Treatments for Tietze’s SyndromeFiled under: Treatment | 36 Comments »

What are the best treatments for Tietze’s Syndrome?

Rest

Being barely able to move for six weeks due to Tietze’s syndrome was incredibly hard for me—I was a very active person and walked several miles a day. However, avoiding many “normal” activities were a must, to allow my ribs to heal. These included:

Coughing Heavy breathing (i.e. no intense exercise) Lifting Pulling Pushing Repetitive motions (tennis, baseball, scrubbing floors etc.) Sneezing Straining Lying down on my back (I slept propped up with many pillows). Lying on my

back forced pressure onto my breastbone.

Anti-inflammatory drugs

Nonsteroidal Anti-inflammatory Drugs (NSAIDS) like ibuprofen can help with pain management, but it’s important to realize that if your Tietze’s syndrome lasts more than a few weeks, you should probably consider alternate therapies. Many painkillers are harsh on the stomach, and are not without side effects. Phenylbutazone used to be used for the treatment of Tietze’s Syndrome, but is no longer sold in the United States for human consumption.

Physical therapy

Physical therapy can be helpful to identify what causes your Tietze’s syndrome pain, and to find ways to avoid or lessen the pain. Physical therapists can also help you design a program to strengthen certain muscle groups, so that less stress is placed on the chest area when performing certain tasks. Some physical therapists might use biofeedback when treating Tietze’s Syndrome.

Biofeedback

Closely related to psychotherapy, biofeedback trains a patient to respond to signals from their body. It has been successful with some stroke patients in regaining use of paralyzed muscles. It works for a myriad of diseases, and it could work for Tietze’s syndrome.

Cortisone injections

Cortisone shots into the cartilage can temporarily relive pain. These shots do have some side effects (such as temporary pain at the injection site). I had a cortisone shot once in my foot (I never did summon up the courage to get one in my chest for Tietze’s syndrome!), and it did a remarkable job at lessening the pain I experienced after some cartilage damage. An Intercostal nerve block is a steroid injected around the intercostal nerves located under each rib. One of the pain relief methods of last resort, an intercostal nerve block might help with Tietze’s Syndrome pain if all other methods have been exhausted.

Local Anesthetic Injection

A local anesthetic injection (sometimes in combination with a steroid as seen in this study) can be successful in reducing pain in the vast majority of Tietze’s syndrome patients; some reports state it can be up to 97% effective. You can read about stellate

ganglion block therapy–where a local anesthetic is introduced into the C7 vertebrae, in this article.

Ice packs and/ or heat

I used a heating pad for almost fifteen years for my Tietze’s Syndrome. I’ve read elsewhere that variations of hot and/or cold remedies also work: try one and see which one works for you:

Heating Pad Whirpool bath Microwaved, moist towel Ice Vapocoolant spray Over the counter Heat or Cooling Patches

Prescription patches

There are many types of prescription pain patches for Tietze’s syndrome, including ones that contain lidocaine (an anaesthetic) and ibuprofen (a pain reliever which reduces swelling). I tried a prescription patch with ibuprofen for a short time because I didn’t want to orally consume a lot of pain medication; it worked very well.

TENS (transcutaneous electrical stimulation)

I used a TENS machine during my first and second labors. A TENS machine delivers small electrical pulses to the skin. It doesn’t stop intense pain, but it can be useful to stop the mild to moderate pain associated with later-stage Tietze’s syndrome. The downside is they are expensive to purchase and/or rent, and they only work when the machine is on and the pads are applied (in other words, it would be difficult to use it outside of the house).

Acupuncture and Electroacupuncture

I personally have never tried acupuncture, but some people swear by it. Electroacupunture is acupuncture which delivers small electrical pulses to the skin. There’s no real scientific evidence that it works for Tietze’s syndrome, but as with all alternate therapies—if you think it might help relieve your pain, it could be worth a shot.

