When chest pain is “just” costochondritis

26 Dec

Costochondritis-7by Carolyn Thomas

Many female heart patients become familiar with the word “costochondritis” only while being misdiagnosed with the condition during an actual cardiac event, as in:

  • “My MD said it was just costochondritis and a  pinched nerve, because my ribs were sore.” (LH, age 51, New York: heart attack)
  • “At first, we looked at musculoskeletal causes. It had to be costochondritis; my chest wall seemed tender to touch, so I even had steroid injections in my chest wall.” (ZM, age 59, Arizona: heart attack, 12 stents, triple bypass surgery)
  • “Pains in chest radiating down arm and up to my chin. My GP reluctantly sent me to a cardiologist who was dismissive, said that my age was a big factor and that it was 99% likely to be just costochondritis as I also have fibromyalgia” (BT, age 42, U.K: heart attack, 90% blocked LAD coronary artery, two stents)  

Costochondritis is an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone, or sternum. The condition causes localized chest pain that you can often reproduce by pushing on the cartilage in the front of your ribcage.

Costochondritis can be extremely painful yet, mercifully, it’s often relatively benign. Much of the medical literature suggests that it will usually go away on its own within a few days, but some patients report symptoms that can linger for weeks or even months. It can also be a recurring condition that appears to have little or no warning of onset. Pneumonia can be misdiagnosed as costochondritis. Many patients living with fibromyalgia or chronic fatigue syndrome complain of chest wall pain and restriction of movement, often identified by their health care providers as costochondritis.

Chest pain in adults is considered by most doctors to be a potentially serious sign of a heart problem until proven otherwise. Reporting chest pain usually leads to a battery of medical tests to rule out heart disease. If those tests are normal and your physical exam is consistent with costochondritis, your doctor may diagnose costochondritis as the culprit. It may, however, be difficult to distinguish between the two without specific testing. 

Never assume chest pain is “just costochondritis”.

Here’s an example: Emergency physician Dr. Seth Trueger described this study as one that “might be the coolest chest pain study ever done.”

The study found that when rheumatologists using the American College of Rheumatology criteria for diagnosing costochondritis evaluated patients in the E.R. complaining of chest pain:

“Six per cent of the patients the doctors diagnosed with costochondritis actually had an acute myocardiardial infarction (heart attack).”

(What rheumatologists were doing in the E.R. was not explained . . . )

Most (real) cases of costochondritis seem to have no clear cause. Occasionally, however, the diagnosis might be correlated with:

  • Injury. A blow to the chest
  • Physical strain. Heavy lifting and/or strenuous exercise
  • Arthritis. In some people, costochondritis has been linked to specific problems, such as osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.
  • Joint infection. The rib joint itself can become infected by viruses, bacteria or fungi. Examples include tuberculosis, syphilis and aspergillosis.
  • Tumours. Non-cancerous and cancerous tumours also can cause costochondritis. Cancer may travel to the joint from another part of the body, such as the breast, thyroid or lung.

Costochondritis may also occur as the result of an infection or as a complication of surgery on your sternum.  Sometimes patients with a severe cough can develop this as a result of continued coughing and rapid expansion/contraction of the rib cage.

This condition affects females more than males (70% versus 30%).

Kelly Young is a patient advocate, blogger, and president of the Rheumatoid Patient Foundation. She described costochondritis like this in her blog RA Warrior:

“As early as 1964, the journal ‘Radiology’ published a study explaining that the effects of Rheumatoid Arthritis on the rib joints “have not been adequately described in the literature.”[1] Mayo Clinic’s description of costochondritis makes it clear the word describes a symptom, pain or inflammation of the rib joints that can be caused by various illnesses.[2,3]

“The term is also confusing because there can be varying diagnoses with similar symptoms.”

But Kelly says that she has also read some skeptical articles about costochondritis symptoms, considered by some physicians as the garbage can diagnosis of hypochondriacs.

Costochondritis is not associated with swelling, as opposed to Tietze’s syndrome, where swelling is characteristic.  Tietze’s syndrome is an inflammation of the costochondral cartilages of the upper front of the chest that involves swelling around the joint, the ribs or cartilage near the breastbone. Redness, tenderness, and warmth can also be present, but a localized swelling is the distinguishing finding, although even swelling can be variable from patient to patient. The pain  can cause difficulty with sleeping, and even rolling over in bed is sometimes painful.

Possible treatments include heat or ice, and medications to reduce the inflammation*.  And until there is improvement in your symptoms, avoid unnecessary exercise or contact sports activities. 

In New Zealand, physiotherapists like Steve August (see his detailed comments below) have been successfully treating the backs of his costochondritis patients manually for over 30 years with non-drug, non-invasive physiotherapy, as he discusses in this video.

And as Kelly Young sums up about her own bouts with costochondritis:

“Like other joint inflammation, costochondritis is eased by rest, NSAIDs*, ice or heat, and prednisone. Pain medications can help manage severe costochondritis. And if it is persistent, steroid injections can be used.

“Usually, as with other joints, the inflammation subsides to a more manageable level in a few days.

“I’m counting on that because the only other solution I can think of is to not breathe. It hurts too much!”

.

*  CAUTION:  Studies have found that, among those who had already had one heart attack, people who took the painkillers called NSAIDs (non-steroidal anti-inflammatory drugs) such as Vioxx, Bextra, Aleve, Advil, Motrin, etc. were at >40% higher risk of having a second heart attack compared with those who did not take them.

1  Alpert M, Feldman F. The rib lesions of rheumatoid arthritis. Radiology. 1964 May 82: 872-875
2  Mayo Clinic. Costochondritis. 2012 May 6.
3  HealthHype.com. Severe costochondritis – causes, symptoms, treatment. 2010 May 9.
4  Flowers LK. Medscape. Costochondritis. 2012 Apr 13.

Q:  Have you ever experienced costochondritis?

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80 Responses to “When chest pain is “just” costochondritis”

  1. Lucia Adler January 30, 2016 at 9:05 am #

    I was recently diagnosed with costochondritis, though I’ve been in varying degrees of pain for 4 years. I have had every workup possible except cardiac (aside from echos) x-ray, MRI, full body scan, endoscopy, colonoscopy, abdominal ultrasounds and my blood work is always prefect (aside from elevated amylase – that’s why they did the abdominal ultrasound.

