Costocondritis: Understanding Symptoms, Causes & Management

Question
My daughter is 17 and she was diagnosed with costocondritis.  She has had it for almost 2 years.  Sometimes she can just deal with the pain and other times it is so intense it causes vomitting.  It(vomitting) does stop after sometime, and then the pain finally subsides.  It is pretty severe pain now, seems like the change in pressure, one day warm, and then one day chilly.  We don't know what causes costo.  and we would like to,  We know it is an imflammation.  We need to know how to help when the pain is severe.  What type of doctor usually treats for this.  Her pediatrican has sent her to GI doctors who ruled out everything they could.  She sees a Rhuematologist who doesn't usually see patients with this but he has agreed to see her.  She is on voltare, and elavil.  She falls asleep fine but wakes with pain.  during the summer she had weeks where she felt okay.  this fall is a different story, the pain wakes her.  she takes tylenol and puts heat on it.  most times the pain went away but now the pain lasts and when she sits up to get up the pain increases and then vomits.  it passes after some hours.  when it is gone, the severe pain is gone, but she says the pain never really goes away, it just is dealable.  She has gone to a psychologist too, they recommend we see another doctor.  The don't find any problems with her other than her doctors don't seem to care that she is in pain.  We want to know about treatments. they have tried over the counter meds, celebrex, bextra, none seem to work.  Voltaren semed to work for a while but this month the pains started again.  Can you give us some advice.

Answer
Hi Claudia,
Unfortunately there is no good treatment for Costochondritis.
Her vomiting associate with this makes me believe she has a severe anxiety problem and low pain threshold. There is no reason for vomiting with this except for her  exaggerated response to pain, which if measured clinically, is probably not as bad as she says it is.
Ultimately it will go away. It may take some time but once the stresses in her life level out I will BET that her symptoms disappear completely.
She would do well to be started on Zoloft. She can continue on Elavil for sleep, but the high priced anti-inflammatories are going to work no better that plain old Advil 200mg 4 times a day with food.
I'm sure that you are very worried and frustrated for her, but try not to be an enabler. It is easy to do as her mother but this feeds the problem and can exacerbate her symptoms. You may not want to hear this but in my experience, this holds true in 100% of cases.