Massage Therapy

There’s no doubt about it, poor posture and stress can worsen the symptoms of Tietze’s Syndrome. And it’s a vicious cycle: the pain of Tietze’s can lead to tense muscles and poor posture. Massage therapy can aid in relaxation—an important part of dealing with the disorder. The more relaxed you are, there less likely you are to tense the muscles around your chest. Plus, people who are relaxed are more inclined to breathe deeply through the stomach (the type of breathing that is most beneficial for Tietze’s Syndrome).

Calcitonin

Some research has shown that just a small amount of human calcitonin (a drug more commonly used to treat bone loss in postmenopausal women) improved Tietze’s syndrome patient’s pain after a few days of treatment. According to Ricevuti, the hormone probably works because of the drug’s benefit on the immune system and because of its pain-relieving effects.

Surgery

Surgery is usually deemed necessary only for cases of Tietze’s syndrome that do not respond to conventional therapy. The surgeon can remove the affected joint.

——————————————————-References:Frontera, W. & Silver, J. Essentials of Physical Medicine and Rehabilitation. Philadelphia, PA: Saunders Elsevier, 2008.Kelley’s Textbook of Rheumatology, W B Saunders Co, edited by Shaun Ruddy, et al., 2000.Boehme, M. et al. Tietze’s syndrome–a chameleon under the thoracic abdominal pain syndrome Klin Wochenschr. 1988 Nov 15;66(22):1142-5.Imamura, M. and Imamura, I Essentials of Physical Medicien. Philadelphia, PA: Saunders. 2008.Mansel, R. Recent developments in the study of benign breast disease. New York, NY: Parthenon Publishing Group. 1997.Ricevuti G. Effects of human calcitonin on pain in the treatment of Tietze’s syndrome Clin Ther. 1985;7(6):669-73.Shiel, W. Costochondritis & Tietze Syndrome. Article posted on website medicinenet.com. Retrieved June 10, 2009 from http://www.medicinenet.com/costochondritis_and_tietze_syndrome/article.htm

Valtonen, E. Phenylbutazone in the Treatment of Tietze’s Disease. Annals of the Rheumatic Diseases 1967;26:133-135;

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36 Comments on “Treatments for Tietze’s Syndrome”

1. 1 All About Tietze’s Syndrome » Blog Archive » Tietze’s Syndrome is not Costochondritis said at 11:10 am on June 23rd, 2009:

[...] of Tietze’s Syndrome apart from pain management. This is no longer true: see my article on Treatments for a full discussion of the many options [...]

2.

2 Diana Vincent said at 6:07 am on July 30th, 2009:

I’ve been diagnosed with costochondritis 3 times over the last 2 years I am taking this article to the doctors with me.

3.

3 Steph Kenrose said at 8:57 am on July 30th, 2009:

Diana, I’m glad you found it useful. If your doctor doesn’t listen–find another. It took me a few docs to find one who really knew about Tietze’s…best of luck! Steph

4.

4 carlos said at 4:07 am on August 5th, 2009:

very useful, Ill go through a resonance and then surgery soon, cause Im one of the thought cases, doctors should think of calcification or splinters or other abnormalities when costochondral pains are involved!

5.

5 Teresa said at 8:56 pm on August 6th, 2009:

Hi, I have Tietze and have for over a year. Today I have had twinges of pain unlike my usual soreness type pain. Is this normal for Tietze?

It is a pain in the rear end! Hard to explain to people. I have not found one other person besides my doctor who have heard of it. They have heard of costochondritis, though.

Any help would be appreciated!Thanks!

6.

6 Steph Kenrose said at 5:56 am on August 10th, 2009:

If you mean hot stabbing pain (and you are sure it’s coming from the same area), then yes, I think it’s normal. At least, that’s what happened to me Steph

7.