    I have had constant pressure and dull ache under my left lower rib and in December I had an episode of severe pain while I was doing leg presses. Since then I stopped working out completely. My back is now in constant pain because I stopped working out – it’s the only thing that helped me with back pain. It was suggested that I have a steroid shot in the ribs, but I HATE steroids and even more so because I’m not quite convinced that it is costochondritis.

    Is it possible for costochondritis to last this long? I’m contemplating doing the steroid injections just to rule out costochondritis, but even if I do rule it out I have no clue where else to turn. I’ve seen countless physicians and some told me they have no clue, some said I should wait until something else happens that might help give them an idea and some said I should just live with it.

    I’m 52 years old and have always been in excellent health and I’m also not overweight. Any idea at all what I should do next? I have also not been able to sleep on my back since the onset of this problem and I do get chest pains but only at night usually around 3am. Many times the chest pains wake me up but I was just given anxiety medication for that, which I don’t take. I’ve been taking tumeric/curcumin/coconut oil paste for the past 2 weeks thinking that if it is an inflammatory process I might be able to affect it somewhat but nothing changed – some days the pain is better some day it’s not. I still cannot pinpoint a particular reason why that is! I’m getting depressed at the thought of having to live with this forever!

    Liked by 1 person

    • Carolyn Thomas January 30, 2016 at 12:35 pm #

      Hello Lucia – four years is a very long time to be in pain before a diagnosis! Sometimes there is no sudden specific event or reason that pain can start, and sometimes there is. I’m going to suggest that you revisit Steve August’s link (and his video) about how physiotherapists in New Zealand are approaching costochondritis and see if this makes sense to you. It’s very different from our North American views. Best of luck to you…

      Like

  2. Amanda January 22, 2016 at 6:26 pm #

    I was just diagnosed with costo today. I hurt my lower back last month and was in my second week of physical therapy for it and last night I was doing my stretches and heard and felt something pop in my chest. I thought a rib moved or something, but it’s the most painful thing ever. I can’t even breathe or sit or lay down or anything without pain… They did an x-ray and I guess my ribs are fine, but that’s what the doctor diagnosed me with. I was crying earlier because it hurt so badly. I can’t handle this!

    Like

    • Carolyn Thomas January 23, 2016 at 6:19 am #

      This sounds awful, Amanda. What treatment did the doctor who diagnosed you recommend? As Kelly Young (who has had several bouts of this condition) recommends in this article, many costochondritis patients find relief with ice or heat and anti-inflammatory medications; in her own experience, “the inflammation subsides to a more manageable level in a few days” if it is costo. I hope this will also be true for you!

      You are in very early days yet, but make an appointment to see your family physician as soon as possible for further recommendations. You might also ask your physiotherapist too (watch Steve August’s video for more about how physiotherapy can also help). Good luck to you…

      Like

    • Steve August January 23, 2016 at 10:52 am #

      Hi Carolyn and Amanda.

      Amanda, what you’ve just described would fit squarely into the explanation of costochondritis I’ve put on a couple of YouTube videos on CC which Carolyn has kindly referred to and linked.

      That sharp pop and the feeling that the rib moved is a classic mechanical pain presentation – not an inflammatory one. The rib joint(s) around the back where they hinge onto your spine will be jammed – maybe from whatever you did to hurt your low back, especially if it was a fall. Then when you stretched, the frozen rib hinge(s) round the back couldn’t move, so the rib joints around the front where the ribs hinge onto the breastbone had to try and do all that movement. They’re more delicate, and one of them strained and ‘gave’ – hence the pop and the very sharp instant pain.

      Don’t panic, it’s easy to sort out.The key is, logically, to free up the stuck rib hinges around the back. Have a look at two YouTube videos ‘How to fix (most) costochondritis and Tietze’s Syndrome chest pain’ – Part 1 and Part 2. Ask your physio to view them also. This is a perfectly reasonable request – I’m a physio myself (in New Zealand).

      Carolyn, this is a perfect example of how I think most CC turns chronic and inflamed. Imagine if Amanda’s costovertebral rib hinges at the back don’t get freed up. I’m not being alarmist, just accurate – my own ones stayed stuck for seven years, after my climbing fall. Then the continuing extra strain on the sternocostal rib hinges around the front (which are now trying to do ALL the work of breathing and movement) means they get continually strained and irritated, and then inflamed.

      Cheeringly, Amanda’s ribs haven’t been jammed for very long, so should be easy to free up. Not too difficult even if it has been years – just takes longer.
      Best wishes,
      Steve August

      Like

  3. Shanelle January 12, 2016 at 12:10 pm #

    I was diagnosed in Oct 2015 with Costochondritis and it’s been a living hell ever since. I first started experiencing the pain after smoking. My chest tightened up and I had a “full” feeling over my chest and throat. I rarely hear people describe it going up their throat but that’s where I feel it most and it frightens me. They ran so many tests on me as my brother passed away 5 years earlier from a pulmonary embolism and wanted to rule it out.

    I can’t stop worrying that maybe they got it wrong. Does anyone feel that way? Feeling an odd feeling in their throat and perhaps this is anxiety but I have to remind myself how to swallow while breathing. The Aleve medication helps but so much…. I don’t experience the soreness at all…it’s just an “My chest is too full, too tight, and it hurts and scares me”.

    Am I alone in this feeling regarding costochondritis?

    Like

    • Carolyn Thomas January 12, 2016 at 12:33 pm #

      Hi Shanelle – I’m not a physician so can’t comment specifically on your case, but I’d advise you to seek a second opinion focused on your throat pain if you are still experiencing it as a “living hell”. As you know, smoking irritates the throat, causing it to become dry, red and inflamed, so if you’re still smoking, that could also be contributing to your symptoms.

      Like

      • Shanelle January 12, 2016 at 1:00 pm #

        Oh I quit smoking immediately after being diagnosed. The pain comes and goes but I do have to admit with other replies left here it is a scary feeling to feel your chest tighten up so much and only being prescriped generic aleve or naproxen. Wish there was more information on this diagnosis on the web. Everywhere it states the same thing as if it’s no big deal!

        Like

        • Adrienne February 1, 2016 at 6:35 pm #

          Shanelle, I am experiencing the exact symptoms. For several weeks I have seen more than six doctors and even went to the ER. I was told it was costochondritis but I also have a subluxation on my sternoclavicular joint. I have radiating pain to my throat under chin. This is a condition not treated by many doctors. You have to find someone who knows and will listen! I am still looking and having relentless pain. Good luck!

