Intercostal Neuralgia: Symptoms, Causes and Treatments

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Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine 

Chest pain is not always related to heart or lung problems. They may also be due to a intercostal neuralgia as a result of wrong movement, infection or injury. What is intercostal neuralgia? What are its symptoms? When should you be worried? How is she treated? Discover in this article everything you need to know about intercostal neuralgia.

What is intercostal neuralgia? (short anatomical reminder)

La intercostal neuralgia, also called " intercostal pain indicates pain in the chest, specifically between the ribs. It is usually due to inflammation, irritation or damage to an intercostal nerve. The latter finds its root in the spinal cord located between the ribs.

To better understand this type of neuralgia, here are some concepts of anatomy of the thorax. The thoracic cage is made up of:

  • 12 vertebrae dorsal (or thoracic) which form the spine in back ;
  • 12 pairs of ribs which articulate with the thoracic vertebrae on the sides;
  • a sternum at the front.

intercostal nerve

To put it simply, a intercostal nerve is a nerve that path between the intercostal spaces, that is to say between two upper and lower ribs. In humans, there are eleven pairs, located on either side of the spine. They innervate la most of the chest wall et abdominal.

More precisely, they innervate the intercostal muscles and abdominal wall, and are involved in breathing.

During a intercostal neuralgia, one or more of these intercostal nerves has a problem.

Intercostal nerve stuck, really?

There is a lot of misinformation about pinched nerves. So let's get this straight: pinched nerve is a very rare instance, and it's usually a myth. Here's why :

Le human nervous system is an incredibly complex and robust system. It is made up of billions of nerve cells, or neurons, which constantly send and receive signals.

These signals travel the entire length of the neuron, cell body to the axon (the long, thin part of the neuron). The axon is covered with a layer of insulation called myelin, which helps protect the nerve and maintain signal strength.

Now imagine that you have an injury or inflammation in your arm. This can put pressure on the axon of a nearby nerve cell.

However, since the axon is protected by myelin, this pressure will not actually pinch or damage the nerve. The signal can be slowed down or interrupted, but it will not be completely stopped. So, contrary to popular belief, nerve pain does not equal a pinched nerve. It would take an extremely great force to sever or compress a nerve.

Of course, this does not mean that the pain is not real. Pressure on a nerve can still cause symptoms as discussed in the next section.

What are the symptoms of intercostal neuralgia?

Le premier sign of intercostal neuralgia is a sharp pain located in the chest wall. It can relate to a specific point or spread along a coast. If generally, it is unilateral (affects only one side), it can also be bilateral.

La chest pain appears violently and brutally. It can interfere with such ordinary gestures as breathing, laughing or speaking. It can be amplified by efforts, movements of the spine, bad postures, sneezing or a fit of coughing. It is the same when palpating or pressing the area concerned.

La intercostal pain during neuralgia can be associated with other symptoms such as:

  • abdominal pain;
  • a fever ;
  • loss of appetite;
  • tingling or numbness;
  • pain in the arms or shoulders.

What causes intercostal neuralgia?

Risk factors for intercostal neuralgia

La neuralgia of the intercostal nerves usually affects people over the age of 50 who suffer fromvertebral osteoarthritis, shingles, pulmonary pathologies or herniated discs. This neurological disorder can also be observed in athletes or smokers. While sporting activity often exposes you to the risk of injury, the tabagisme causes coughing and lung disease.

What causes intercostal neuralgia?

THEorigin of intercostal neuralgia is multiple. This disorder may be related to

  • false movements that can cause blockage in the ribs and vertebrae;
  • vertebral osteoarthritis which causes degeneration of the vertebrae and decreased movement of the vertebrae;
  • a pregnancy, because during this period, weight gain can be significant, which can lead to an increase in the volume of the rib cage;
  • a violent and transient cramp of the intercostal muscles;
  • trauma (injury, sprain or rib fracture caused by a road accident, etc.);
  • the practice ofstrenuous physical activity or a long episode of coughing which promotes the rupture of the intercostal muscles.

Intercostal neuralgia can also be related to other diseases such as liver disorder, spinal metastasis, chest tumor or myeloma.

This is also the case with shingles (post-herpetic neuralgia). Since the varicella virus only remains latent in certain lymph nodes or certain cranial nerves, it can be reactivated in case of failure of the immune system. This failure can be favored by old age, great stress or illness.

How is stress related to intercostal neuralgia ?

Although not the primary cause, stress may be related to intercostal neuralgia.

We often think that stress is nothing more than an unpleasant feeling, but it can actually have a profound effect on physical and mental health.

