results.” Sometimes I feel like they should be paying me. He didn’t have any tips except for rest and I’ve found out on my own and from other patients in my group that rest is really the only thing you can do with that kind of chest inflammation. I tried steroid injections and steroid burst packs, but there wasn’t much of a difference so now I know the best thing I can do is not move and then try to sort out the arthritis crap from not moving later.

    Katie Clark

    (August 8, 2021 - 8:52 pm)

    I’ve had this since I was 15 or so; not the feeling of a heart attack, but once I was actually told by the ER doctor that I had a small hole in a lung! I have it in my sternum the worst, but over the past couple of years, I have it in my ribs. Also, though, I have breast tissue pain (dense breast that hurt). Definitely, not fun:(

      Carrie Kellenberger

      (August 9, 2021 - 12:42 pm)

      It really is awful. There are so many women suffering from it in my fibro and AS group. It’s one of the most talked about symptoms because when it hits, it lays you out for months. That’s what I’m going through right now. Not fun at all. (But no way did I give my hug up from Caleb!) 🙂

    Chris Hamilton

    (October 23, 2021 - 5:28 am)

    The image here is really appropriate for any chronic condition. You’re constrained and though the pain is intense, it won’t kill you. It’ll just dominate your every thought when its bad. And it’ll confine you.

    I haven’t had this, and maybe dudes who have fibro don’t get it. But it’s good to know. Thank you for the in-depth write up.

      Carrie Kellenberger

      (October 24, 2021 - 3:18 pm)

      Always good to hear from you, Chris! Yes, I agree. And yes, it does dominate every thought until it passes. The attack I had in 2015 lasted four months. It was utter misery. That’s a good question. I assume that men also experience it. If you’re on FB, you could ask Men with Fibromyalgia or ask in Fibro Connect. (They’re both closed support groups that provide information.) That’s the only reason I’m still on FB to be honest. There are no English support groups here in Taiwan. Thanks for reading!

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