DEAR DOCTOR K:
I recently broke a couple of ribs, and the pain is so bad I can hardly move. I can’t sleep at night and I can’t take a deep breath. I went to the doctor, but he said there isn’t much he can do. I was surprised that he didn’t even tape up my ribs. Is there anything I can do to help my ribs heal quicker and ease my discomfort?
I understand why you ask the question. If you’ve ever fractured a bone, it has probably been put in a plaster cast or a splint. Keeping the broken parts of the bone from moving helps the bone heal and reduces the pain. The pain from a fracture generally occurs when the broken parts of the bone move. You know the old joke: “I’m OK, doc. It only hurts when I move.”
And rib fractures, like any fracture, do hurt. So why didn’t your doctor try to keep your broken ribs from moving by taping your ribs? Here’s the dilemma: Your ribs have to move every time you take a breath. And we all need to breathe.
In addition, after a rib fracture, the surrounding bones and muscles generally hold the bones together well enough on their own. Over time, the fracture heals and the pain goes away.
But that doesn’t mean that nothing can be done to ease your discomfort in the meantime. For any fracture, it’s important to relieve pain. Relatively high doses of painkillers available over-the-counter can be sufficient. That includes acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve). If these do not provide sufficient relief, your doctor should prescribe a more potent prescription painkiller. I have prescribed narcotic pain relievers such as codeine to ease the pain of rib fractures.
Your doctor should also make sure that nothing more serious has happened. Sometimes a broken rib punctures an artery and causes internal bleeding around the lung, which can cause shortness of breath.
Rarely, a broken rib can cause a “punctured lung,” or pneumothorax, in which the lung collapses and air enters the space around the lung. This can cause severe pain and shortness of breath. Occasionally, fluid or air collects outside the lung and squeezes the lung. This also can cause shortness of breath.
How do people fracture ribs? By far the most common cause is trauma. Another cause is coughing — really strong, repeated coughing. Every time a person coughs, the muscles and bones (ribs) of the chest are working extremely hard. Air is coming out of your mouth at hundreds of miles an hour.
The force of coughing can sometimes break a rib, even a healthy rib. However, when a patient of mine breaks a rib from coughing, I usually do testing to look for conditions that can weaken ribs — particularly a cancer that has spread to the bones. It’s a rare cause of rib fractures, but it can occur.
I’ve never seen a patient with a broken rib caused by cancer. It’s always been someone like you, and it always has healed completely.