Intercostal Neuralgia

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Introduction

What is intercostal neuralgia?

Intercostal neuralgia is a rare condition that causes pain along the intercostal nerves. Intercostal nerves are located between your ribs. Ribs are long, slender bones that curve around your chest to create your rib cage. The top 10 ribs on both sides of your body attach to your thoracic (midback) spine and breastbone (sternum). The bottom two ribs attach to your spine, but not to your breastbone. These ribs are sometimes called the “floating” ribs. The intercostal areas between the ribs contain muscles and nerves. These intercostal nerves can become damaged or inflamed due to a variety of diseases, disorders and conditions, resulting in intercostal neuralgia.

Intercostal neuralgia may produce sporadic episodes of acute pain or pain that is dull and constant. The pain is often described as stabbing, tearing, sharp, spasm-like, tender, aching or gnawing. It typically feels like the pain wraps around your upper chest in a band-like pattern. The pain may intensify during exertion or with sudden movements involving the upper chest, such as coughing or laughing.

Intercostal neuralgia is often associated with injury or inflammation of the nerves, muscles, cartilage and ligaments in the rib cage and middle spine area. Common causes of intercostal neuralgia include pregnancy, tumors, chest or rib injury, surgery to the chest or organs in the chest cavity, and shingles. Shingles can attack nerves in the chest and upper back.

Intercostal neuralgia may be preventable and is often treatable. Seek prompt and regular medical care to minimize the risk of developing shingles, one common cause of intercostal neuralgia, and to diagnose and treat other causes as soon as possible.

In some cases, intercostal neuralgia can cause severe, debilitating pain that makes it difficult to move and breathe effectively. In addition, pain in the rib cage area may be caused by a condition other than intercostal neuralgia that should be immediately evaluated in an emergency setting. A heart attack is an example. Seek immediate medical care (call 911) if you, or someone you are with, have unexplained, severe pain in your rib cage, chest pain, a crushing feeling or pressure in your chest, severe shortness of breath, difficulty breathing, or a change in consciousness.

Symptoms

What are the symptoms of intercostal neuralgia?

The main symptom of intercostal neuralgia is pain in the rib cage area, often described as stabbing, sharp, spasm-like, tearing, tender, aching or gnawing. The pain may wrap around your chest or radiate from the back toward the front of your chest in a band-like pattern. Sometimes you may feel pain uniformly along the length of your ribs.

Intercostal neuralgia may occur in sporadic episodes of acute pain or it may be dull and constant. The pain of intercostal neuralgia may intensify with exertion. This includes activities such as lifting heavy objects, twisting or turning your torso, coughing, sneezing, or laughing.

Intercostal neuralgia may involve other symptoms including:

  • Abdominal pain

  • Fever

  • Itchiness

  • Numbness

  • Pain in your arm, shoulder or back

  • Restricted mobility of your shoulders or back

  • Tingling

Serious symptoms that might indicate a life-threatening condition

Intercostal neuralgia can cause severe, debilitating pain that makes it difficult to breathe. In addition, pain in the rib cage or chest area may be caused by a condition other than intercostal neuralgia that should be immediately evaluated in an emergency setting. A heart attack is an example. Seek immediate medical care (call 911) if you, or someone you are with, have unexplained, severe pain in your rib cage or any of the following symptoms:

  • Chest or rib pain, which may spread to the left arm, jaw, shoulder, or back

  • Chest pressure, cramping, tightness, or a tearing sensation in the chest

  • Coughing up yellow-green phlegm (mucus)

  • Heart palpitations or a fluttering feeling in the chest

  • Respiratory or breathing problems, such as severe shortness of breath, difficulty breathing, labored breathing, or inability to take a full breath

  • Severe abdominal pain

  • Severe chest pain when breathing or coughing

  • Sudden confusion, dizziness, or change in level of consciousness or alertness, such as passing out or unresponsiveness

Causes

What causes intercostal neuralgia?

