Xiphoid Process Pain: Causes, Symptoms, & Treatments
Xiphoid process pain is a widely considered as a self-limiting condition. It does not need any aggressive medical management. Treatment is typically focused on underlying causes. For example, if the pain is associated with cardiac conditions, treatment will be focused on the cardiac condition. Physicians also have to ensure that vital internal organs won't be harmed by damage to the xiphoid process, such as in the case of fracture.
In the absence of associated conditions, treatment is focused on managing pain.Mild analgesics could be prescribed given until pain disappears. These are over-the-counter medications given as first line of pain management. Non-steroidal anti-inflammatory drugs (NSAIDs) are also part of the first line of pain management for xiphoid process pain.
Conservative measures such as heat and cold therapy may also work. This involves alternately applying hot compress and cold packs over the painful, swollen area. This will help promote blood flow that supports healing and reduction of inflammation.
Before resorting to xiphoid injections, the physician may opt to try conservative physical therapies. Short course treatments may include application of low-level laser or use of ultrasound. However, there is not enough evidence that establishes the effectiveness of such methods.
A compromised xiphoid process may cause nearby structures to compensate. This may lead to further injuries or to the dislocation of the xiphoid process. In these cases, wearing an elastic rib belt can help. The belt supports the injured structures, reducing the strain during movement. It also applies pressure over the sternal area to reduce the pain. The belt also helps keep structures in their proper alignment during movement.
If pain persists or does not respond to NSAIDs and analgesics, stronger painkillers may be prescribed. Opioid analgesics may be given to control pain. Corticosteroids are given to reduce both pain and inflammation.
If pain is severe, local anesthetics (e.g., lidocaine) and corticosteroids may be given. These medications are injected directly on the xiphoid process. This treatment option may help get rid of the pain. However, it comes with risks. Xiphoid injections carry risks for complications such as peritoneal perforation (puncture of the peritoneum or membrane covering the abdominal cavity), infection, pleural perforation (puncture of the membranes covering the lungs) and pneumothorax (air within the pleural cavity).
Aside from medications, people suffering from xiphoid process pain are also advised to refrain from lifting heavy objects. Large and heavy meals should also be avoided while the xiphoid process and attached muscles heal.
Physiotherapy applied on the chest muscles may also help in reducing pain. Focus is placed on the muscles attached to the xiphoid process. This treatment helps in soothing the pain and relieving tenderness. Gentle exercise proves to be beneficial in improving mobility. At the start of physiotherapy, physicians may recommend pain medication. Manipulating the muscles may initially increase pain but is needed in order to improve mobility.
For pain associated with GERD, making dietary changes to the symptoms of GERD might be helpful. This may lead to the reduction of pain in the xiphoid process.
If none of the mentioned treatment methods work, the last resort is surgical removal of the xiphoid process or xiphoidectomy.
The xiphoid process is an important structure and has clinical significance. However, its function is not critical. Removal will not have a huge impact on overall health and bodily functions.
The procedure is complex and requires the skills of a specialist. The entire xiphoid process is not necessarily removed. Most often, removal of the protruding portion of the xiphoid is enough to treat the pain and other symptoms.