Inflammation of the intercostal nerves is called intercostal neuralgia. Intercostal neuralgia can have many causes, but in most cases the cause is unclear. The pain that intercostal neuralgia causes can be sharp, burning, radiating, or aching. However, many treatment options are available. Learn more about the causes, symptoms, and treatment of intercostal neuralgia in this informative guide.
Intercostal neuralgia is an inflammatory condition of the intercostal nerves.
Intercostal neuralgia induces pain that can be sharp, tapping, burning, radiating, or aching.
The causes of intercostal neuralgia range from surgery and rib fractures to herpes zoster and many other conditions.
In addition to medication, there are many other treatments such as intercostal nerve blockades, spine manipulation, and exercise therapy.
Intercostal neuralgia is an inflammatory condition of the intercostal nerves. Intercostal nerves go from the thoracic spine's first vertebra and end at the thoracic spine's eleventh vertebra. These nerves innervate the intercostal and abdominal wall muscles, latissimus dorsi, and serratus anterior muscles as well as the skin of the chest wall and abdomen.
When you have intercostal nerve inflammation, it causes pain. The pain can be sharp, tapping, burning, radiating, or aching. It can be constant or intermittent. Mostly, people describe the pain as a band-like pain. Moreover, sharp pain appears when someone tries to rotate the trunk, jump, laugh, sneeze, cough, and sometimes breathe.
Causes of intercostal neuralgia
There are a lot of causes of intercostal neuralgia, which can vary from the peripheral and central nervous systems and psychological mechanisms.
However, the main reason why people have intercostal neuralgia is unclear. Here are a few common sources that cause intercostal neuralgia:
- Anterior cutaneous nerve entrapment syndrome
- Breast surgery
- Rib fractures
- Nerve impingement
- Diabetic peripheral neuropathy
- Herpes zoster (HZ)
Sometimes intercostal neuralgia appears in pregnant women because of the stretching of the nerves as well as in obese persons or during frequent coughing.
Treatment of intercostal neuralgia
The treatment of intercostal neuralgia depends on the cause.
When intercostal neuralgia is caused by herpes zoster (shingles), you should treat the infection to treat the inflammation. In the early stage of HZ, antivirals such as acyclovir and corticosteroids can reduce the pain. Non-steroidal anti-inflammatory drugs, antidepressants, opioids, topical agents, and transcutaneous electrical nerve stimulation have positive effects in acute and chronic phases of HZ. However, preventive care is more critical, because vaccination with the live attenuated vaccine can reduce the HZ incidence by about 51%.
If a person has had thoracic surgery, it is important to reduce acute symptoms to avoid the development of chronic pain. It is very important to determine the plan of pain control with neuraxial or peripheral blockade and analgesic agents. This treatment option can reduce post-thoracotomy pain syndrome and improve pulmonary function and mechanics.
Regardless of the cause of intercostal neuralgia, non-steroidal anti-inflammatory drugs, antidepressants, anticonvulsants, and opioids can help to relieve the pain.
Intercostal nerve blocks also can be helpful during the treatment of intercostal neuralgia associated with multiple rib fractures. This pain relief is short-lived.
The manipulation of the thoracic spine is another interventional technique. Sometimes thoracic vertebrae can irritate the costal nerve because of the vertebra position or costovertebral joint. Manual techniques can relieve the pressure on the intercostal nerve as well as relieve the pain during the impingement of the costal nerve.
Practical tips to relieve intercostal neuralgia
Physical therapy can be a very good painkiller because of exercise-induced hypoalgesia. Stretching can be a very helpful practice during intercostal neuralgia. Here are a few helpful stretching exercises:
- Rise your hands above the head and lock your fingers together. Bend your spine to one side and hold for a few seconds then slowly back to starting position and repeat to the other side.
- Practice a deep breathing exercise by trying to expand your ribs to the sides and front while standing straight. That helps to increase your rib cage mobility because most of the patients avoid to breathing deeper because of the pain.
- A simple tip for breathing into the side of your ribs is to place your hands on the sides of the ribs and try to inhale in your hands. Now you are moving the ribs to the sides.
- Another breathing exercise is to breathe first into one side. Do this a few times. Now try to breathe into the other side. Focus on which side of the ribs was more restricted, and take a few more breaths to the restricted side.
- Spine rotation with breathing is a very helpful exercise to mobilize the thoracic spine. Sit on a chair and slowly twist your spine to one side. Keep this position and breathe deeply. If it is painful, breathe gently and after that gradually deepen your breathing.
What is the prognosis of intercostal neuralgia?
About 5% of patients will develop chronic pain conditions after thoracic surgery. Chronic pain decreases the quality of life and physical function, affects sleep, and can cause depression.
Moreover, another negative prognosis can be a negative effect on respiratory mechanics and the fear of breathing. That is why breathing exercises must be performed, starting slowly with small breaths and gradually increasing to deeper breathing.
- StatPearls. Intercostal Neuralgia.
- Current Pain and Headache Reports. A Review of Techniques of Intercostal Nerve Blocks.