7 Joan said at 10:59 am on August 23rd, 2009:

Hi,I was diagnosed with Tietze Syndrome in Feb., 2001 after spending 3 days in hospital for what they thought was a heart attack. My heart checked out fine and when I went back to my family doctor, he diagnosed me with the syndrome. I was under a lot of stress at the time and the pain was mainly in my ribs, but radiated through to my back and down my arm. Hence, the heart attack theory. I believe I have had it all my life because I remember laughing really hard and getting pains in my chest. Running, hills, stairs and lifting heavy objects put me in considerable pain. I had a pacemaker put in back in Sept. 1999 and they replaced it in Aug. 2006. When I awoke from the procedure, I was in a lot of pain when they tried to move me from the table to the stretcher. They rushed me to x-ray to see if they had injured a rib. The x-ray showed nothing. I then asked the doctor if they had pressed on my ribs during the procedure and he said yes, at times. I proceeded to tell him of my condition and the mystery of the pain was solved. I never thought to mention it before they did the replacement. I am amazed at the number of doctors how have never heard of this syndrome. I was luck to have a doctor that was trained in Ireland and they are very well trained on diagnosis over there. As long as I watch what I am doing and stay relatively stress free, I am usually pain free.

8.

8 Jo said at 9:03 am on September 5th, 2009:

Hi,I was diagnosed with Tietze syndrome almost a year ago. I noticed a swelling on my rib on the left side and went to see the doctor. I did an x-ray, but it showed nothing. I also did scintigraphy with technetium to make sure it wasn’t a tumor and it wasn’t. So they diagnosed me with Tietze syndrome. But the thing is, I’m missing the main symptom – I don’t feel pain, I only have the swelling. Now I’m concerned they misdiagnosed me… And I’m also confused wether I should apply ice or heat.If anyone could help, I would appreciate it. Thanks

9.

9 Steph Kenrose said at 10:54 am on September 5th, 2009:

Jo,When I went for physical therapy they alternated the hot and cold packs. As far as getting the swelling down, I believe you would use ice packs (at least, that is what was recommended to me by my knee surgeon .

Best,Stephanie

10.

10 Elisa said at 8:50 am on September 9th, 2009:

My 13 yr old son was initially diagnosed with costochondritis. However, no oral pain killers would make the pain go away. The pain has persisted for 3 weeks and lately, he only responds to IV tramal. He was switched to gabapentin for 2 weeks which although was successful in managing the pain, caused hostile behavior in him. After 2 weeks of pain-free, I think it’s coming back….

11.

11 Steph Kenrose said at 6:49 am on September 10th, 2009:

Elisa,Your story touched me. I have a copy of my book “Tietze’s Syndrome” that I’d like to send to you. I thought perhaps if your son reads about the condition, it might help him understand it and help with his recovery (stress makes any pain worse!). If you would like the complimentary copy, shoot me your address to the mailbox “info” at TietzesSyndrome.com.Good luck,Stephanie

12.

12 Nickie said at 4:29 pm on September 17th, 2009:

Today I was told I have costochondritis by the doctor. It was a tightening feeling under my breast bone that radiated through my chest under my collor bone. I remember also when i was breathing i would have sharp pains in my ribs. When it first came on i thought i was having heart problems. Everything ran through my head, like it could be breast imflamation cancer and so on. It has been a very frightening month for me, but Knowing you have a disease is less frightening then knowing it’s terminal. If anything it gave me a more awareness of my body and made me appriciate life : )

13.

13 Steph Kenrose said at 4:36 am on September 19th, 2009:

I know how you feel…feel better soon!

Glad you found the site.

14.

14 Gemma said at 10:42 am on September 25th, 2009:

I Am A 13 Year Old Girl Who Is Going Through Her 2nd Session Of Tietzes Syndrom. I Have Had Pretty Much Every Painkiller Under The Sun, And Now The Pain Has Been There For Over 2 Months.I Am Beginning To Think There Is Nothing Else To Try.Does Anyone Have Any Suggestions On What Else I Could Try?Gemma x

15.

