Background and Aims Tietze syndrome is characterized by swelling of sternocostal junction and is a rare cause of unilateral thoracic pain. The pain may radiate in the arms, and can be prescribed as stabbing, dull or tingling. Here we report the case of a 64 year-old woman, presenting in our outpatient pain management center two years ago.

Methods The woman was referred to our center by a thoracic surgeon, with the diagnosis of Tietze syndrome. She reported pain (intensity 8/10 almost constantly) with neuropathic elements (DN4 6/10) that started 18 months prior and worsened over time. The pain was located around the 2nd sternocostal joint and radiated in the upper right hemisternum. She had already been treated with the maximum daily doses of NSAIDS, pregabalin and p.o. opioids with minimal effects. Imaging of the area(CT,MRI) showed no pathological findings.

Results Since the patient had already been treated with numerous p.o. medications with no relief, we decided to perform a PEC I block under ultrasound guidance. 15 ml ropivacaine 0,375% and 8mg of dexamethasone were injected and no complications were reported. A significant improvement was reported, with the patient grading her pain 2–3/10. After 3 months her pain gradually began to increase, and is scheduled for a new PEC I block, and will be assessed for potential RF ablation of the intercostal nerves.

Conclusions Rare chronic pain syndromes many times pose challenges in the efficient management of the patient. If the pharmacological approach does not aid, invasive methods could provide a better result.