Intercostal neuralgia is a condition characterized by pain that originates from the intercostal nerves. These nerves are extensions of the thoracic spinal nerves, running along the chest wall beneath the ribs. When these nerves become irritated, inflamed, or damaged, they cause neuropathic pain. This sensation is felt across the trunk and is distinct from musculoskeletal pain, reflecting a problem within the nervous system itself.
Direct Causes of Nerve Damage
Physical trauma to the chest wall, such as fractured ribs or severe bruising from accidents or falls, is a common cause of intercostal neuralgia. The mechanical force of the injury can compress or tear the nerve, leading to persistent irritation even after the bone or muscle has healed.
Another significant cause is nerve injury secondary to surgical procedures. Operations that require an incision into the chest cavity, like a thoracotomy to access the heart or lungs, carry a risk of damaging the intercostal nerves. Even procedures such as a mastectomy or breast surgery can sometimes lead to nerve trauma in the area.
Viral infections represent a third major pathway to this condition, with the most common being Postherpetic Neuralgia (PHN). PHN is a complication of the Herpes Zoster virus. After a person recovers from chickenpox, the virus remains dormant in the nerve cells and can reactivate later in life, causing the painful shingles rash. When the virus affects the intercostal nerves, the resulting inflammation can lead to long-lasting neuropathic pain that continues long after the external rash has cleared.
Compression or entrapment of the nerve also causes intercostal neuralgia. This pressure can stem from adjacent structures, such as a tumor in the chest or abdomen that presses against the nerve. Furthermore, conditions that affect the spine, including scoliosis or thoracic spinal arthritis, can cause inflammation or misalignment that traps the nerve as it exits the spinal cord.
Characteristic Symptoms and Diagnostic Process
The primary symptom of intercostal neuralgia is pain described as sharp, burning, or shooting. This discomfort tends to follow the path of the affected nerve, wrapping around the rib cage from the back toward the front of the chest in a band-like pattern. The pain is frequently intensified by movements that stretch or compress the chest, such as coughing, sneezing, deep breathing, or twisting the torso.
In addition to the pain, individuals may experience areas of numbness, tingling, or a heightened sensitivity to touch called allodynia, where even light touch is perceived as painful. The diagnostic process is complex because chest and abdominal pain can signal serious conditions, requiring the doctor to rule out issues like a heart attack, pulmonary embolism, or pleurisy.
Diagnosis typically begins with a detailed patient history. A physical examination involves checking for tenderness between the ribs and assessing the quality of sensation in the affected area. The final confirmation is often clinical, based on the specific distribution and nature of the pain, but may be supported by a diagnostic nerve block. If a local anesthetic provides temporary pain relief near the suspected nerve, it confirms that the intercostal nerve is the source of the discomfort.
Treatment and Pain Management Options
Managing intercostal neuralgia focuses on alleviating the neuropathic pain. The initial approach often involves specific medication designed to quiet down overactive nerve signals. This commonly includes anticonvulsant drugs like gabapentin or pregabalin.
Tricyclic antidepressants, such as amitriptyline, are also frequently prescribed because they can effectively modulate the pain pathways in the nervous system. In addition to systemic medication, topical treatments like lidocaine patches or creams can be applied directly to the painful area.
When oral medication is not sufficient, interventional procedures are used. An intercostal nerve block is a common procedure where a local anesthetic and a steroid are injected near the affected nerve to reduce inflammation and block pain signals. If pain remains refractory, more advanced techniques are available, including radiofrequency ablation (RFA), which uses heat to temporarily stop the nerve from transmitting pain signals. Supportive care, including physical therapy to improve posture and muscle function, may also be used in conjunction with medical treatments.