Can sulfasalazine help with Tietze's syndrome?

Personally, I won’t be trying sulfasalazine (or any other prescription drug for my Tietze’s syndrome). I’ve avoided prescription drugs ever since I tried Vioxx a decade ago (for those of you unfamiliar with the Vioxx fiasco, you can read about it–and the questions it raised about other drugs on the market–here). A recent stress test confirmed all is well with my heart but there’s still a voice in my head that tells me I had a very close call and I don’t want that kind of stress again! I’ve learned to manage my Tietze’s syndrome in other ways, including dietary changes and wearing sports bras. My pain is practically non-existent now, but I remember those years when the pain was excruciating!

You can find all the different kinds of treatments for Tietze’s syndrome at my Treatments for Tietze’s syndrome articles page.

Reference:

FREESTON J, KARIM Z, LINDSAY K, and GOUGH A. Can Early Diagnosis and Management of Costochondritis Reduce Acute Chest Pain Admissions? Retrieved July 16, 2009 from http://www.jrheum.com/subscribers/04/11/2269.html

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I recently came across an article in the Japanese Journal of Anesthesia called stellate ganglion block therapy for a patient with Tietze’s syndrome.” The article, which can be found here, describes a patient who had severe Tietze’s syndrome for more than six years. Her pain (on a scale from 1 to 10) was a full 10; anyone who has ever had Tietze’s syndrome knows that kind of pain. But after this specific kind of therapy, the woman’s pain diminished to 3 out of 10.

The researchers treated the 45-year old patient with SGB therapy. When the woman first arrived, she had the classic signs of Tietze’s syndrome–excrutiating pain radiating toward her left shoulder and swelling of one costal cartilage. The researchers performed an ultrasound and saw that the first costal cartilage was swollen (as shown in the following pictures).

Ultrasound Images of Tietze’s Syndrome

Image from the Journal of Anesthesia of Tietze's syndrome

The stellate ganglion is found at the 7th cervical vertebrae, just behind the first rib. Stellate ganglion blocks  (injections of local anesthetic) around this area has been shown in the past to help with the pain caused by other chronic diseases, such as complex regional pain syndrome. The stellate ganglion is also a site targeted in acupuncture to alleviate pain.

Image from Northwestern University

Series of Stellate Ganglion Blocks Reduce Tietze’s Syndrome pain

The researchers injected 5ml of mepivacaine (a local anesthetic) into the stellate ganglion, which reduced the Tietze’s syndrome pain for six hours. After the fifth injection (she received one per week), her pain had lessened to 3 out of 10, and she was able to sleep through the night. Stellate ganglion blocks are known to have this effect–the more you have of them, the longer the pain relief lasts.

Stellate ganglion block to treat Tietze’s syndrome is performed under local anasthesia and only takes a few minutes. Side effects are rare. A full description of stellate ganglion block, how it’s performed and what you should expect can be found here, at the Redding Anesthesia Associate website.

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The Cookbook that Cured Tietze’s Syndrome?

I started cooking with the recipes from this cookbook. Nine months later, I haven’t had so much as a twinge in my chest. I am convinced it’s because of the vegetarian diet. Sure, you’re probably thinking. Another “miracle cure” on the web. I can’t enter sworn testimony here, but I can share the abundance of scientific evidence I have since come across that explains the “miracle” (which in all honesty wasn’t so much a miracle as a stroke of luck in eating the right foods).

Vegan Diet and Tietze’s Syndrome

A lot of research backs up my finding that a vegan diet (rich in fruits, vegetables and soy–NO sugar, High Fructose Corn Syrup or other artificial additives) can help with the arthritic-like pain of Tietze’s Syndrome (sometimes called Tietze Syndrome). Arthritis literally means “inflammation of the joints“; Tietze’s Syndrome usually involves the inflammation of one joint (for more information on the specific area affected by Tietze’s Syndrome, see this article).

A quick search on Google for food-related arthritic conditions will inform you that there are tens of thousands of suspected food triggers, including dairy products (which have been shown to cause many health problems), and some fruits and vegetables, like eggplant. The evidence from most of these sites is anecdotal. A woman from Colorado who suffered from out claimed that she recovered when she switched to a meat-free diet. A man from Hawaii with rheumatoid arthritis claimed that once he stopped eating fish, his arthritis disappeared.

However, there is actual science to back up these anecdotal claims. Dava Sobel’s groundbreaking 1989 book, Arthritis: What Works, surveyed a thousand arthritis patients (Tietze’s syndrome is an arthritic-like disease) to find out what was causing their condition to worsen, and what was causing it to get better. Common triggers included: red meat, dairy products, fat, and sugar–items commonly missing from a vegan diet.

A significant article in the Rheumatology Journal found that after following a vegetarian diet, 59% of patients reported a decrease in joint pain after they stopped eating meat, and 45% reported a decrease in symptoms after they stopped ingesting sugar and coffee. This article that appeared in the Scandinavian Journal of Rheumatology found that one of the culprits was dairy protein, not fat (found in all types of milk and milk products).

Tietze’s Syndrome Research

If you go to the National Institutes of Health and perform a search for Arthritis/Rheumatism/joint pain and diet, you’ll find a glut of research (including this one) showing that changing to a vegan diet, rich in Omega-3s, helps with arthritic conditions. You can find the full text of one research article at this website on how rheumatoid arthritis symptoms diminished after only four weeks on a vegan diet. It stands to reason that if rheumatism can be helped by diet, so can Tietze’s Syndrome.

Some other studies that you can find on Pubmed:

• A gluten-free vegan diet improves the signs and symptoms of rheumatoid arthritis.
• A raw vegan diet  rich in antioxidants and fiber decreases joint stiffness and pain.
• for the brave at heart, this study showed that fasting followed by a vegetarian diet can improve symptoms.

Why do researchers think that a vegetarian or vegan diet might work with reduction in joint pain found in Tietze’s syndrome? Part of the reason is that antioxidants–found in vegetables–neutralize the free radicals which contribute to joint pain. The nutrients found in abundance in vegetables (vitamins C and E), also assist in this process. Meat on the other hand, supplies very little vitamin E, and no vitamin C.

The diet I went on last year to combat my reactive hypoglycemia was an almost raw-vegan diet. It was almost impossible to stick to–I spent hours in the kitchen cooking (although I did feel better). Over the course of months, I added eggs and meat substitutes (like Morningstar Farms products and Quorn). I even found a substitute for fried chicken–one of my pre-diet favorites.

The result was this book, The Reactive Hypoglycemic Cookbook, which is the only change in my lifestyle I made. Although the book is for reactive hypoglycemia, by complete coincidence the diet for that disorder is the same as for the one recommended by researchers for joint pain: meat free, high in antioxidants and Omega-3s, low in fat and no dairy or sugar. After sixteen years of Tietze’s syndrome agony, I’m now symptom free. Although I didn’t start out liking the idea of going almost-vegan, being pain free has made me a fan…I’d recommend a vegan diet to anyone trying to combat this  painful disorder.

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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.

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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;

Related posts:

1. SGB therapy for Tietze’s syndrome pain