15 Stevie said at 6:14 pm on October 1st, 2009:

My 11 year old son was diagnosed with teitze syndrome 6 weeks ago. It started by choking and coughing and he has been in pain since. Dr’s at the hospital gave him pain killers which had to be increased and changed due to constant pain. He is currently on Diazepam, Ibuprofen and paracetamol and currently off school. He is still in pain and it seems to be worse when he goes to bed causing him to cry with pain through the night. Does anyone else have a solution in reducing the pain?

16.

16 Steph Kenrose said at 12:50 am on October 8th, 2009:

Wow, 11 with Tietze’s…that has to be tough :/

Make sure you check out the “treatments” post. There’s everything from corticosteroid shots to alternative meds listed.

I wish your son a speedy recovery,

Stephanie

17.

17 Steph Kenrose said at 12:54 am on October 8th, 2009:

Have you tried everything on the treatments post? I hope something helps soon.Stephanie

18.

18 Harsha said at 7:02 pm on October 16th, 2009:

Hello,

Yours is the first site that seems to have so much info on tietzes syndrome. Thanks so much. I am 29 years and 18 weeks pregnant with twins. I don’t even know if I have tietzes syndrome but I am feeling pain in my right rib(s) right under my breast. I some times feel it is burning and it doesn’t radiate anywhere. It comes on and off all day and night. It sometimes feels as burning. I have gone to my ob/gyn and she order some blood test to check my gall bladder and liver and also send me for a gall bladder ultrasound. Everything came out normal and she said she has no idea ab’t that pain and that it might not be related to pregnancy. I don’t know what I should do now. Should I just bear the pain or go see another ob/gyn or general doctor? I eat healthy food and do walking for about 20 minutes everyday. I never had this pain before in my life and it started all of a sudden 2 weeks ago. It is hard to sleep at night Any insight would be greatly appreciated.

Thanks,harsha.

19.

19 Carol Meyer said at 3:43 pm on October 17th, 2009:

I have had this since 3/09 and have tried PT, Chiro. went to er twice for burning pain. Had 3 shots in my left breast and 3 in each side of my ribs under my breast same joint on both sides, 2x. I also had a thoraic spine shot at NY Pres. one of the best pain hospitals in US(didn’t help that much). What has worked the best Neurontin(gabapentin)but made me sick and hurt my stomach but really erases the pain. Amitripline but takes weeks to work, but it does help you sleep. Also,Clonopin and Xanax to keep the anxiety of the pain away.Ice packs and heat.Lidocaine didn’t help that much, but Flector patches really help and can be worn 24 hours. Indocin and Napro. helped and other NSAIDS, but the eat you stomach and caused gastritis. An abdominal belt you can purchase at CVS, helps when you ride in the car or walk, or bend over, the velcro kind also helps if it hurts to breathe to deep. Learning how to abdominal breath to relax. No housework.I have had every test possible and they keep saying it’s Costo. or Tietze caused by a virus or a thoracotomy (lung donor). MRI, bone scan, Catscan, xray, everyblood test and a mamogram, colon., heart tests. Still am in pain, but hoping it will go away.

20.

20 Sim said at 9:06 pm on October 25th, 2009:

I was diagnosed with this syndrome 2 days ago. But it all started with this feeling that my throat was swollen shut almost and a few days later I started experiencing an extreme amount of pain in my upper chest. But I haven’t been coughing at all… It’s been 1 week now and I can’t even eat or drink because it increases the pain in my chest. Has anyone else experienced this? I’ve been taking a compound prescribed by my doctor of aspirin and codiene… which seems to help with the pain. But I’m really concerned.. the web says this can be resolved in upto 12 weeks but I’ve read some of you have had it for over a year now… Does anyone know if there are any tests that can be done to confirm this syndrome? Im still trying to digest all this information…

21.

21 Steph Kenrose said at 2:03 pm on October 31st, 2009:

Sim,There are many tests to diagnose the syndrome. I’ve outlined them all in my book, but the latest research indicates a combo of tests is the best option. I have had the disease for almost 20 years now. Good luck,Stephanie

22.

