Costochondritis Chest Pain in Fibromyalgia

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A condition called costochondritis, which causes pain around the breast bone and rib cage, is believed to be common in people with fibromyalgia (FMS). It's also called noncardiac chest pain or musculoskeletal chest pain.

A lot of people don't realize this pain could be caused by a separate condition causing that requires its own treatment. Because any other sources of pain can make your FMS symptoms worse, it's important for you to treat costochondritis.

Costochondritis can make you think you're having cardiac problems, which is a scary thing. Even though costochondritis is common, you should seek medical advice if you have unexplained chest pain. You don't want to assume that it's FMS-related and end up with permanent heart damage or worse.

Overview

Costochondritis is an inflammation of the cartilage that connects your ribs to your breast bone. Depending on how much inflammation there is, it can range from a mild annoyance to extremely painful. People sometimes describe the pain as stabbing, aching, or burning.

The causes aren't clear but may include:

  • chest trauma, such as from a car accident
  • repetitive trauma or overuse
  • viral infections, especially upper respiratory infections

Some experts believe FMS may cause costochondritis as well. Regardless, FMS can make costochondritis much more painful.

Why Do They Go Together?

Estimates are that between 60 and 70 percent of people with FMS have symptoms very similar to costochondritis.

In one study, non-specific chest pain is listed as the most common reason people with FMS were hospitalized. Another lists FMS as a frequent cause of musculoskeletal chest pain.

No one is exactly sure whether it is true costochondritis or why it occurs with FMS. If the hypothesis of inflammation of the fascia is accurate, that may explain it.

Also, the fibromyalgia tender points just beneath the collar bone may play a role. Myofascial pain syndrome, which is common in FMS, also could be a cause.

Costochondritis is typically a minor injury that heals within days. If symptoms don't clear up, they could be a sign that something else, such as FMS, is going on.

Symptoms

Pain in the chest wall and rib cage is the chief symptom of costochondritis. Generally, it will get worse with activity or exercise. Taking a deep breath can also cause more pain because it stretches the inflamed cartilage. Sneezing and coughing can increase pain as well.

The pain can radiate to your shoulder and arms as well (another way the condition mimics a heart attack). Sometimes the pain is accompanied by redness and/or swelling in the most painful areas. When that's the case, it's called Tietze's Syndrome.

Diagnosis

Your doctor can diagnose costochondritis by pressing on the area where the ribs and breast bone come together. If it's tender and sore there, costochondritis is the most likely cause of pain.

Doctors generally will perform other tests to rule out heart problems and other causes of pain before making a diagnosis.

Treatment 

You can treat costochondritis the way you'd treat any inflammation—ice and anti-inflammatory drugs, including Aleve (naproxen) and ibuprofen-based drugs such as Advil and Motrin.

This treatment sometimes runs counter to FMS treatments, which can include other types of pain relievers and heat. If you have both, you might find yourself with an ice pack on your chest and a heating pad on your back at the same time.

Your doctor may recommend other types of treatment as well, including physical therapy or acupuncture.

Be sure to check with your doctor or pharmacist about any possible interactions between anti-inflammatories and your other medications.

Living With Both Conditions

It's bad enough to live with one source of chronic pain. The more you heap on, the more pain you'll have and the more it can impact your life.

Fortunately, costochondritis is fairly easy and inexpensive to treat, and managing it will keep it from exacerbating your FMS symptoms.

Sources:

Ayloo A, Cvengros T, Marella S. Evaluation and treatment of musculoskeletal chest pain. Primary Care. 2013;( 4):863-87.

Flowers, LK. Costochondritis. eMedicine.

Haviland MG, Banta JE, Przekop P. Fibromyalgia: prevalence, course, and co-morbidities in hospitalized patients in the United States, 1999-2007. Clinical and Experimental Rheumatology. 2011;(6 Suppl 69):S79-87.

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