intercostal neuralgia

Intercostal Neuralgia: Symptoms, Causes and Treatments

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?


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;
  • un sternum in the front.


floating coast


This cage plays the role of protecting various important organs like the heart, lungs and large vessels. Between each intercostal space, there is a thoracic spinal nerve which is responsible for transmitting sensory and motor information. In total, each individual has 22 intercostal nerves which provide sensitivity to a specific area of ​​the skin: 11 on the left and 11 on the right.


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



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.


intercostal neuralgia aggravated by coughing


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.


tietze syndrome


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 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.


intercostal pain


The following symptoms are also considered alarming and require immediate treatment:


  • persistent cough associated with mucus;
  • tearing sensation in the chest;
  • breathing difficulties (dyspnoea);
  • heart palpitations ;
  • sharp abdominal pain;
  • muscle paralysis or aplasia;
  • confusion, dizziness or loss of consciousness.



How to treat intercostal neuralgia?


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.


doctor analyzing medical imaging of the ribs


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.


Treatment of 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.


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:


drugs for intercostal neuralgia


  • 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.




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