Intercostal Neuralgia

Intercostal neuralgia is neuropathic pain involving the intercostal nerves. These are the nerves that arise from the spinal cord, below the ribs. Intercostal neuralgia tends to cause thoracic pain, which affects your chest wall and upper trunk.

What are the symptoms?

The main symptom of intercostal neuralgia is burning, sharp, or shooting pain. This pain may be felt:

  • around the ribs
  • in the upper chest
  • in the upper back

Additional symptoms in these areas include:

  • a squeezing pressure sensation that wraps around the chest from front to back
  • tingling
  • numbness

The pain might feel worse even when doing gentle physical activities, such as deep breathing or stretching. It might also intensify when you laugh, cough, or sneeze. Some people also notice referred pain in their shoulder blade or lower pelvis. Referred pain is pain that you feel in an area other than the affected one.

Intercostal neuralgia caused by the shingles virus (postherpetic neuralgia) can also make your skin itchy and extremely sensitive, even to clothing.

Symptoms of more severe cases of intercostal neuralgia include:

  • involuntary muscle twitching
  • loss of appetite
  • paralysis
  • muscle atrophy
  • pain that feels like a lightning bolt

What causes it?

Intercostal neuralgia is caused by irritation, inflammation, or compression of your intercostal nerves, which are just below your ribs.

A number of things can cause this, including:

  • trauma to your chest
  • viral infections, such as shingles
  • nerve entrapment or pressure
  • injury from a surgical procedure that involved opening your chest to access your throat, lungs, heart, or diaphragm (thoracotomy)

Sometimes, intercostal neuralgia doesn’t have a clear cause. In this case, it’s called idiopathic intercostal neuralgia.

How is it diagnosed?

Before diagnosing your intercostal neuralgia, your doctor will want to rule out any other causes of your pain. During a physical exam, they’ll likely press the area between your ribs or ask you to take a deep breath. If either of these cause pain, you may have intercostal neuralgia.

Depending on your symptoms, you might also need a neurological exam to check for any problems with your nervous system. Your doctor might also use an X-ray, ultrasound, CT scan, or MRI scan to look for any signs of injury.

How is it treated?

There are several options for relieving intercostal neuralgia, and many people find that a combination of treatments works best.

Over-the-counter options

Some over-the-counter topical treatments can provide temporary pain relief. These include:

  • capsaicin creams or skin patches
  • lidocaine gels or skin patches


Antidepressants are sometimes used to treat nerve-related pain. Common ones include:

  • amitriptyline
  • desipramine (Norpramin)
  • duloxetine (Cymbalta)
  • imipramine (Tofranil)
  • nortriptyline (Aventyl, Pamelor)
  • venlafaxine

Your doctor might also have you try an anticonvulsant medication, such as:

  • carbamazepine (Carbatrol, Epitol, Equetro, Tegretol)
  • gabapentin (Gralise, Neurontin, Horizant)
  • oxcarbazepine (Oxtellar, Trileptal)
  • pregabalin (Lyrica)

In severe cases, your doctor may prescribe an opioid-aspirin or opioid-acetaminophen to help with the pain. These are all powerful medications with many side effects, so they’re usually a last-resort option.

Source: Healthline Plus

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