          Like

      • Alise January 12, 2016 at 1:53 pm #

        I’ve had costo problems; I’ve had the pain that also traveled up to my throat. My rheumetologist diagnosed me with costo but he also suggested the possibility of anxiety as a result of fear that naturally occurs. I also see a cardiac doctor (I have atrial fibrillation, yet my heart and valves are in good condition). I have an irregular heartbeat at times. But when I’m in pain that lasts longer than 15 minutes, I usually go to the ER primarily to rule out angina which also can cause chest pain. As a side point: if chest pain is relieved by NSAIDS (ibuprofen, etc.) it’s probably not cardiac problems. (EDITOR’S NOTE: see FDA warning in my response below) Go to your doctor and request a work up to rule out cardiac problems; it will alleviate much of the anxiety issues. Remember: knowledge is power!

        Like

        • Carolyn Thomas January 13, 2016 at 5:49 pm #

          Just a cautionary reminder here for my readers: last summer, the FDA strengthened its prior consumer warning that NSAIDS pain medications (nonsteroidal anti-inflammatory drugs) like brand-name Motrin, Advil, Aleve, Celebrex, Voltaren (or generic ibuprofen, naproxen, celecoxib, or diclofenac) increase the risk of having a heart attack or stroke, and may also elevate blood pressure or cause heart failure. The risk is greatest for people who already have heart disease, according to this Harvard bulletin.

          Aspirin is also an NSAID, but apparently does not pose a risk of heart attack or stroke, and is not covered by this new warning.

          Like

  4. Susan January 6, 2016 at 7:52 am #

    I’m 24 and have had this recurring chest pain for over 7 years now. It lasts for a minimum of a month if I’m lucky and the ERS says this is what it is. Now it is spreading to my neck and back and my chest is breaking out which it never does, and personally it’s starting to freak me out.

    Like

    • Carolyn Thomas January 6, 2016 at 8:09 am #

      Hi Susan – I’m not a physician so cannot comment on your specific case, and I’m not sure if you mean you’ve been diagnosed with costochondritis or not. If you have, you should have some type of treatment plan in place. Seek a second medical opinion, or conversely consider a physiotherapy consultation. Seven years is a long time to withstand distressing symptoms!

      Like

  5. Stacy December 8, 2015 at 2:22 pm #

    This has helped me a lot. It seemed as if my doctor wasn’t concerned, but the chest pain was alarming. I have lost 5 people of my age in the last year. I now feel a bit more comforted knowing I am not the only female feeling this discomfort, especially when wearing these underwire bras, which make it worse.

    Liked by 1 person

    • Carolyn Thomas December 8, 2015 at 3:29 pm #

      Stacey, life is just too short to ever wear an uncomfortable underwire bra! If your chest pain continues, seek medical help, okay?

      Like

      • Steve August December 11, 2015 at 2:41 am #

        Hi Carolyn.

        I’m the New Zealand physiotherapist who made comments about how we’d see and treat costochondritis (CC) over here back on August 27. (Essentially we’d see it as a straightforward musculoskeletal problem where the costovertebral rib joints at the back are jammed, requiring the anterior rib joints around the front to work excessively to compensate, leading to irritation, then inflammation of them.) You graciously allowed the post, even though it includes mention of a device we make which I do find genuinely appropriate for the problem – thanks for that.

        We’ve put up a YouTube video which probably explains what I was going on about much more clearly than my long verbose email to you. It’s titled ‘How To Fix (most) Costochondritis and Tietze’s Syndrome Chest Pain.’

        I’m not at all saying this is the answer to all CC. But clearly the standard medical view (e.g. Mayo Clinic) that it’ll probably settle down in a few days or weeks is simply not correct for the numerous patients who’ve had it for years – as evidenced on any of the CC blogs. I would like to put forward this standard NZ manual physio view of CC – patients can decide if it seems like a fit with their particular problem.

        You had asked for research evidence of my stance. Happy to report I’ve found Martin Ian Rabey ‘Costochondritis: Are the symptoms and signs due to neurogenic inflammation. Two cases that responded to manual therapy directed towards posterior spinal structures‘ in ‘Manual Therapy‘, Vol.13, Issue 1, Feb.2008, pp 82-86. This is exactly what I’ve been talking about – I’m delighted to find something on it in print.

        Best regards,
        Steve August

        Liked by 2 people

        • Carolyn Thomas December 11, 2015 at 9:16 am #

          Steve, this is what I was talking about. Evidence! Also, your YouTube video is excellent: simple, clear explanations and suggested remedies. Thanks for these two resources. I’m going to include a link within the text of this article (speaking of which, always include URL links to journal articles/videos when recommending them – it saves the blogger from having to look them up!)

          Liked by 1 person

          • Steve August December 11, 2015 at 11:19 am #

            Hi Carolyn. Thanks for that! And roger, wilco re the URL.

            Re evidence, there’s a recent article in ‘The Lancet’ on troponin levels indicating that two-thirds of acute admissions to hospitals with chest pain are not having a heart attack.
            Even allowing for some further admissions with chest pains from respiratory and other medical problems, that’s a lot of people (maybe half?) walking out again with a costochondritis label and wondering what to do about the pain.

            Cheers,
            Steve August

            Liked by 1 person

            • Carolyn Thomas December 11, 2015 at 1:21 pm #

              Thanks Steve – we have long known that the vast majority of the chest pain that brings us to the ER is not heart-related, as I wrote in January here (which includes a number of other reasons for this distressing symptom. I spend much of my time, however, hearing from women whose heart attacks have been misdiagnosed by Emergency Department physicians – yes, even like my own, when chest pain is a dominant symptom.

              Like

    • Lerato Marsh January 22, 2016 at 10:41 pm #

      Oooh I feel the same I’m no longer wearing underwire bra, if I will try, two minutes is enough.

      Liked by 1 person

  6. Cherie Davis November 27, 2015 at 10:58 pm #

    Exactly 1 week ago I had a mammogram; it was done twice and was very abrupt and hurt a lot more than usual. The pain kept getting worse, radiating down my arm, severe pain at the sternum (felt like a heart attack), sharp pain in the back, can’t cough, hard to breathe- feels like a broken rib under the breast.

