Home' Australian Pharmacist : Australian Pharmacist May 2012 Contents Australian Pharmacist May 2012 I © Pharmaceutical Society of Australia Ltd.
investigation (e.g. ECG, serum troponin,
chest X-ray) are necessary to exclude
other potential diagnoses, and the
diagnosis of costochondritis is made only
after more serious causes of chest pain
have been excluded. Musculoskeletal
chest pain can usually be confirmed by
clinical examination alone. Pain that is
reproduced by movement or palpation
of the chest wall is unlikely to be of
cardiac origin and can help to confirm
a musculoskeletal cause.3 Symptoms of
costochondritis are typically exacerbated
by trunk movement, deep breathing,
coughing or sneezing. Importantly,
the presence of costochondritis does not
exclude the possibility of concomitant
serious cardiac or pulmonary conditions.
The aetiology of costochondritis is not
clear. It is most likely related to repetitive
minor trauma to the chest wall, viral
infections (particularly upper respiratory
infections) and fibromyalgia. Bacterial or
fungal infections of the costochondral
joints are uncommon and usually occur
following thoracic surgery or major chest
injuries, or in people who are intravenous
The symptoms of costochondritis
generally resolve gradually over a period
of 4–8 weeks, although recurrences are
common. Spontaneous resolution is
seen in most cases within one year.2,9
Reassurance about the benign nature of
the problem and avoiding activities that
involve stressing the structures of the
front of the chest cage are often all that
is required.3 Otherwise, costochondritis
usually responds to conservative drug
treatment, including oral or topical
non-steroidal anti-inflammatory drugs
(NSAIDs) unless contraindicated or
simple analgesics.3,7,9 Applying heat with
compresses or heating pads can help,
particularly in cases of muscle overuse.9
In severe cases of costochondritis,
corticosteroid or lignocaine injections
have been used. In recurrent cases,
sulfasalazine may provide long-
Pharmacists and patients should
appreciate that chest pain is an
NMS brings together the partners to Australia’s National
Medicines Policy along with international representatives
to learn, discuss and debate contemporary quality use
of medicines issues. A must for anyone involved in the
medicines and health care industries.
WHY YOU SHOULD ATTEND
For safer use of medicines
In an ever changing health system
Enabled by new technologies
Through valuing the consumer experience
By putting policy into practice
Prof Nick Barber
The School of Pharmacy,
University College London (UK)
Vice President for Online
Services, Kaiser Permanente
Dr Krisantha Weerasuriya
Medical Officer, Medicines
Access and Rational Use
in Essential Medicines and
STELLAR LINEUP OF SPEAKERS INCLUDING:
SYDNEY CONVENTION & EXHIBITION CENTRE
24–25 MAY 2012
PROJECT NMS PrintAd April
SIZE / STAGE 210mm x 137mm / FA01
CONTACT / DATE MvdM / March 13, 2012
FONT FAMILY USED: GOTHAM FAMILY
CLIENT: Whilst all care is taken in preparing this artwork the client assumes sole
responsibility for copy accuracy and printing
PRINT SUPPLIER: Yo u are responsible for checking artwork before plates are made
for accuracy in measurements, plate requirements, registration and
COLOURS are a guide only – refer to Pantone colour chips.
NPS0049_NMS Ad 210wX137h April FA01.indd 1
13/03/12 6:20 PM
emergency and medical attention
should always be sought immediately.
There are a range of possible causes
of chest pain or discomfort that may
involve cardiovascular, musculoskeletal,
pulmonary or other systems. A cardiac
cause of chest pain should always be
suspected, particularly in older patients
with a history or risk of coronary
1. Fam AG, Smythe HA. Musculoskeletal chest wall pain. CMAJ.
2. Disla E, Rhim HR, Reddy A, et al. Costochondritis. A prospective
analysis in an emergency department setting. Arch Intern Med.
1994; 154(21):2466–9 .
3. Jensen S. Musculoskeletal causes of chest pain. Aust Fam
Physician. 2001; 30(9):834–9 .
4. Eslick GD, Fass R. Noncardiac chest pain: evaluation and
treatment. Gastroenterol Clin North Am. 2003; 32(2):531–52 .
5. Wolf E, Stern S. Costosternal syndrome: its frequency and
importance in differential diagnosis of coronary heart disease.
Arch Intern Med. 1976; 136(2):189–91.
6. Mayo Clinic Health Information. Costochondritis [online]. 2012.
7. Fam AG. Approach to musculoskeletal chest wall pain. Prim
Care. 1988; 15(4):767–82.
8. Flowers LK. Costochondritis [online]. 2009. Medscape
Reference. At: http://emedicine.medscape.com/
9. Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment.
Am Fam Physician. 2009; 80(6):617–20.
10. Freeston J, Karim Z, Lindsay K, et al. Can early diagnosis and
management of costochondritis reduce acute chest pain
admissions? J Rheumatol. 2004; 31(11):2269–71 .
11. Peterson G. Chest pain: prompt referral is the best approach.
Aust Pharm. 2003; 22(4):296–8 .
Links Archive Australian Pharmacist June 2012 Australian Pharmacist April 2012 Navigation Previous Page Next Page