Intercostal Neuralgia

Intercostal Neuralgia: What Is It?

The term “intercostal” refers to the muscles surrounding the abdomen (the “chest”) and “neuralgia” means inflammation of nerves. The word “nervegia” comes from the Greek words neuro meaning nerve and gairos meaning pain.

What Causes Intercostal Neuralgia?

There are many causes of intercostal neuralgia. Some of them include:

Exercise related injuries such as sports injuries, car accidents, falls, and other trauma. These types of injuries cause pressure on the nerves in your back. If not treated properly these injuries may lead to permanent damage to the nerves.

Certain medications such as certain antibiotics, some antidepressants, and others. These drugs can affect the nervous system causing symptoms like numbness, tingling, weakness or paralysis of the lower body.

Infections such as herpes simplex virus type 1 (HSV-1) and HSV-2. Both viruses cause cold sores on your skin. They can lead to pain in your lower back if left untreated.

Cancer such as leukemia and lymphoma which are blood cell cancers, bone cancer, skin cancer, lung cancer, liver cancer, ovarian cancer, brain tumors, and others.

Arthritis and other conditions that affect the musculoskeletal system such as ankylosing spondylitis. These conditions can cause inflammation of the spinal cord.

Fibromyalgia which is a long-term condition that causes pain all over the body.

Rheumatoid arthritis which is an autoimmune disease that causes pain and swelling in the joints.

Bursitis also known as “housemaid’s knee”, which is caused by swelling of the bursa (fluid-filled sacs) that acts as a cushion between your muscles, tendons, and bones.

Sprains or strains, which are injuries to the muscles, nerves, and tendons in your back. These conditions are caused by overstretching or tearing of the muscles in your back.

Who Is Affected By Intercostal Neuralgia?

Anyone can develop intercostal neuralgia but it is more common in older people. Other factors that increase your risk of getting intercostal neuralgia include:

Smoking cigarettes, nicotine in cigarettes can cause blood vessel constriction and prevent blood flow to the nerves reducing their ability to heal.

Eating a poor diet lacking in nutrients such as vitamins and minerals.

Having a sedentary lifestyle such as a desk job where you are sitting for long periods of time without moving around.

How Is Intercostal Neuralgia Diagnosed?

There are several tests that your doctor may perform to rule out other causes of your symptoms such as:

Blood tests to rule out a blood disorder such as leukemia or lymphoma.

Urine tests to rule out a urinary tract infection.

X-rays, CT scans and MRI scans of your chest to look for bone abnormalities such as tumors or arthritis.

Electromyogram (EMG) to check the electrical activity of your muscles.

Nerve conduction test to check the speed of electrical signals in your nerves.

How Is Intercostal Neuralgia Treated?

Treatments for intercostal neuralgia are very dependent on the cause of your condition and may include:

Antidepressants such as Amitriptyline, Desipramine, and Doxepin to reduce pain.

Anti-seizure drugs such as Carbamazepine, Gabapentin, and Pregabalin to reduce pain.

Opioids such as Codeine, Fentanyl, and Tramadol for severe pain.

Other medications such as muscle relaxants, topical anesthetics or lidocaine patches.

Other treatments that your doctor may suggest to relieve pain are:

Apply an ice pack two to three times per day for ten minutes at a time.

Take over-the-counter pain relievers such as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve).

Do stretching and strengthening exercises such as yoga or pilates.

Nicotine patches to help you quit smoking.

In some cases, surgery is recommended such as a spinal fusion to stabilize your spine.

Always consult with your doctor before taking any medications after a new diagnosis. Some medications such as Coumadin (warfarin) or aspirin can increase the risk of bleeding and may not be safe to take if you are prescribed these medications after surgery.

When Is Surgery Needed?

If your intercostal neuralgia is caused by a spinal condition such as herniated discs, stenosis or a pinched nerve surgery may be needed. Your surgeon can remove the damaged disc material that is pressing on the nerve root or they may perform a microdiscectomy to remove the herniated portion of the disc. In some cases where the herniated portion is small, they may perform a fenestration procedure to remove part of the bone that covers the nerve to relieve pressure and allow the nerve to heal.

If you suffer from frequent chest pain or weakness in your chest, arm, or shoulder, you should see your doctor immediately as this may be a sign of a more serious condition.

Finding the right treatment for your condition may take some time but there are many methods to relieve pain. Your doctor will work with you to determine the best course of action to alleviate your symptoms and help you get back to your normal routine.

Sources & references used in this article:

Topiramate relieves refractory intercostal neuralgia by ZH Bajwa, N Sami, CA Warfield, J Wootton – Neurology, 1999 – AAN Enterprises

Intercostal neuralgia associated with internal mammary artery grafting by ID Conacher, JC Doig, L Rivas, AK Pridie – Anaesthesia, 1993 – Wiley Online Library

Neurectomy for treatment of intercostal neuralgia by EH Williams, CG Williams, GD Rosson… – The Annals of thoracic …, 2008 – Elsevier