    Today I go to Urgent Care and am told that I have Costochondritis and it is not related to the [hard] mammogram (I’ve have numerous done- so I know this one was different). Given a anti inflammatory shot, told to get a rib brace and take ibuprofen (problematic due to acid issues). Hard to believe that this coincidentally occurred at the same time. The back, neck and shoulder hurt. Everything I read seems very likely this came from the minor but twice repeated trauma of the mammogram. Thoughts?

    Liked by 1 person

    • Carolyn Thomas November 28, 2015 at 8:35 am #

      Hi Cherie – ouch!! I haven’t heard specifically about a mammogram causing costochondritis, but the literature does mention that this inflammatory response is often linked to “injury” as a known cause (minor trauma, a blow to the chest, physical strain, overuse of the arms, heavy lifting, strenuous exercise – even severe coughing). See your doctor if you have trouble breathing, a fever, or worsening pain despite your ibuprofen. Best of luck to you….

      Like

      • Cherie Davis November 28, 2015 at 11:53 am #

        Thank you. God bless you for providing comfort and information to others. Jesus said that which you have done for the least of these, you have done for me. Matt 25:40

        Like

    • Marian Howard January 1, 2016 at 11:37 am #

      I have spent almost 3 years in pain and discomfort visiting GPs, physiotherapists, osteopaths, having ultrasound, MRI scans, blood tests, ECG and more to find the cause of my constant pain.

      Like Cherie, my pain also occurred not long after I had my first mammogram which was also done twice. I remained in the uncomfortable position I had been placed in while waiting for the operator of the machine to take another image as there had been a problem with the first one. I am not sure if the cause was the mammogram or my excessive heavy gardening duties at the time.

      I have gone from a happy, healthy, fit 50 year old to an overweight, unhealthy 53 year old who struggles to carry out simple everyday tasks due to the immobility and pain from costochondritis.

      My family have no idea how frightened I have been when I feel I am having a heart attack when I exert myself or carry anything heavy.

      I have trawled the internet in a quest to find help as I am certain the damage to my body can be repaired… but how?

      Today I have finally found the help I have been seeking for 3 years. I have watched Steve August on YouTube and I now have hope that I can turn my life around and regain my health and fitness.

      I long to be able to run, ice skate, swim and take huge lung fulls of air again. I will update on my progress.

      Thank you Carolyn and Steve for your helpful information.
      Best wishes to all contributing to this discussion.

      Like

  7. Taryn October 4, 2015 at 3:35 pm #

    Carolyn — thank you for this post. I just found it. I was misdiagnosed for 3 weeks with costochrondritis by 2 primary care doctors and ended up having a heart attack during this period. :( I am a 51 year old woman whose only cardiac risk factor was being overweight. I eventually had a stent placed, but have had many problems since — it has been like falling off a cliff — I survived the fall, but I am being battered around by the rocks underneath. I really love your blog and appreciate the time and energy it takes to maintain it. Thank you!!!

    Liked by 1 person

    • Carolyn Thomas October 4, 2015 at 5:59 pm #

      Hi Taryn – “falling off a cliff” is a really good description of how many of us feel (except often it seems like we were pushed off that cliff!) Unfortunately, it can also be common for cardiac problems to be misdiagnosed as costochondritis (or indigestion, or anxiety, or gall bladder, or . . . ) Hope you continue to feel better as time goes by.

      Liked by 1 person

  8. Magdalena September 30, 2015 at 10:26 pm #

    I live with fear, this “costochondritis” is not curable.. the medicine, home remedies, etc., is not enough. I wish there was a cure to this condition; to me all of this recommendations are just like putting on a bandaid. It is hard to live like this.

    Like

    • Carolyn Thomas October 1, 2015 at 5:09 am #

      Costochondritis seems like a mystery. Much of the medical literature claims it’s “benign” and goes away within a few weeks or months on its own, but even the comments here show that this isn’t always the case. Best of luck to you…

      Like

    • Amanda January 22, 2016 at 6:58 pm #

      It’s so much pain.

      Like

  9. Amanda Barnes September 22, 2015 at 1:59 pm #

    A little over two years ago I woke up one day with severe chest pain. I was diagnosed with JRA at the time so they upped my prednisone and tried a different biologic. Since then, I’ve been to every doctor imaginable and through every test to rule out everything which left me with a dx of costochondritis. They did discover I have lupus now and I’ve started infusions for that, but even though I’ve had multiple sets of cortisone injections in my chest, prednisone shots, take anti-inflammatories, ice multiple times a day, and am on an incredible amount of horrifying narcotics, nothing seems to help.

    In fact it seems to be getting worse and it’s hard to function when it hurts to move and is difficult to breathe. I’m astounded at how many people there are suffering from this for years with no answers or relief when everything says it should clear up within a few weeks. Sorry for the long post – I just get frustrated especially when doctors can’t help, or worse – tell you to just accept it and give up like my pain doctor.

    Liked by 1 person

    • Carolyn Thomas September 23, 2015 at 5:45 pm #

      Yikes. Your pain doctor told you to “just accept and give up”? I’m not a physician so cannot comment specifically on your symptoms, but I can tell you that generally lupus can sometimes affect the heart through inflammation of the pericardium, the sac that surrounds the heart. This may feel like a sharp pain in the chest. Best of luck to you…

      Like

    • Tracy January 19, 2016 at 12:18 pm #

      I had a rapid heart rate 160 and extreme fatigue for 2 months, went through all kinds of testing. Then woke up and had pain on and off all day ended up in the ER, admitted for bilateral pulmonary embolism ( blood clots) – in the hospital for 2 months for pain control. I had to have fluid taken out of lung walls. And have resolved clots, now a year later and still have the same pain not as bad as when I had clots. I have minimal scarring in my lungs. And still have chest pain. Was diagnosed with microvascular heart condition. And that pain is higher in my chest. They have no clue why I still have pain in the same exact spot of my clot pain!!! So they say it must be this condition.

      Like

      • Carolyn Thomas January 20, 2016 at 5:49 am #

        Hi Tracy – what a year you have had! My understanding is that, although most patients recover well after PE, recurring chest pain can persist with others (scar tissue? Chronic Thromboembolic Pulmonary Hypertension, especially in women?) This University of North Carolina resource recommends that if there has been no significant improvement at 6-9 months after PE, or if improvement has reached a plateau at an “impaired functional level”, ask for a medical referral just to rule out pulmonary hypertension. Best of luck to you…

        Like

  10. Sreekanth September 20, 2015 at 10:48 am #

    I am 34yr old male. Having pain over the left side chest muscle. sometimes it hurts when I touch near the heart. Went to multiple cardiologists and have had 4 ECGs, 3 2d echos and 2 lipid profile tests. Every report came normal. I also had a treadmill stress test 15 months ago – came back normal.

