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Costochondritis and PBC?

I was told about 4 years ago (pre-PBC diagnosis) that I had costochondritis. There really isn't a test for this, they just treat you with ibuprofen and if you get better they figure thats it (or that is what I was told) I have been having left side upper chest pain, localized just to the left of my sternum for a long time. Thought it was cardiac related, underwent several ekg's and last Friday had a nuclear cardiac stress test, all normal. My back on that side hurts too. I am in just in so much pain. This all started back again, after the past couple of months of super high stress. Two deaths in the family, cancer diagnosis (me) etc. I know its probably related, but I would really like to know what is causing this. Tylenol takes away the pain somewhat, but I broke down and took some ibuprofen for a day (even though I'm not supposed to with my liver) and it made it much better. I really would like to take more ibuprofen by my liver ached when i took it. So its either suffer the chest and back pain or the liver discomfort knowing I making it flare. Do you know if there is a direct coorelation between PBC and Costochondritis or even Tieze's syndrome, which is the chronic version of this?

8 Replies

This is the answer that I needed. About 5 weeks ago I had such bad chest pain as you describe and by way of A&E ended up spending the night on a cardiac ward. The following morning the specialist/consultant ruled out heart problems-pushed hard on my ribs and then said it was muscular/skeletal. I realised it was due to stress and went to see my own doctor and between us we decided I should try anti-depressants. Too early yet to say I notice a huge difference but feeling a bit less anxious.


I have no chest pain except when under stress. My question is...i have always thought acetaminophen(tylenol) was toxic for liver, that ibuprofen was better to take. I hardly take any, buy when necessary i go with ibuprofen. Have i been wrong all along? My drs have adviced me to take as few tylenol as possible and i have also read about it online.


Hi Notor,

So sorry to hear about everything you are going through. Given all that's going on, I think you are holding together really well, but I'm not surprised about the stress.

You were really helpful to me last year when I had costo. And 'yes': then I'd been ignoring rib/chest/ back pains, until it was sharp on my right side and I thought it was my heart. My Gp was brilliant, and did ECG etc, full bloods, examinations, etc immediately, and sent me for X-ray. All was clear, and he concluded - as he had originally suggested - that it was costo. (One site, online, said there are viral and bacterial forms of costo, but they are worse, less common, and would be picked up by 'bloods'). The physical form I had is most common, and from comments, it often seems to be stress-related. But it also happens if you have been ill or run down & lost some of your strength, but have tried to do something that you are not yet up to, and caused a strain ... that's when the costo can kick in ... & when you are stressed.

My GP emphasised making sure I built up my strength and fitness as much as possible once the costo had gone & I felt fit enough to exercise. He said it's important to go carefully & build up to, and maintain full body fitness. Good advice ... hard to do. I have only proceeded in fits and starts, as 'life' seems to interrupt any fitness routine: not to mention colds, pulled muscles, etc.

I have noticed some mild recurrences, I think (have not been back to the GP), which seem to be equally split between overdoing exercise after a cold/layoff, and/or being stressed. And, yes, it seems the only solution is ibuprofen. An online friend with PBC (I only have AMAs, but am seeing a new consultant soon for a re-assessment) did question her PBC consultant about taking ibuprofen, but he said to take it. I would discuss it with your Gastro, but also: ask about ibuprofen gel. A friend who got costo after doing something physical too soon after an op, said she found the gel more helpful than tablets. However, I don't know how you regulate the dose, or if the liver still has to process the ibuprofen. Also, do not use gel along with tablet form.

A recent up-to-date paper I read on PBC - that summarised all the linked conditions - did not mention costo. I wonder if its incidence in folk with PBC is more to do with stress and/or getting physically run-down? I guess this is part of why Collette emphasises exercise and fitness ... and doing things you love. We try, I know, but it's not always easy.

Hope this helps and all goes well,

Take care,

Gritty xx


Thanks Gritty. I remember talking on here about costo, but I couldn't find my post :) This is about the worst this has ever been, actually. My shoulder and back is involved too. I think mine, besides the stress, is made worse by the way I sit at work. I sit hunched over my computer and lean on my left arm which I'm sure makes it worse. I've been told this by a physio therapist too, and that my back was weak and making my chest worse. I think it is probably making the costo worse. I decided last night to try to sleep up right and not lean on my shoulder and side as well as try low levels of ibuprofen. I need to try to not lift too much either. I think the connection with PBC or any autoimmune issue is inflammation. I think when our liver gets upset, during heavy stress it causes our joints to become inflamed. Mine is on the chest and my knees where I feel it worse. Add in a dose of scoliosis, which I also have and you have a recipe for disaster. I'm just concerned that this will get better on its own. I can't take anymore med procedures.


Aaah, yes! ... I remember it well. All last June and July, sleeping in the spare room , half-sitting up and propped on pillows!!

When it's gone, I do recommend a really good, gentle pilates class, for strengthening all of the back. Try to find a good, qualified, well recommended teacher and do some one-to-one sessions, until you are happy with them, and until s/he thinks you are ready for class. Irrespective of costo, I used to have bad lower back and hip pain, and thanks to Pilates it had all gone - though some has crept back since I've not been doing so much, and have let things slip.

Again, 'Yes', the worst is the way I sit at my computer!

I've got my pilates, yoga and gym classes lined up for next week, after the half-term. But I will take it very slowly and gently, following my last costo 'blip' last week.

Agree about trying to deal with it on one's own, though, I can't face my GP with something else!

Take care and try not to get despondent - and treat yourself! Don't get down: try to avoid stress ... have your stress busting 'kicks' lined up, ready!

Gritty xx


Well I am just trying to keep on even keel until my thyroid surgery on June 11. After that things will be up and down. I will have to deal with getting adjusted on thyroid meds as well as facing radioactive iodine treatment later in the summer. I need to do some sort of activity though. I think I am getting "stoved up" as my dad likes to call it. I am so tired, that I set at work, slouching, then I go home, worn out and lay in my chaise and slouch. I slept in it last night and I have felt better today, that and the ibuprofen. I may need to sleep in it a few more nights until the really bad tenderness passes. I have thought I need a new bed too. But one thing at a time!


I sometimes get a pain in my left rib area which first started 41 years ago during prwgnancy. I now get it after lifting heavy bags or saucepans or if I sit upright at a dining table for too long. However I find relief if I lift my left arm above my head which stretches out the ribs so I have assumed it to be due to pressure on a nerve.

I have never taken medication because I can relieve the pain simply by lifting my arm. Had xrays about 30 years ago which found nothing so I have integrated this into my life and just get on with it. Now I see it may be called costochondritis. I have never linked it with stress in my case, nor did I think it has anything to do with pbc but I have a very open mind these days so who knows.

What I would say to others is try stretching out and notice if it has any effect as it does for me. God bless, its so good to have you all to compare symptoms, for the most part the rest of the world doesn't really understand. Diane x


I had costochondritis several years ago. It lasted several months and was very uncomfortable! GP said it can come back if you get colds, flu etc . I'm sure it's a physical thing rather than something that could be related to stress though. Although it probably feels harder to deal with if your stressed I suppose.


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