Possible Costochondritis

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Hello all.

As I know I've mentioned before, one of my worst symptoms of ANS/POTS is crushing chest pain. My doctor and I ruled out any serious heart problems which of course was a relief, but doesn't help me at all with managing the pain. It's an every-day all-day thing, although some days are better than others, and it hurts more when I breathe, so my docs suspect it's related to lungs/trachea. At first we thought maybe it was caused by GERD (which I have) but I've done a lot to improve the GERD and feel a lot better in general but don't feel any different with the chest pain. Now my doc is talking about possible chondritis, but I don't have EDS, just POTS and a few general dysautonomia problems that haven't really been pinned down (including the chest pain). So I have three main questions.

First, *is* costochondritis related to POTS at all, or only other ANS problems like EDS?

And secondly, for those of you who have it, how do you deal with it and does anything help with the pain??? When I take massive amounts of anti-inflammatories it seems to help some, but I don't want to damage my liver by taking them every single day. I've had this problem for almost two years so I don't think it's going to go away on it's own.

Lastly, how could my doctor diagnose this for sure? She mentioned I could have an x-ray, but that it might be inconclusive, and she seems reluctant to do it because it's expensive and I have bad health insurance. Are there any tests that are fairly conclusive, and would be worth my money so to speak?

Any advice would be greatly appreciated!!

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[marshallgurl]

Well, as far as the relation to POTS I have no clue, But I also have costochondritis and it ***** most of the time. When first diagnosed I was taking 800mg of Ibuprofen 3x a day but have since stopped this. It helped a little but not enough to really make a difference and after the prolonged use of this Med I now have a lot of problems with constant pain. I was recently diagnosed with advanced arthritis in my back and leg and the Ibuprofen doesn't help anymore, doc said it was because my body is too used to the drug so it doesn't work properly (or something like that).

This excerpt is from WebMD- Costochondritis does not lend itself to diagnosis by tests. Personal history and physical exam are the mainstays of diagnosis. Tests however are sometimes used to rule out other conditions that can have similar symptoms but are more dangerous, such as heart disease.

For me, I had several chest X-rays, basically 1 every 3 months for a year; My Cardio at the time did a lot of poking to find the specific location of pain which was also the site of most of the swelling; We also did several other Cardio-related tests and he said that there was evidence of swelling.

I hope this helps a little, it isn't much info but I don know what you are going through and it definitely *****. I don't really do anything specific to treat the problem, I just try to avoid things that I know will make it worse (like letting my 20lb cat lie on my chest). I take Ibuprofen ONLY if I need it bad enough, like you have said, I would like to not cause any damage to my liver.

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Thanks marshallgurl, that was really helpful information.

One thing I keep reading over and over is that "costochondritis usually goes away on its own in 2 - 8 weeks." I even read on one medical website that is it NEVER a chronic condition. Have you had it for a long time? If I've had this problem for over a year, does that mean it isn't costochondritis?

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[marshallgurl]

That's a good catch on the 2-8 weeks thing. I am pretty sure that I was diagnosed sometime in 2004, so going on 4 years now. That makes me wonder if the pain is still considered to be costochondritis if there is no swelling. I've been told many times over the last few years that that is what I had/have, and that is why my chest will hurt as often as it does, so that I won't freak out and think i'm having a heart attack. I'm going to ask about it going away on its own, I never gave it much thought before now.

I can at least say that I don't currently have any pain and haven't really had any lately, at least nothing to bother me too bad. I do recommend more than one opinion, nothing against my PCM but with these kinds of problems I like to know that I am getting as much info as I can. So I would make sure to ask more than one Doc. just to be as informed as you can be.

I wish you the best and if there is anything else I can tell you just let me know.

Sarah

[pat57]

My Dr. ordered Advil gel caps 2x a day for 8 days (WITH FOOD). It worked.

This may sound silly but make sure your bra is not to tight and trash the underwires -lets say for a month.

It matters.

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Pat, that doesn't sound funny at all!!

I already take all the underwires out of my bra, and I tend to wear them pretty loose.

Did your experience with this last for a long time?

The more I read the more I question that this is what I deal with. This has been a very consistent pain for well over a year - it never goes away completely, although if I do something like wear a back pack it gets worse. Plus, I can't make it hurt more by pushing on my ribcage -- although it is definitely my ribs that hurt. It's more of an all-over rib pain instead of a particular swollen spot.

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[Amber]

fibromyalgia maybe?