    Cardiologists diagnosed the problem as anxiety neurosis, prescribed me a few muscle relaxants and antidepressants to use. As long as I use those medicines I will get some relief. When I stop taking those pills again, I feel chest pain and will become anxious about my heart health.

    For 18 months, I am suffering from this problem. And I am also suffering from strong palpitations. Don’t know how to convince my brain and relax with this problem. Please help me out, this is like an on-and-off situation for me. Need a permanent solution for this….

    Like

    • Carolyn Thomas September 20, 2015 at 11:02 am #

      These are distressing symptoms, Sreekanth. I’m not a physician so cannot comment specifically on your case, but I can say that generally, heart-related chest pain does not feel worse if you press on it. I’d suggest you keep taking the meds that seem to be helping you, and perhaps discussing costochondritis with your physician. If you can make an appointment with a physiotherapist or someone who specializes in musculo-skeletal issues, that might also be useful. Best of luck to you…

      Like

    • htjadhav November 29, 2015 at 9:28 pm #

      Sreekanth, I have a similar problem. My email is htj.rit at gmail dot com

      Like

  11. Kimberly Riggs September 6, 2015 at 2:34 pm #

    I was diagnosed with costochondritis in 2002. Thought I was having a heart attack. ER ran tests and EKGS. Came back normal till x rays of my sternum. I had broken my sternum in 1992 in a car wreck. It was exactly 10 years to the day. I have to get injections in my sternum area to relieve the pain at times. Winter months are terrible.

    Liked by 1 person

    • Carolyn Thomas September 6, 2015 at 5:51 pm #

      That’s fascinating, Kimberly. Ten years to the day! A blow to the chest is sometimes associated with costochondritis – but I wonder if it usually takes a full decade for symptoms to develop! Best of luck to you – stay warm!!

      Liked by 1 person

  12. Steve August August 27, 2015 at 11:30 am #

    Hi Carolyn and the others. I’m a New Zealand physiotherapist – have been treating spines for 30 years. I do sympathise with you guys. There just doesn’t seem to be an awareness in the UK or USA of what causes costochondritis (CC) or how to fix it. It’s really logical and easy to treat – truly!

    Sure, it’s irritation and inflammation of the front ends of the ribs where they join onto the breastbone (sternum). But you have to stand back and ask WHY they’re inflamed in the first place. The answer is almost always that the rib joints at the back ends of the ribs where they hinge onto the vertebrae of your middle back (they’re called costovertebral joints (CVs)) are jammed up. You have to have movement of the rib hinges just to let you breathe and move around. If the CV hinges at the back are frozen, the rib hinges at the front where the ribs join onto the breastbone have to work overtime to compensate. So they get irritated and then inflamed.

    The front chest pain can be really severe and debilitating, and it’ll last as long as the CV hinges around the back are frozen, and that can be pretty much indefinitely. It’s NOT an injury taking time to heal – it’s a locking hinge problem, and they can just stay stuck until you get enough leverage onto them to free them up.

    Cheeringly, this isn’t difficult.

    There’s a New Zealand home device we use for it called the Backpod. It’s a high-tech fulcrum you lie back on at home, which uses your own upper body weight to stretch out the tough shortened material (called collagen) which holds a frozen rib hinge immobile. Just exercises on their own don’t have enough specific leverage to work the stuck hinges free – you have to use a strong localised external force. Once the CV hinges are freed up, the hinges at the other end of the ribs where they join onto the breastbone don’t have to work overtime simply to let you breathe, so they just settle down and stop being sore. It really is as logical and easy as that. Just treating the inflamed rib hinges around the front misses the point and doesn’t work.

    The Backpods are available off this website We built the Backpod for the usual hunching upper back problem in front of computers but they work excellently well for this specific rib problem. Best of luck – it’s truly a readily fixable problem.

    Steve August (B.A.,Dip.Physio.)

    Liked by 1 person

    • Carolyn Thomas August 27, 2015 at 1:20 pm #

      Hi Steve – I usually don’t publish comments related to selling a specific product, but given how little is available to patients living with costochondritis, I’m running your comment and contact info in case any of my readers would like to research and follow up. READERS TAKE NOTE: publishing Steve’s comment here does not suggest personal endorsement of the backpod.

      Like

      • Steve August August 27, 2015 at 2:50 pm #

        Hi Carolyn. Thank you! I really am trying to help – am not a car salesman! I’ve been reading some of the costochondritis (CC) blogs from the UK and the US and am sort of appalled at how much the problem just isn’t understood in those countries.

        New Zealand (and Australia) are good at practical musculoskeletal answers and CC simply isn’t difficult to sort out once you realise that it’s just the frozen hinge movement at the spinal end of the ribs that drives the acute irritation pain around the front. That really isn’t an inflated “I-am” claim: we certainly don’t get everything right but CC is one of the most straightforward logical conditions that we get to treat. I like seeing them presenting at my practice because they respond so well and logically.

        There are standard NZ hands-on physio techniques for freeing up the frozen rib hinges and sorting out the problem. But it seems like UK and especially US physiotherapists aren’t generally aware of them. So I think for anyone in those countries getting hold of a Backpod is a pretty good personal answer. The disclosure is that, yes, I am the inventor – but we developed it out of my expertise on spines: 30 years of treating patients and lecturing. I thought there was a need for something patients could use at home to free up frozen thoracic spinal and rib joints. Given the comments on the blogs, this is demonstrably the case!

        The Backpod website covers its main use in treating the common hunched upper back (usually over laptops, tablets and smartphones) driving neck pain and headache. The user guide that comes with it has specific instructions on how to use it for the tight rib hinges driving costochondritis. I’d have emphasised this latter use more if i’d realised how poorly the problem is understood outside NZ and Australia. Don’t give up – it’s readily fixable!

        Cheers, Steve August (B.A.,Dip.Physio.).

        Like

        • Carolyn Thomas August 27, 2015 at 3:21 pm #

          Steve, can you send us some links to recent studies on the link between this “frozen hinge movement” and costochondritis?

          Like

          • Steve August August 28, 2015 at 8:45 pm #

            Hi Carolyn.

