Intercostal neuralgia: all about this intercostal pain

Intercostal neuralgia is chest pain in the intercostal nerves. It is caused by the compression of one of the 24 nerves located between the ribs and the intercostal muscles, at the level of the rib cage.

Treatment of intercostal neuralgia depends on its cause. In this article, find out everything you need to know about intercostal neuralgia.

What is intercostal neuralgia?

Intercostal neuralgia is characterized by pain located in the chest. This pain is caused by inflammation or damage to an intercostal nerve, which is a nerve that originates from the root of the spinal cord and is located between the ribs.

Causes and risk factors for intercostal neuralgia

Causes of intercostal neuralgia

Intercostal neuralgia can be caused by various conditions such as infection, inflammation, injury to the chest or ribs, or surgery on the chest region.

For example, surgical removal of the kidney can damage the intercostal nerves.

There are other causes such as:

  • a cracked or fractured rib as a result of trauma;
  • degeneration of the intercostal nerves;
  • vertebral osteoarthritis, which causes inflammation of a nerve;
  • abdominal distention
  • pregnancy, which causes an increase in the rib cage;
  • an infection such as shingles (postherpetic neuralgia caused by shingles)
  • a benign or malignant tumor in the chest or abdomen that presses on the intercostal nerves
  • skin, muscle, and ligament lesions at the level of the vertebrae;
  • post-thoracotomy pain (after a surgical incision of the chest wall)
  • intercostal neuritis (pain in the chest).

In the case of acute pain, inflammation is observed with increased production of cytokines (molecules of inflammation) released by damaged tissues.

In the case of chronic pain observed in intercostal neuralgia, the mechanisms causing pain are still poorly understood.

What are the risk factors?

There are certain risk factors for intercostal neuralgia such as:

  • Infection with varicella and shingles virus. This virus can reactivate after the age of 60;
  • participation in speed or contact sports activities such as skiing, snowboarding, and football;
  • Trauma from a road accident resulted in injuries to the ribs and intercostal nerves.

Can stress cause intercostal neuralgia?

Intercostal pain can be felt in a very anxious person.

Symptoms of intercostal neuralgia

Recognizing intercostal neuralgia

The main symptom of intercostal neuralgia is a pain in the chest area. This pain associated with intercostal neuralgia can be bilateral, like a stab.

The pain is in and around the chest area on either side and can radiate from the back to the front of the chest. Sometimes the pain is felt evenly along the entire length of the ribs.

In other cases, the pain appears with breathing, laughing, or sneezing. The pain increases with exertion.

Other symptoms

  • Pain in the ribs, especially on the left side, which can be mistaken for heart pain or angina. Warning: any intercostal neuralgia should be considered as heart pain until proven otherwise;
  • numbness and/or tingling
  • abdominal pain
  • loss of appetite
  • fever
  • pain in the arms and/or shoulders Pain on the left side of the shoulder and arm joint is often mistaken for heart pain or angina.

The most severe symptoms

The following symptoms should lead you to call the SAMU center 15:

  • Chest pressure or a feeling of tearing in the chest;
  • persistent cough with mucus
  • heart palpitations
  • difficulty breathing
  • acute abdominal pain
  • confusion, dizziness, or decreased level of consciousness;
  • paralysis and atrophy of the muscles

Complications of intercostal neuralgia can include chronic chest pain, decreased range of motion, pneumonia, or respiratory failure.

Who is most affected?

Individuals who perform high-impact sports are more likely to suffer from intercostal neuralgia.

Diagnosis of intercostal neuralgia

The diagnosis of intercostal neuralgia is made using:

  • a detailed neurological examination performed to identify the cause of the pain;
  • a pain questionnaire;
  • radiological examinations such as chest X-ray or MRI;
  • a visit to a pulmonologist to determine whether or not there is an infection.

In general, the context and neurological examination are sufficient for the doctor to make a diagnosis.

Treatment of intercostal neuralgia

Prevention

Prevention of intercostal neuralgia involves reducing risk factors, for example, by vaccinating against chickenpox and herpes zoster, and adopting safer driving in order to avoid an accident.

Protective devices can help prevent intercostal neuralgia. This includes wearing a helmet or using padding when participating in contact sports.

A warm-up is also recommended before the practice of a sport.

How to treat intercostal neuralgia?

Once all other urgent and serious causes of intercostal neuralgia have been eliminated, your doctor will suggest simple analgesics such as paracetamol or anti-inflammatory drugs depending on the level of pain if an infectious origin is eliminated.

Secondarily, the treatment of the cause is important, it is necessary to know if it is osteoarthritis, false movement, or inflammation.

If these treatments are not sufficient, consult a pain doctor or neurologist who can offer:

  • Medications such as those used in neuropathic pain (capsaicin-based cream) help relieve pain associated with intercostal neuralgia, as do non-steroidal anti-inflammatory drugs (ibuprofen) or antidepressant medications that help calm nerve pain;
  • radiofrequency treatment;
  • A local anesthetic or corticosteroid may be given to the affected nerve. Corticosteroids help reduce the risk of postherpetic neuralgia;
  • antihistamines are used to relieve itching;
  • antiviral drugs reduce the severity and duration of symptoms;
  • anticonvulsants.

Complementary approaches

Other treatments for intercostal neuralgia may accompany conventional treatments and include massage, sophrology, acupuncture, and yoga.

No medical evidence is currently published at this time, however, it is recognized that any technique aimed at relaxing the intercostal muscles can have a beneficial effect.

Image Credit: Image by Drazen Zigic on Freepik

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