When we are stressed, our body releases hormones like cortisol and adrenaline, which prime the body to respond to a threat. These hormones can lead to increased muscle tension, including in the chest area, which can exacerbate symptoms of intercostal neuralgia.

Additionally, stress can have an effect on the nervous system, making the nerves more sensitive to pain. This increased sensitivity can make symptoms of intercostal neuralgia more noticeable and painful. Stress can also affect pain perception, making individuals more aware and less tolerant of painful sensations, which can worsen the experience of intercostal neuralgia.

Also, stress can impact behavior, such as posture or breathing patterns. Poor posture or shallow breathing, often seen in people under stress, can contribute to muscle and nerve tension in the chest area, making symptoms of intercostal neuralgia worse.

It's also possible that stress and intercostal neuralgia are circularly linked: pain from neuralgia can cause stress, and that stress can in turn make the pain worse. For this reason, stress management can be an important component in the overall treatment of intercostal neuralgia.

Besides causing pain, stress can also lead to other problems like anxiety, depression, and insomnia. It is therefore important to manage stress in order to preserve physical and mental health.

How is this disease diagnosed?

For this type of pain, you should contact a general practitioner. the diagnosis of intercostal neuralgia begins with the description of the pain. The doctor will then do a neurological examination detail that helps determine the origin of the pain.

If necessary, other radiological examinations can be performed like an MRI or chest X-ray. In case of suspicion of an infectious origin, the attending physician can refer the patient to a pulmonologist.

It should be noted that intercostal pain can be diagnosed only with the help of a well-conducted history and neurological examination. Radiological examinations are secondary and serve above all to reassure the patient. Indeed, thanks to these examinations, the hypothesis of a cardiac or pulmonary origin can be totally excluded.

How long does this neurological disorder last?

Depending on the degree of intercostal pain, neuralgia can be categorized into 3 forms: mild, moderate and severe.

In general, for a mild form, the neuralgia disappears in just two to three weeks. For a moderate form, the patient may take six to seven weeks to recover. As for the severe form, it takes eight to ten weeks for complete healing. Indeed, this case is often linked to a complete rupture of the intercostal muscles.

When the intercostal pain left untreated, it can cause complications such as pneumonia, respiratory failure, or chronic chest pain.

Intercostal neuralgia: when to worry?

Generally, a patient with intercostal neuralgia worries when the pains appear along the ribs. This is because this pain can be mistaken for heart or lung pain.

However, there are a few key differences that help distinguish intercostal neuralgia from these other conditions.

For example, intercostal neuralgia is more likely to cause burning sensation, while heart pain is more likely to cause feelings of pressure or crushing.

Also, intercostal neuralgia is more likely to be aggravated by coughing or deep breathing, whereas other conditions are not.

If you feel a chest or rib pain, it is important to see a doctor to determine the cause. With proper diagnosis and treatment, intercostal neuralgia can be effectively managed.

Potentially Dangerous Symptoms

Several key factors indicate when intercostal neuralgia may be cause for concern. Here are the symptoms synonymous with a severe impairment :

  • If the pain is accompanied by shortness of breath, chest pain, or difficulty breathing, it may be a sign of a more serious condition.
  • Persistent cough associated with mucus;
  • Tearing sensation in the chest;
  • Breathing difficulties (dyspnea);
  • Heart palpitations ;
  • Acute abdominal pain;
  • Paralysis or aplasia of the muscles;
  • Confusion, dizziness or loss of consciousness.
  • If the pain is severe enough to interfere with daily activities or disrupt sleep, it is important to see a doctor.
  • If the pain persists for more than a week despite home treatment, it is also advisable to consult a doctor.

Although intercostal neuralgia is usually not a serious condition, these symptoms may signal a more serious problem and should therefore be evaluated by a healthcare professional. Consult urgently if the above symptoms persist.

What are the complications of intercostal neuralgia?

Intercostal neuralgia is a form of chest pain which occurs when the nerves that run along the ribs are irritated or damaged. This condition can be extremely painful, and it may be difficult to take a deep breath or move the affected arm or leg.

The pain can be caused by a nerve damage, inflammation or pressure on the nerve. It can be a debilitating condition which makes it difficult to perform daily activities. There are several potential complications of intercostal neuralgia, including:

Chronic pain 

The most common complication of intercostal neuralgia is Chronic Pain. This can be intense enough to hamper the activities daily and make it difficult to get a good night's sleep.

The pain may be constant or intermittent and may worsen with movement or coughing.

Damage to the intercostal muscles 

Another potential complication of intercostal neuralgia is muscle weakness. This may be due to damaged nerves or unable to function properly.

Dysfunction of the intercostal muscles can make it difficult to move the affected limb or body part and can lead to falls or injuries.

