Intercostal neuralgia: Causes, symptoms, diagnosis, and treatment

Intercostal neuralgia is a form of neuropathic pain that results from the damage or dysfunction of one or more nerves of the peripheral or central nervous system. Intercostal neuralgia affects the nerves running between the ribs and is seen in an estimated 3–22 percent of patients referred to pain clinics. Prevalence in the general population is about 15 percent.

Damage to intercostal nerves can occur due to a variety of diseases and conditions. This can lead to sporadic episodes of acute pain, often felt as a tearing, sharp, aching or gnawing sensation that wraps around the upper chest. Pain can be exacerbated by sudden movements like when laughing or coughing.

Causes and risk factors for intercostal neuralgia
Nerve damage or dysfunction of the intercostal nerves may occur due to infection, inflammation, direct trauma, or even certain diseases of the lung or chest wall. However, one of the most common causes of intercostal neuralgia is injuries caused during surgery involving the thoracic chest. This usually involves spreading apart the ribs to access the internal organs, possibly damaging the intercostal nerves in the process.

Various intercostal neuralgia causes include:

Rib infection or osteomyelitis
Shingles
Nerve degeneration
Inflammation of a nerve or group of nerves (neuritis)
Pregnancy, due to ribcage expansion to make room for the fetus
Pulled or strained muscle in the chest wall, shoulders, back, or arm
Direct chest or rib injury
Intercostal nerve entrapment
Surgery on organs, bones, and tissues in the thoracic cavity
Tumors in the chest and abdomen (can press on the intercostal nerves)
Risk factors that can lead to the development of intercostal neuralgia include:

Varicella-zoster infection
Not vaccinated for varicella zoster, especially after the age of 60
Playing contact sports such as football can put you at risk for a rib injury. Other activities that may lead to injury may also cause the condition
Unsafe driving that leads to an accident causing injury
Symptoms of intercostal neuralgia
Intercostal neuralgia symptoms are primarily characterized as sharp, spasm-like pain felt around the chest, often in a band-like pattern that wraps around from the back towards the front, with pain presenting on one side of the chest or both (bilaterally). However, some cases may present as a constant dull pain instead. Pain typically intensifies with exertion during activities like lifting heavy objects, twisting the torso, coughing, sneezing, or laughing.

The following are additional symptoms that may also present with intercostal neuralgia pain:

Pain in your arm, shoulder, or back
Restricted mobility of your shoulders or back
Tingling
Numbness
Abdominal pain
Loss of appetite
Fever
Simply breathing involves the movement of the rib cage, which may exacerbate intercostal neuralgia pain and lead to respiratory problems and difficulty breathing. Additionally, more serious symptoms of intercostal neuralgia that present with serious chest pain symptoms possibly combined with feelings of tightness or pressure should be evaluated at the emergency room to rule out a possible heart attack.

Additional serious symptoms may include:

Pain radiating to the left arm, shoulder, and back
A persistent cough producing yellowish-green phlegm
Increased heart rate and force (palpitations)
Sudden confusion, dizziness, or loss of consciousness
Paralysis of muscles
Severe abdominal pain

Diagnosis of intercostal neuralgia
The physical examination is an important part of an intercostal neuralgia diagnosis once a presentation of intercostal pain appears. This often involves inspection of the area at rest and palpitation of the vertebra and paravertebral structures. Various movement will also be assessed, looking for the production of pain which may point to a possible origin source. Pain produced under pressure from simply pressing down lightly at various areas around the thoracic area will also be assessed. A detailed neurologic examination will also be done to identify the cause of pain.

To rule out any pathological causes of intercostal neuralgia, additional testing will be done. This will help diagnose causes such as lung diseases or cardiovascular conditions. Once the potential cause has been found, additional tests looking for confirmation will be carried out.

Additional diagnostic tests may include:

Blood test
Electrocardiogram
Echocardiogram
Chest X-ray
CT/MRI
Ultrasound
Treatment for intercostal neuralgia
Treatment for intercostal neuralgia will depend on the underlying cause, but in most cases, symptoms tend to resolve on their own. Because nerve pain, in general, can be quite unpredictable and problematic, various methods for dealing with nerve pain can be implemented. Various intercostal neuralgic treatments include:

Non-steroidal anti-inflammatory medication (NSAIDs): Helps reduce pain and inflammation.
Epidural injections: Done into the nerve root to reduce pain symptoms.
Selective radiofrequency or cryo nerve ablation: Offered to patients who experience frequently recurring intercostal pain and involves destroying the specific portion of the nerve causing the symptom.
Antidepressants: Found to be useful for reducing nerve pain.
Capsaicin cream: A common item that helps to reduce pain.
Intercostal nerve block: With the use of a local anesthetic or corticosteroid to black the intercostal nerve causing pain.
Neuropathic pain medication: Can be used to block the action of nerves that cause pain.
Treatment may also come in other forms, such as complementary medicine or through alternative therapies. These are expected to be used in conjunction with traditional forms of treatment to help manage symptoms. Various complimentary treatment may include:

Acupuncture
Massage therapy
Yoga
With that said, it’s important to see a doctor when you begin to suffer from intercostal neuralgia, as you don’t want to risk any serious complications arising.

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