Intercostal neuralgia can be caused by a variety of mild to serious diseases, disorders and conditions. This includes infection, inflammation, trauma, malignancy, and other abnormal processes. A common cause of intercostal neuralgia is surgery that involves the thoracic (chest) cavity. This type of surgery often requires spreading apart the ribs, which can damage the intercostal nerves.

Causes of intercostal neuralgia include:

  • Chest or rib injury, such as a broken rib or bruised chest

  • Intercostal nerve entrapment

  • Nerve degeneration

  • Neuritis (inflammation of a nerve or group of nerves)

  • Pregnancy, which can cause the rib cage to expand to make room for the fetus

  • Pulled or strained muscle in the chest wall, shoulders, back or arm

  • Rib infection

  • Shingles (reactivation of the varicella zoster virus)

  • Surgery on organs, bones and tissues in the thoracic cavity, such as kidneys, ribs and spine

  • Tumors in the chest and abdomen, which can press on the intercostal nerves. These tumors can be either malignant (cancerous) or benign (noncancerous).

What are the risk factors for intercostal neuralgia?

A number of factors increase your risk of developing intercostal neuralgia. Risk factors include:

Infection with varicella zoster virus, the virus that causes chickenpox and shingles

Participation in sports that involve high speeds or contact with other athletes, such as skiing, snowboarding, football, wrestling and rugby

Unsafe driving and motor vehicle accidents, which may cause injury to the ribs and the intercostal nerves

Reducing your risk of intercostal neuralgia

These healthy lifestyle habits may help prevent intercostal neuralgia and the injuries that may cause it:

  • Driving motor vehicles safely

  • Getting vaccinated with the chickenpox vaccine

  • Getting vaccinated with the herpes zoster or shingles vaccine if you are 60 years of age or older

  • Wearing a seat belt when driving or riding in any kind of motor vehicle

  • Wearing appropriate protective sports equipment, such as helmets and padding

Treatments

How is intercostal neuralgia treated?

Intercostal neuralgia may resolve on its own or it may require treatment. Treatments include:

  • Intercostal nerve blocks, which are injections of a local anesthetic or a corticosteroid around the affected intercostal nerve

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) naproxen (Naprosyn, Aleve), and indomethacin (Indocin). NSAIDS help reduce inflammation and pain.

Medications that may be used to treat shingles include:

  • Antidepressant medications, which can help reduce nerve pain

  • Antihistamines, which relieve itching

  • Antiviral medications, such as acyclovir (Zovirax) and famciclovir (Famvir). Antiviral medications may reduce the severity and duration of your symptoms.

  • Capsaicin cream (Zostrix), which helps relieve pain

  • Corticosteroids, which may reduce the risk of developing postherpetic neuralgia (pain continuing long after the actual shingles outbreak)

Complementary treatments

Some complementary treatments may help some people to better deal with intercostal neuralgia. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for full medical care.

Complementary treatments may include:

What are the potential complications of intercostal neuralgia?

The complications of untreated or poorly controlled intercostal neuralgia vary depending on the underlying disease, disorder or condition. Any kind of rib cage area pain, whether it occurs alone or is accompanied by other symptoms, should be evaluated by your doctor or healthcare provider. Once the underlying cause is identified, following the treatment plan you and your healthcare provider develop specifically for you will minimize the risk of complications of intercostal neuralgia and its underlying cause. These complications include:

  • Chronic rib pain, chest pain, weakness, or stiffness

  • Low oxygen levels

  • Permanent stiffness and decreased range of motion in the trunk or shoulders

  • Pneumonia

  • Postherpetic neuralgia

  • Respiratory failure and respiratory arrest

  • Spread of cancer

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 19
  1. Intercostal Nerve Block. Lahey Clinic, Tufts University School of Medicine. http://www.lahey.org/Departments_and_Locations/Departments/Pain_Management_Center/Nerve_Blocks/Inter...
  2. Intercostal Neuralgia. Columbia University Medical Center. http://www.columbianeurosurgery.org/conditions/intercostal-neuralgia/
  3. Shingles. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001861/
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