[Sunfish]

there's definitely no direct relationship between costochondritis & POTS (or any dysautonomia for that matter). that said, i don't know enough about EDS, (which is generally understood to, in some cases, be related to POTS), to say whether it (EDS) may be a risk-factor for costochondritis. but seeing as you don't have EDS that doesn't really matter much, does it? so moving on...

i've had costochondritis so know first-hand that it is NOT fun. mine was pretty distinctly the result of an injury from vomiting; considering how much of that i've done over the years (b/c of gastroparesis) my doc told me that she was amazed it was the first time i'd had a problem. so i guess i'm lucky?!

initially my pain had a sharp component that reminded my of pain i've had with several bouts of pneumonia &/or pleural effusions; the difference was that there was also a soreness component externally, aka with palpation. the sharp part of the pain improved a bit before the soreness but would still come back with a deep breath. and it hurt pretty badly for sure. as an FYI, the fact that your pain hurts upon breathing doesn't particularly point to it being a lung/ respiratory problem. when i had the costo breathing was just as painful as many (though not all) of the times i've had pneumonia &/or pleural effusions.

in addition to taking motrin/ ibuprofen alternating with tylenol, as well as increasing my regular pain meds (opiates) for a few days so that i could at least be comfortable enough to breath well enough to function/ sleep, my doc prescribed me a patch by the name of "Flector" (the name brand). it's fairly new to the market & not cheap, but it worked quite well. essentially it's an anti-inflammatory that works locally rather than systemically. you put the patch on over the area that hurts the most & after a bit of time (i can't remember how long....a couple of hours i think) the full effect kicks in. it didn't take care of the pain entirely but allowed me to take significantly less "oral" (for me via my J tube) meds & certainly made for a more pleasant few months. the patches are intended for a wide variety of inflammatory conditions and, by way of whether or not they help at all, are in a way diagnostic in terms of whether the pain one is having has an inflammatory component. each patch last 12 hours so the idea is to change them on a schedule to keep a steady dose of the med going such that you don't have the lag time of waiting for it to kick in.

i don't know a lot about costochondritis but what i do know supports the idea that it usually goes away on its own within a few months or so. that said, if there's any way you might be doing something (i.e. vomiting) chronically to keep irritating/ injuring the area, i don't see why it couldn't be something chronic. as for diagnosis, i do know that xrays aren't worth a whole lot. they'll show if something (i.e. a rib) is broken, but won't show a thing as far as injury/ inflammation in the cartilage. when i was hurting my doc said we could do an xray if i really wanted but that it wouldn't change anything as, even if i'd had a break/ fracture, we'd still be treating me the same way; as such i didn't get one. i'm not sure if an MRI or CT scan would ever shed light on a long-standing problem such as what you're dealing with? though as a long shot i doubt either are a viable option with less than ideal health insurance.

regardless, i'm sorry you're dealing with this. i don't envy you one bit. i live with pain all of the time (mostly related to intestinal pseudo-obstruction) but the costo pain was particularly tough as it was so interconnected with every part of me....any move i made regardless of position, breathing, etc so i certainly hope you find, if not an answer, a way to find a bit more relief. since you say that anti-inflammatories do seem to help you some perhaps trying the flector patches might be a viable option? as for the expense, one thing to keep in mind is that they're pretty large and, as such, you may be able to get 2 uses out of one patch; they are safe to cut in half.

hope this helps,

melissa

[pat57]

I have had 3 bouts with it. the first ,I was only 8, suffered about a year ended up inpatient in the hospital and they didn't find the cause either. But after that my Dr. did. Then there was a pregnancy. Bras too tight. Went away on its own. This last time I guess about a year also. The Advil cured it.

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Thanks so much for all the information!!

This has all been really interesting. I'm going to see about trying those patches to see if they help more.

The reason I thought it was connected to POTS/dysaut is that the pain gets significantly worse when my other symptoms get worse -- but I wonder if my POTS symptoms are just aggravating the problem instead of causing it. I wonder if tachycardia could be re-irritating my ribcage? My heart beats hard when I'm not well but I'm not entirely sure it beats THAT hard. Last week I did have much worse pain after I had been sick (vomited) the day before, which had been due to pushing myself and I had lots of GI problems as a result. So that could be part of it....

Another thing is it gets much much worse when I don't drink enough water. I'm not sure if I'm going to ever really figure out what's going on, though. I keep researching things on-line and don't really find anything that sounds like a true description of what I'm dealing with. . . .

Thanks again, if anyone has any thoughts on how hydration might affect chest pain, I'd love to hear about it...

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