22 Steph Kenrose said at 2:10 pm on October 31st, 2009:

Carol,I feel for you. I hope your pain improves soon. It should…over the course of time, TS tends to get better, not worse. I wish you the best!Stephanie

23.

23 Steph Kenrose said at 2:13 pm on October 31st, 2009:

Harsha,Thanks for the compliment on the site. Does the pain get worse if you press on the area? If yes, then it def. could be TS. The only person who can say if you have TS would be a rheumatologist. He may be able to do an ultrasound to diagnose you (safe, seeing as you are pregnant).Good luck,Stephanie

24.

24 Wendy said at 12:14 pm on November 1st, 2009:

Hi, I also have dull pain that goes into my throat and neck. Hope to get over this sooner than later. Does anyone think the lido patch works?

25.

25 Hayley said at 1:54 pm on November 5th, 2009:

hi i am 34 years old i was diagnosed about 7 years ago, at the minute i am in so much pain in my chest & in my right breast i am finally having an ultra sound next week. does anyone get a clicking noise from the sternum? is a burning pain in the chest normal for tietze

26.

26 Steph Kenrose said at 5:22 am on November 6th, 2009:

That clicking is most probably the cartilage. I don’t get it in my chest but I do get it in my knee (where I also have cartilage problems!). Sorry to hear you are experiencing that pain, but if it’s any reassurance–very severe pain is normal.

27.

27 Heather said at 7:20 pm on November 20th, 2009:

I started having chest pain when I was nine years old leading to my diagnosis at the age of 12 for Tietze’s Syndrome. I am now 22 years old and have exhausted almost every juncture known to man. I am going in for yet another doctor opinion tomorrow whom will hopefully opt for surgery. I would like to thank all of those who have participated in this blog letting others know they are not alone with this syndrome. I have had all of the above stated symptoms ranging from the mild to severe pain, the mimicking of a heart attack, and the chest “clicking.” I am looking forward to finding a light at the end of the tunnel! I wish you all the best of luck in your healing from this literal pain!

28.

28 Bex said at 5:57 pm on November 25th, 2009:

Hi, I’m 31 and I was in Hospital twice last year friends thinking Iwas possibly having a heart attack (my family has heart disease on both sides) i was eventually sent to a specialist who said I had T.S. I am looking for somewhere that will outline all the symptoms possible…my common symptoms are sharp pains when I breath in on the left or right side of my chest, my chest hurts to touch and I have a constant burning feeling straight across my chest which almost feels like heartburn but goes on for weeks and weeks….is this normal T.S symptoms or do I have costochondritis? From what I have researched there is a difference between the two. Any help or information will be greatly appreciated.

29.

29 Steph Kenrose said at 3:25 am on November 28th, 2009:

Hi,It sounds like you have a classic case of Tietze’s. At least, you could have been describing my symptoms from the early 1990s.Here is a post about the difference between costochondritis and Tietze’s syndrome..Welcome to the site!Stephanie

30.

30 Wendy said at 3:36 am on December 1st, 2009:

I have just been 2 hosp. Was worried about pains in L breast as my mother died of Breast Cancer. V painful incl. sharp pains in breast, in shoulder and down left arm. Debilitating pain at times. Have been diagnosed with Tietze’s sydrome but am confused as the leaflet produced by ‘Breast Cancer Care (UK) says the sydrome IS ‘costochondritis or Tietze’s Syndrome’. Your site says these are different diseases!. I have been told by the nurse practitioner to take Ibuprofen 3 times a day for a month but that it can take 2 years to improve. Thankyou for your site which has made me feel less alone in the pain I am suffering.

31.

