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Q
Non-Threatening Chest Pain?

I'm a drummer in a rock band and have recently developed costochondritis. I don't want this condition to end my musical career, but the pain isn't getting better. What can I do?

A
Answer (Published 6/13/2002)

Reviewed on 1/24/2005

Costochondritis causes chest pain that can get worse when you take a deep breath, cough, change position, or raise an arm over your head. It can mimic cardiac (heart) pain, which has to be ruled out - with an electrocardiogram, for example, before you get the final diagnosis. Fortunately, costochondritis is far less serious that a heart attack - in fact, it is a relatively harmless condition that eventually goes away. It is due to inflammation in the chest where the upper ribs join with the cartilage that holds them to the breastbone.

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No one knows for sure what causes costochondritis. Sometimes, a viral respiratory infection is to blame; sometimes, repeated minor trauma to the chest wall appears to be the cause. Less commonly, bacterial and fungal infections may be responsible.

Your diagnosis is unlikely to end your musical career. Non-infectious costochondritis usually doesn't last long. Recovery from the infectious variety can take a long time, but it, too, eventually resolves. In the meantime, you will need relief from the pain. Conventional medicine treats this condition with nonsteroidal anti-inflammatory drugs such as ibuprofen. If they don't help, a steroid injection or local anesthetic may be recommended. Infectious costochondritis is treated initially with intravenous antibiotics, followed by oral antibiotics, and rarely, surgery may be recommended to remove the inflamed cartilage.

In addition to anti-inflammatory drugs, you might try acupuncture, applications of heat and cold to the affected area, or topical applications of DMSO (dimethyl sulfoxide), a chemical made from wood pulp that penetrates the skin and promotes healing of pockets of inflammation. (Ask for it in health food stores and apply a 70-percent solution three times a day for three days; then discontinue if it doesn't help; if it does, cut down to twice a day for three more days then once a day for a final three days.) You also could try natural anti-inflammatory agents such as ginger (1-2 grams of powdered dry ginger capsules daily), curcumin, an extract of turmeric, the yellow spice that colors curry (follow directions on the product, available in health food stores), or boswellin, an extract of the herb Boswellia (follow directions on the product). All are effective, but have to be used regularly for four to six weeks to produce full benefits.

Andrew Weil, M.D.

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