            What I’d like to get across is just how mainstream and accepted the approach I’ve been talking about is inside New Zealand manual physiotherapy. It must be decades since I’ve looked for specific research on it. The explanation and treatment approach was worked out long ago – we’ve just been getting on with it and using it to fix the problem. I didn’t even realise it was a big problem outside NZ – let alone a mysterious and intractable one – until I strayed by chance into a costochondral blog.

            Happy to discuss this. I can see it’s a bit startling from your viewpoint. From my perspective it’s a bit weird also – feels like I have to assert and justify that, yes, the sun actually does rise in the east.

            Cheers,
            Steve August

            Like

            • Carolyn Thomas August 29, 2015 at 1:02 pm #

              Hi Steve – you don’t have to assert or justify anything to me. But if you’d like me (and my readers here) to take your word for it, help us out by providing links to the science. This could be the best thing since sliced bread, but if you read any of my blog posts at all, you’d already know that I like evidence, whether we’re talking abut statins or stents or frozen hinges!

              Like

    • Deone January 26, 2016 at 4:46 pm #

      Steve: What about exercise related CC? I’m relatively certain that’s what kicked mine off as I was doing dips (really deep, and likely with bad form), and felt some pain.

      The pain is really high up though, between my pecs. Does this sound like costo (I had begun to think I cracked my sternum as the pain worsened and became sharp upon going back to pipeline work where I have to carry 75lbs+ regularly).

      Like

  13. Carolina August 21, 2015 at 1:11 am #

    Hello,

    I’m a fifteen year old female and during mid July I started experiencing chest pain that felt like my chest was closing in, there was a lot of pressure, I had difficultly breathing and felt like I couldn’t get enough air. At first I didn’t make a big deal of it because it went away a few hours later.

    Days passed and the pain would come back occasionally, where some days it would get worse. Even when I do everyday things (walking, running, standing, laying down, sitting etc) I would lose my breath and have a little bit of pain; then two days ago it came back and my mother who was concerned brought me to the hospital to see if it was anything serious. The doctor had diagnosed me with costochondritis and recommended me to take some Advil. However it does help the chest pain but it doesn’t help when I have trouble breathing. I don’t know if anyone else experienced this either? The doctors said it’s stress but to be honest I have no stress whatsoever. It happens everyday when I feel like I’m losing my breath, not getting enough air, and coughing a lot.

    Like

    • Carolyn Thomas August 21, 2015 at 6:44 am #

      Hello Carolina – sorry to hear you have these distressing symptoms. If this is costochondritis, it’s not uncommon for pain to increase when taking deep breaths, hence the shallow breathing problems sometimes reported (not so much that you can’t breathe, but that you can’t do so without experiencing more pain). Sometimes symptoms flare after a cold or other upper respiratory infection; rest seems to be an important therapy. If your symptoms continue, do not hesitate to seek further medical help. Best of luck to you…

      Like

  14. Alise August 15, 2015 at 7:00 am #

    My Rheumatologist hasn’t decided whether it’s costochondritis or rheumatoid arthritis. The pain that I get seems to begin in my throat, it feels like an anxiety attack starting. I’ve had a stress test, an EKG and the X-ray that comes with it and found that my hyper anxiety is 90% as my stress increases. So I know and can relate to what everyone was discussing. Even as I’m typing this, my chest wall feels sore again.

    I do know that while I was in school carrying a heavy backpack of books not long after a head injury, I’d been having this pain. But now my anxiety level has increased to the point of having caused a fit. As my stress increases so does the anxiety and as the anxiety increases so does the costo. Sometimes I feel like I’m in a no-win situation.

    I’m going to my cardiologist in a couple of days because I need him to explain the difference or how to tell the difference between costo, angina, and panic attacks.

    Like

    • Carolyn Thomas August 15, 2015 at 7:30 am #

      You have hit upon the real question here, Alise: how to tell the difference between three possible diagnoses that can all show very similar symptoms. Best of luck to you in your appointment…

      Like

  15. Hannah June 14, 2015 at 9:53 pm #

    I’m fifteen years old and was diagnosed with chronic costochondritis two years ago.

    I was doing dishes when I suffered my first attack. It was sudden; I hadn’t moved anything heavy, no quick movements that could’ve caused injury. It was an abrupt mixture of a burning, throbbing, and tightening pain right under my breasts on my ribcage; the pain radiated to my stomach and my back. It felt like someone had stabbed me underneath my sternum. My father quickly took me to the nearest hospital, where I was diagnosed with it and was sore for months, as well as trouble getting a proper inhale.

    My symptoms and flareups have eased considerably over the last couple of years. I still experience flareups around my menstrual cycle, random stabs of pain usually in a few of my left ribs or left breast, right over my heart. It’s a bit scary considering I feel tremors and tightness over such a critical area, and reading this article has definitely expanded my awareness. My breasts are sore and tender as well as my back and the pain sometimes runs through my arms and legs. Even under my armpits are extremely tender. The only way I can describe the discomfort is like a spear going through my back at any angle where the pain is: pain starting from one side directly to the other in the same spot. It almost feels like my chest is covered in bruises or starting to bruise.

    The odd thing about my condition is that my father suffered with the same thing starting around my age, peaking in his early twenties and then slowly dying down. He’s now forty-five, saying that he still has slight pain but has become accustomed to it. However, there is no scientific link to costochondritis being genetic.

    Is there any way to calm the pain and ease the severity of flareups without NSAID’s? I take Aleve but it usually does nothing. My mother suggested cortisone shots as well. I feel like the pain will never die down, nothing seems to work anymore.

    Liked by 1 person

    • Carolyn Thomas June 15, 2015 at 4:30 am #

      Hello Hannah and thanks for sharing your story here. I’m so sorry you have had to go through all of this pain, especially at your age – but it’s interesting that your Dad also suffered the same symptoms. Some scientists suggest there may indeed be a genetic predisposition. I’m not a physician so cannot comment specifically on your case, but I can tell you that there have been some studies suggesting a link between costochondritis and other inflammatory conditions (arthritis, fibromyalgia, irritable bowel syndrome, for example) and possibly even Vitamin D deficiency. If there is a Pain Clinic near you, consider asking your physician for a referral (pain self-management is an important skill taught by most pain specialists). Best of luck to you…

      Like

    • paul June 17, 2015 at 1:19 pm #

      Hi
      Here is my recommendation of what to do, having gone through the same symptoms after a heart attack.

