Chronic Pain, 3+years Tietzes or Costochondritis?

by Melissa

Thankyou for the opportunity to discuss my ongoing pain. My question is what would you suggest as treatment for me? I have a lovely Chiropractor who is willing to follow a program if I suggest it. I have avoided visiting him as of late due to feeling worse after a lumbar back/hip adjustment.

I am a 38 year old female, wife, and mother of two young children. My Tietzes began in July 2011 after a very strong chest infection that went to Pneumonia. Treated with antibiotics. I have had random episodes with short sharp chest pains, visited the ER and had ECG monitoring, other tests etc. was sent home both times and told I was having panic attacks. It's been a rollercoaster of pain ever since.

Some days are better than others, but always the worst at night. I need to sleep on my stomach every night as it is the only way to avoid the stabbing pain. Heat packs can help.

Fast forward 3+ years later, my primary care doctor is really great and has exhausted his avenues with tests and medications to try. My Rheumatologist diagnosed me with Costochondritis and said unfortunately it is linked with my Fibromyalgia and possibly will never improve.(I'm not willing to accept this!)

I do take Ibuprofen which is the only drug that helps a little. I have tried oral Prednisolone twice which makes me very unwell but persevere to take the whole course on the chance it will clear the costo. Then several rounds of xray guided and unguided cortisone injections by Rheumatologist and Physician directly into the costal joints. So very painful and I also have a drug reaction to these. I have found the cortisone drugs simply do not help me for this condition.

I have had several chest xrays, a chest cat scan, spine and neck cat mri and two bone scans (for other health issues too...I have Trigeminal Neuralgia bilaterally which is a terrible indescribable thing to live with, lumbar L4 and L5 S1 disc herniations, right foot plantar fasciitis, and diagnosed with Fibromyalgia; need a new body!! lol).

The bone scans were both showing contrast had settled in my costal joints. Consistent with Costochondritis.
Physically I am having trouble sleeping with the flares of aching stabbing and burning pain, this past 2 weeks I have had ongoing aching and stabbing pains especially at night. Even during day naps I have a conscious feeling of a burning aching pain in my ribs back and especially my sternum.

I have only had 3 physical hands-on examinations of the area and each time the doctor involved has agreed there is swelling and palpable lumps. They are reluctant to hands-on examine me. The swelling seems to be getting worse over time. It is so painful to touch at times and the sternum feels very swollen to me, as though it is pointing sharply inwards. I am so surprised this does not show on any xray or scan I have had.

Thankyou for reading this far. Hope you can reply with suggestions for my Chiropractor, I hope to find a way to move forward in my treatment.

Hello Melissa,
The one thing that is encouraging is that your history is remarkably typical of those suffering from Tietze's syndrome. That makes it easier to treat. The only aspect that is missing is indigestion and heartburn. Do you have them too?

Firstly, you have able a generalised inflammatory condition of your whole body. That means you probably are on a diet with high omega-6/omega-3 ratio. Radically decrease the omega-6 oils in your diet (sunflower, corn and soybean are the most common) by changing to olive oil, and increase the omega-3 oils. That means more fatty fish and freshly ground flaxseed.

Secondly, get on to an anti inflammatory diet. Avoid all foods made with white flour and sugar. Perhaps even start making your own whole grain flour bread. Make sure you are getting plenty of salad, fruit and veg. The chilli family oddly is strongly antiinflammatory.

Thirdly, take a block of ice with you to the shower, and give yourself an ice massage directly over the painful joints, alternating with hot water.

Fourthly, after your shower, take a little cream and gently massage with your index and middle fingers, starting at the breastbone with the painful rib between your fingers, and moving towards your breast. Has the collarbone-sternum joint been affected?

I've worked out a chiropractic protocol that will improve this condition, but alas won't cure it. Would you be happy with say 50% less pain and a monthly chiropractic visit? If so, ask your chiropractor to contact me via Contact, and we can talk about it on Skype.

If you have a visible, palpable lump, I'd appreciate a photograph. You have to get the light just right so that it can be seen.

There's hope Melissa, let's see where this all takes you. Perhaps nowhere, you'll be healthier for it anyway.

Dr B

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

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