31 Amy Jo. said at 8:55 am on December 1st, 2009:

This has been so informative!!! I was diagnosed with Costochondritus by a Rheumatoid Doctor a few months ago. That was after months of tests given to me by my PCP. I kept telling her the pain is ALWAYS in my sternum and it pops all the time. Then the attck happened…the pain got so bad I thought for sure I was having a heart attack. My husband brought me to the ER and they said my heart was fine except that I had Pericarditus and Pluerusy. So the gave me meds for

that. the pain came and went for a good three months before subsiding to just the pain in my sternum. a few months later I got the familiar pain radiating across my chest up my neck and down my arm. My PCP then gave me meds for nerve damage…they made me sick and din nothing for the pain. Finnaly after another bout with the pain a few months later I went to the Rheumatoid Doctor to rule out arthritis. So I got the dianosis of Costochondritus. But after reading this I belive I have Tietze Syndrome and I will be mentioning it to my doctor today as I have yet ANOTHER flair-up as we speak!! I have missed so much work do to this…and my quality of life while I am in pain is just awful…God I hope they can find something to help me!!! Thank you for all this info!

32.

32 Daire Thornton said at 12:15 pm on December 2nd, 2009:

I have also recently been diagnosed with TS. I often find it very difficult to drive as the pain I experience is mostly in my right ribs and my left shoulder. Also I have an office job and I find that sitting at my desk becomes more and more difficult through out the day. Does anyone else work at a desk and find it difficult too. Any suggestions?

33.

33 Steph Kenrose said at 4:48 am on December 3rd, 2009:

Diane,

I did work at a desk for a few years, and the pain didn’t worsen for me. I was lucky though, because I was the ergonomics person for my department. If your chair/desk set up is causing you discomfort, you should have it checked for ergonomic set up.

Good luck!Stephanie

34.

34 jean said at 11:54 am on December 4th, 2009:

I was diagnosed with chondritis and told to take nurofen for a couple of weeks and it would go away. After researching I thought it may be tietze syndrome. Eight weeks later I still have the same symptoms. I don’t have the pain that most people suffer with but I feel like the whole of my chest area is swollen. I also feel very fatigued after simple tasks. My breathing is not so good and am often very

wheezy. I haven’t been able to go about my normal life. I feel like my life is on hold at the moment.

35.

35 Sue said at 5:24 am on December 30th, 2009:

Hi everyone, having found this website by accident I feel I am not alone,it was a wonderful feeling to know that there are other people out there feeling the same,although I would not wish this on my worst enemy! I got sick in Sept this year with the flu and started coughing,now 3 mths on, I still cough,not as much,but the pain in my rib under my left breast is terrible.Any pressure on it feels like my chest is going to explode,this radiates around the underneath of my breast to under the armpit,press one bit and you could cry with pain!! I went to a doctor who gave me painkillers/anti inflammatory pills and said 2-3wks you will be ok!! My own doctor was much better when I saw her the following week and stated I have TS! Never heard of it I said,she printed out the sheet and gave me Tramadol, I was as high as a kite for over a week,not good when you own a horse and have work to do. Have been off work now since the 6th Dec and still taking pills although not high now,have had xrays and blood tests and awaiting results. I feel scared and alone,hence why I am writing this to reach out to people like me. By the way I had the steriod injection in my chest, DO NOT DO IT,PAINFUL YES AND NO IT DID NOT WORK!! But who knows it may work for others but I am doubtful,even my doctor was as she injected me!!

36.

36 Christine said at 4:42 pm on January 10th, 2010:

Just wanted to say to be careful with steroid injections. I have both Costo and Tz – and I have them because I have Chronic Lyme disease…and these are both conditions that we are seeing on the rise with this disease…

unfortunately, it all too often goes undiagnosed and/or misdiagnosed…and if one has Lyme who also has these get steroids – it will cause major issues – as steroids is like pouring miracle grow into our systems…so just please anyone considering steroids, and you have many other medical issues…it could make things much worse…

i had a local injection – w/out steroids and it did help….I ended up having to inject myself with toradol for several months before i got it under control…

I have found taking Turmeric (a spice) helps with this tremendously…