      Muscles develop a memory and just need a little jog to forget the spasms they create. Like driving a car your legs muscles do the work automatically or riding a bike, so the more pain they create the more normal the muscles believe it is correct.
      Find a Musculoskeletal Doctor, write a list of all your symptoms and give it to them to read, as they will start asking questions which can drag you off track and you will forget to mention things.

      When you are about to go to the appointment, get a pen or some small Band-Aids and mark or put them on the sore spots. Tell the doctor you want a local anesthetic injected into all the hot spots that you have found and the muscles around the area, including the muscle between the shoulder blades and the muscles that come down from the side of you neck to the top of your shoulders, they usually have knots in them which can also cause light headedness.

      Then wait till the next morning and it should have helped, once the muscles have relaxed your state of mind will relax and so will the body. You may have to go back for a little tweaking from time to time. You won’t need to take any drugs, which I found nothing worked anyway.

      Good Luck
      Paul

      Like

      • Carolyn Thomas June 17, 2015 at 9:43 pm #

        Paul, it’s important to remember that costochondritis is generally unrelated to cardiac pain following a heart attack, so what worked for you (local anaesthetic) may have nothing to do with costochondritis.

        Like

  16. Steve Davis June 13, 2015 at 5:48 am #

    I used to workout in cable crossover machine in the Gym and one day I pulled little heavy weights. After 2 days I felt chest discomfort so bad that I ran to ER. There was nothing in the EKG and doctor gave me a few medicines including Aspirin. The other day I felt chest discomfort again in the office. I ran to the ER a second time but nothing came up in the EKG.

    After that I went to a cardiologist; he ran many tests like stress test, heart ultrasound, heart CT Scan. The result was 0% blockage of arteries with mild heart valve leak. Cardiologist said it’s normal. Cholesterol level was high to 225 and LDL 130 so he put me to 20 mg Lipitor medication.

    After 2 months of Lipitor I started feeling low blood pressure. I was not able to exercise after that and getting shocks in chest in movement. I complained to the doctor and he reduced the Lipitor dose to 10 mg with CoQ10 medicine. Doctor said there is no heart issue.

    But I remained as it is with chest pain in center. I cannot bend down to lift any object or weight from ground because I feel heavy pain in whole chest from center. In the morning I cannot wake up and roll over in bed as my chest gives me unbearable pain in center when moving my position and waking up from my bed. I am not sure where to go to find the cause and which doctor will do the treatment. I am left with chest pain forever.

    Like

    • Carolyn Thomas June 13, 2015 at 6:25 am #

      Steve, I’m not a physician so cannot comment on your specific case. But I can tell you generally that when symptoms strike suddenly after what looks like a specific incident in the gym, that seems a good place to start investigating – especially since all of your tests don’t seem to indicate a cardiac source for pain that is affecting your daily quality of life. Consult your family doctor right away for referrals to solve this mystery. Something is causing your symptoms – you and your doctor need to find out what that is. Best of luck to you…

      Like

  17. Susan P May 26, 2015 at 11:20 am #

    I’ve been diagnosed multiple times with costochondritis and/or pleurisy. I have an aching, sore feeling in my chest along my bra line under both breasts – but more prevalent under my right breast. I’ve had multiple EKG’s and my gallbladder has been tested, so it isn’t either of them. I do have fibromyalgia and some sort of internal inflammation (my doctor hesitates to call it rheumatoid arthritis yet), but this chest pain has lasted for almost a year, off and on. It is very frustrating because nothing seems to be being done.

    Liked by 1 person

    • Carolyn Thomas May 26, 2015 at 1:07 pm #

      Hi Susan – my understanding is that if this were costochondritis, treatments that work include rest, ice/heat, anti-inflammatory/pain medications, or even (as Kelly Young has found) steroid injections for severe cases. Go back to the doctor who diagnosed you for a comprehensive treatment plan. Do not accept “nothing can be done” for an answer!

      Like

    • Carole July 29, 2015 at 11:40 pm #

      I haven’t been able to wear a bra without pain for over 40 years. I know how you feel. The pressure from the band under the bra is too much. I was labeled with fibromyalgia in 1989, but suffered years before that. Luckily I am only a B cup and found ways to wear clothes in the winter to disguise my missing bra, but summer is harder. I never tried cortisone shots along bra line, because I never thought of it. They did help immensely in other areas. You might want to try it. I may check it out for myself now! :) Good luck!

      Liked by 1 person

      • Carolyn Thomas July 30, 2015 at 6:11 am #

        40 years of pain is a long time, Carole! Thanks for sharing your experience here, and best of luck to you…

        Like

  18. Marsha May 11, 2015 at 10:47 pm #

    Year 2013, my doctor told me that I have costochondritis, and the pain was there. My doctor give me pain relievers and after that the pain would come back and radiate in my right upper back. Year 2014, I go back to the doctor and he told me that I have scoliosis as seen in my x-ray… The pain is there… what can I do?

    Like

    • Carolyn Thomas May 13, 2015 at 7:50 am #

      Marsha, please make an appointment with your doctor to review a full treatment plan for your symptoms – no matter what the diagnosis. Do not leave that appointment until you understand all the details of your diagnosis. Best of luck to you…

      Like

  19. Shoshanna April 23, 2015 at 3:38 am #

    I’m only 15 and I’ve had Costochondritis since I was 8 and they diagnosed me with it last year…

    It’s very painful, for me it’s like mini heart attacks and it aches and sometimes the pain radiates to my stomach or back but it usually is under my left or right breast bone. However the pain actually has hurt pretty much everywhere around my breast bone, sometimes the pain is attached to my breathing though. I went to the doctor after being in severe pain for a whole week straight and he ended up popping my bone back in place. I stopped drinking caffeine and I stopped working out my arms because they both make my Costo hurt bad… Inhaling smoke is really bad too, and I just don’t do workouts except cardio that doesn’t include my arms at all.

    Liked by 1 person

    • Carolyn Thomas April 23, 2015 at 5:25 am #

      Hello Shoshanna and thanks for sharing your story here. Seven years is a long time to wait for an accurate diagnosis! You’ve modified a few strategies that work to relieve symptoms (caffeine, workouts) but next time, do NOT wait a full week before seeking medical care for severe pain. Best of luck to you…

      Like

  20. Janine December 17, 2014 at 2:52 pm #

    I have now been living with infectious costochondritis for the past 3 months,after getting gastritis.

