FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

CHEST PAIN MAY BE TIETZE'S SYNDROME

Question: I'm having a terrible time with chest pain. My doctor says I have costochondritis, and he has recommended that I take aspirin. It helps my pain, but it hurts my stomach enough that I can't continue to take it. What causes costochondritis and what can I do for it since I can't take aspirin?

Answer: Chest pain is a common symptom. Most males think they are having a heart problem when they first experience chest pain, and most females think they have breast cancer. These are normal reactions since these conditions are common and serious. Fortunately, costochondritis isn't a life-threatening illness as are heart disease and cancer. However, it sure can make you mighty uncomfortable.

Our ribs are an important part of the human body. They form a protective cage around the vital organs within the chest. In addition to their protective role, the ribs also must move sort of like the sides of a bellows to help force air into and out of the lungs. Accommodating these two roles poses some mechanical dilemmas. The best protective rib cage would be rigid, while the best "bellows" action requires movement. Creatures with a bony skeleton, including humans, solve this problem in a similar way.

Ribs are rigid because they are bone, and this rigidity provides an excellent protective cage as well as a firm structure for the attachment of muscles. Each rib is attached to the vertebra of the backbone with a type of joint that allows gliding motion. The situation is a little different in the front of the chest where most ribs are attached to the breastbone with a section of flexible cartilage that bends to accommodate rib motion instead of gliding as most joints do. Only the 11th and 12th rib pairs are not attached to the breastbone in this manner. Ribs, by the way, are numbered starting with the first pair near the neck and continuing down to the 12th set of ribs at the waist.

Costochondritis is just a quick way of describing the symptoms of painful swollen rib cartilage. It occurs most often to the cartilage of the second and third ribs either on one or on both sides of the chest. Ribs move with respiration, particularly with the deep breathing of exercise. The ribs also provide an attachment for some of the muscles that move the neck and shoulder. As you might assume from this arrangement, costochondritis can turn simple activities like taking a deep breath or reaching to retrieve a can from the pantry into a difficult and painful experience.

Medical science hasn't determined the cause of this condition, but it has given it an additional name Tietze's Syndrome. The symptoms usually clear without treatment in a few months, but that is a long time to wait for pain to go away. Pain medication, like the aspirin you have taken, anti-inflammatory drugs including aspirin, and heat may ease the discomfort. There is no specific medication or treatment that works best for this problem, and we have found no treatment that shortens the length of the illness. Our treatments only make it more bearable. Talk to your doctor about an anti-inflammatory medication that is less irritating to the stomach than aspirin. I'm sure he can help you get relief from the discomfort while you wait for your body to heal itself from this condition.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.