Pneumonia 

Complications of intercostal neuralgia can include pneumonia, due to fluid buildup in the lungs. The person may also suffer from heart failure, as the heart is unable to pump blood efficiently.

In severe cases, death can occur. The treatment of intercostal neuralgia usually consists of a combination of painkillers and physical therapy.

Surgical intervention is rarely necessary. However, if the person does not respond to conservative treatment, surgery may be recommended to decompress the nerve.

Breathing disorders 

According to severity of condition, intercostal neuralgia can lead to a number of complications. The most common is difficulty breathing because the chest muscles are unable to fully expand.

This can range from a slight shortness of breath to a more severe lack of air. In severe cases, it can even lead to respiratory failure. Other possible complications include pneumonia and atelectasis (collapsed lungs).

How to treat intercostal neuralgia?

At first, the doctor prescribes drugs to soothe the pain such as analgesics (paracetamol) or anti-inflammatories if it is not an infection. On the other hand, he looks for treatments adapted to the cause of the intercostal neuralgia if it is osteoarthritis, inflammation or the consequence of a false movement.

Physical therapy (physiotherapy) sessions may also be helpful in relieving pain and improving function. The therapist will notably prescribe activities helping to strengthen the trunk region, increase flexibility, etc.

If the main treatment proves ineffective, the patient should consult a neurologist or pain specialist. Radiofrequency treatment may be offered. Different medications can also be prescribed such as:

  • nonsteroidal anti-inflammatory drugs (such as ibuprofen);
  • antidepressant drugs;
  • anticonvulsant drugs;
  • antihistamine medicines for itching;
  • corticosteroid or local anesthetic;
  • antiviral drugs...

Note that alternative medicine such as homeopathy, naturopathy, osteopathy or acupuncture also offers solutions to relieve intercostal neuralgia. In addition, it is quite possible to use them as an adjuvant treatment. However, you should always seek the advice of your doctor beforehand. Remember that pain in the chest is always delicate.

Intercostal neuralgia and osteopathy

Osteopathy is a health care approach that focuses on the treatment of musculoskeletal disorders through manual manipulations and mobilization techniques. It may offer an attractive treatment option for intercostal neuralgia.

Although there is not much scientific evidence on this, osteopathy aims to restore balance and harmony to the musculoskeletal system, which can have a beneficial effect on the intercostal nerves.

One of the main ways osteopathy can help treat intercostal neuralgia is by improving mobility in the spine and ribs. Movement restrictions in these areas can put pressure on the intercostal nerves, contributing to pain. Osteopathic techniques can help release these restrictions, which can reduce pressure on nerves and relieve pain.

Additionally, osteopathy can help relax surrounding muscles that may be tight or spastic, a condition often associated with intercostal neuralgia. Muscle relaxation can indirectly reduce pressure on nerves, which can lessen pain.

Osteopathy also considers the whole body and seeks to identify and treat imbalances that may be contributing to pain.

For example, poor posture or muscle imbalances in other parts of the body can impact the chest region and contribute to intercostal neuralgia. By addressing these underlying issues, osteopathy can offer a more holistic approach to managing pain.

How to sleep with intercostal pain?

When you sleep on your stomach, you put unnecessary pressure on your back and spine. The your back muscles can then contract and become even more painful.

Sleep on your back or on your side instead. You can place a pillow under your knees for support. If you sleep on your side, place a pillow between your knees to keep your spine aligned.

Sleeping on your back or side will also help you breathe easier, which can be helpful if you suffer from intercostal pain.

Difficulty breathing is often caused by tension in the chest muscles, so sleeping in a position that relieves these muscles can help you breathe easier.

Using a proper pillow

For sleep on your back, use a pillow to support your head and neck. To sleep on your side, place a pillow between your knees. If you must sleep on your stomach, place a pillow under your pelvis or between your knees.

Using a proper pillow will help you maintain good posture and relieve pain.

Use an appropriate mattress

Un mattress too soft or too hard can cause back pain. A medium-firm mattress is often the best choice for people with back pain.

If you have intercostal pain, sleeping on a firm mattress may be more comfortable. A firm mattress provides support and stability, which can help relieve pain.

You may also consider using a memory foam mattress. Memory foam conforms to your body and relieves pressure points. This can help reduce pain and improve sleep quality.

Sleep is an important part of healing and managing intercostal pain. Make sure you get enough rest each night.

References

https://www.passeportsante.net/fr/Maux/Problemes/Fiche.aspx?doc=nevralgie-intercostale_pm

https://www.doctissimo.fr/html/sante/encyclopedie/douleur-intercostale.htm

https://www.femmeactuelle.fr/sante/sante-pratique/douleurs-intercostales-dois-je-minquieter-37928

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