    I am in so much pain practically every day, it really is debilitating, I can’t do much in a day, I have to rely on my family a lot, I have been off work now for 4 months and fear I may have to give up my job, as have been told this is a long term illness for me.

    One doctor said it’s the worse case of costochondritis he has ever seen in all his 25 years as a doctor. I am at my surgery every other week, as the painkillers stop working after a while. So I go back for stronger ones. If I have 2 good days then it comes back with a vengeance. Am also on antidepressants to help me cope with the pain, but it’s not letting up. I honestly think the doctors are running out of things to do for me. And my 13 year old daughter is fed up with having a mum who is in chronic pain.

    It just seems like not a lot is being done research wise. Not that I would but I can seriously understand why people who live with chronic pain take their own lives.

    Like

    • Carolyn Thomas December 17, 2014 at 4:29 pm #

      Thank you Janine for sharing your costrochondritis story here. It is not surprising at all that you are depressed – few people understand that living with pain can change your entire personality. If you have access to a pain clinic near you, please ask your doctor for a referral. Meanwhile, I’m keeping fingers crossed that your symptoms will start to ease up very soon.

      Liked by 1 person

    • Stephanie September 21, 2015 at 4:42 pm #

      I have had the same symptoms as you for three years. I also get vertigo too. I’m so fed up with pain, don’t know what to do any more.

      Like

      • Stephanie September 21, 2015 at 4:45 pm #

        Can I ask does anyone with these problems have food intolerance like diary gluten etc?

        Like

  21. Amy November 2, 2014 at 4:25 pm #

    I was diagnosed with costochondritis Feb 2013. After 10 months of trying different medications and therapies I finally had it controlled enough to go back to work. It continued to bother me but I was able to tolerate the pain.

    Then today I ended up in emergency department with what felt like a heart attack. After 3 1/2 hours on heart monitors and heavy pain meds, they ruled it to be my costochondritis. Everything I read says that this condition only lasts days or months. Where can I find more information on this condition and what things I could encounter with it? It doesn’t look like it is going away anytime soon for me.

    Like

    • Carolyn Thomas November 2, 2014 at 4:38 pm #

      Amy, I’m so sorry to hear your story. This sounds just awful! You were smart to go to Emergency – as you never want to assume that symptoms are “just” costochondritis. Here’s what I’d do if you haven’t done so already: do a search on the WomenHeart online support community – just type in costochondritis into the search box called Search This Community in the upper right corner. You’ll get dozens of discussion topics on this subject. Best of luck to you…

      Like

      • Amy November 2, 2014 at 4:41 pm #

        Thank you I will certainly check that out. =)

        Like

  22. Jo October 14, 2014 at 7:02 am #

    I have 8 stents in. Lately, I have symptoms of what I think is “costochondritis.” It feels more like sore chest wall pain rather than the chest pain I had before when I had my heart attack. It actually hurts when I try to speak long sentances. My chest starts squeezing and hurting as I speak and until I take a breath it is like a crescendo of pain-soreness. Today it was rather bad so I just ate 3 junior baby aspirins. If there is a doc out there, I wanted to know, is there such a thing of chest wall pain from the stents I may have? Has this ever been discussed or recorded. Sometimes the pain is sharp and sore in my chest. I keep thinking it is the actual stents hurting….is this possible?

    Like

    • Carolyn Thomas October 14, 2014 at 7:36 am #

      Hello Jo – I’m not a physician so of course cannot comment on your specific symptoms. But I can tell you that in general, something docs call “stretching pain” is common in recently-stented patients. If your stents were implanted some time ago, however, please see a doctor about your pain.

      Like

  23. Ralph Beckett, MD December 30, 2013 at 10:12 am #

    When I went to medical school 35 years ago, the teaching was to be very careful with the diagnosis of costochondritis. Because 50% of the time, chest pains are actually something else. This should be an expected piece of knowledge in any health care providers’ brain.

    On the other hand, I have seen many patients who have undergone extensive (and unnecessary) cardiac evaluations without the slightest consideration of something besides heart problems. Two cardiac caths before the diagnosis of costochondritis is inexcusable. This problem cuts both ways.

    Liked by 1 person

    • Carolyn Thomas December 30, 2013 at 12:35 pm #

      Good point, Dr. B: in either case, non-cardiac issues can cause chest pain – and cardiac issues can have no associated chest symptoms at all.

      Like

  24. Anne December 26, 2013 at 7:22 am #

    Good article. Heart patients need to check in with their cardiologist before using NSAIDs as they raise the risk of coronary damage.

    Like

    • Carolyn Thomas December 26, 2013 at 7:38 am #

      Thanks for this reminder, Anne. Studies have found that, among those who had already had one heart attack, people who took the painkillers called NSAIDs (non-steroidal anti-inflammatory drugs) such as Vioxx, Bextra, Aleve, Advil, Motrin, etc. were at >40% higher risk of having a second heart attack compared with those who did not take them.

      Like

      • Magda December 26, 2013 at 8:33 am #

        Good article. In addition to heart disease, I also have this from a car accident where I was injured by the seatbelt. I often have swelling and pain, but no doctor has diagnosed it. I had to learn to tell the difference since doctors often dismiss it and tell me to take an anti-inflammatory. I usually suffer through or use ice, since I don’t want to take risks with the NSAIDs.

        Like

        • Carolyn Thomas December 26, 2013 at 9:26 am #

          Thanks Magda – I hope your symptoms improve over time.

          Like

          • Dr. Barbara Keddy December 26, 2013 at 7:13 pm #

            I have both – heart disease and chronic costochondritis. I have lived with the latter for many decades because of fibromyalgia. Because this can mimic a heart attack it causes me great anxiety. My HA presented as the classic chest pain and it was a few minutes before I realized this was different than what I had been living with for many years.

            However, flare-ups are anxiety provoking! Almost a year now and the constant pain in my chest, neck, jaw stirs up the same questions: is it fibro? costochondritis? another HA? I’ve come to the conclusion I have to live with the uncertainty- the challenges of daily living! :-(

            Like

            • Carolyn Thomas December 26, 2013 at 7:42 pm #

              Hello Barbara and thanks so much for sharing your unique personal experience. When I was writing this post, I was so surprised to learn that 60% to 70% of those with fibromyalgia may also have symptoms of costochondritis, too. One report suggests that such people might find themselves “with an ice pack on your chest and a heating pad on your back at the same time.”

              Like

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