What is Intercostal Neuralgia?
Neuralgia is name given to pain occurring in the nerves. This pain usually is triggered without stimulation of pain receptors. There are many types neuralgia, one of which is Intercostal Neuralgia. This is caused due to compression of nerve in thoracic or the abdominal area i.e., the ribcage. Intercostal Neuralgia is a rare condition in which there is pain along the intercostal nerves. These nerves lie between the ribs and any sort of damage to one of the nerves or any loss of function of nerve results in intercostal neuralgia.
There may be many reasons for compression of this nerve causing intercostal neuralgia like a ruptured abdominal tissue, abdominal distention, scar tissue formation around nerve, abdominal muscle overuse, or irregular curvature of vertebrae and the like.
A surgery in and around the chest region can also be one of the reasons in which this nerve can be injured. These nerves can get damaged or inflamed due to different diseases or conditions resulting in intercostal neuralgia. The nature of pain is sharp and spasmodic in and around the ribcage area. Some of the common causes for intercostal neuralgia are pregnancy, tumor, chest or rib injury, surgery to chest or organs in the chest cavity and infections such as shingles. Shingles may attack nerves in chest and upper back causing pain. Intercostal neuralgia is generally preventable and is definitely treatable. In some cases, symptoms of intercostal neuralgia can be severe and incapacitating pain resulting in difficulties with moving and breathing.
Pain in the ribcage area need not necessarily be from intercostal neuralgia, like in heart attack. So, instant medical attention should be sought if an individual is having unexplained severe pain in ribcage, chest pain, pressure in the chest, severe dyspnea, or alteration in consciousness.
Pathophysiology of Intercostal Neuralgia
Pain in ribcage may be occurring due to a variety of reasons. When the cause of pain is the nerves in the chest, then generally the intercostal nerves are the pain generators. These nerves originate from spinal cord and are located under the ribs along with vein and artery. These nerves supply to muscles of ribcage, skin and the chest cavity. These nerves can be damaged as a result of surgery, trauma, infections like shingles, or it can be idiopathic.
The pathogenesis of acute intercostal neuralgia includes many etiologies like skin and muscle injury, dislocation of costochondral joints, damage to costovertebral ligament, postherpetic neuralgia, postthoracotomy pain and intercostal neuritis. In the case of acute pain, the chemosensitive ion channels present in peripheral nociceptors get activated by cytokines released from damaged tissue. Activation of these channels results in generation of action potentials that get charged from peripheral nociceptors from chest area to the thoracic spinal cord via intercostal nerves. The pathophysiology of chronic intercostal neuralgia pain is quite complicated. It involves different mechanisms such as peripheral, central, and psychological. In some instances, a structural or inflammatory source can be located but still there are indeterminate etiologies in many people with primary pain disorders.
Sign and Symptoms of Intercostal Neuralgia
The main symptom of intercostal neuralgia is pain in the ribcage area. This pain associated with intercostal neuralgia can be bilateral, stabbing, sharp, tearing, or aching in nature. The intercostal neuralgia pain is in and around the chest area on either side and may radiate from the back towards the front of chest in a band-like fashion. Sometimes, pain is felt evenly along the length of ribs. Sometimes, there is pain with breathing, laughing, or sneezing. The pain increases with exertion. Intercostal neuralgia may also be present in an intermittent fashion like acute pain or a dull and constant pain.
Other Symptoms Of Intercostal Neuralgia Are:
- Bilateral pain may radiate to back.
- Pain in the ribs, especially on left side may be mistaken for heart pain or angina.
- Numbness and/or tingling.
- Abdominal pain is a symptoms of intercostal neuralgia.
- Loss of appetite.
- Pain in arms and/or shoulders. Referral pain on left side of shoulder joint and arm is often mistaken for heart pain or angina.
Some Of The More Serious Symptoms Characteristic Of A Life-Threatening Condition Are:
- One of the symptoms of intercostal neuralgia is chest or rib pain with radiation to left arm, shoulder, and back.
- Chest pressure with tightness or tearing sensation in chest.
- Persistent cough producing yellowish-green phlegm.
- Breathing difficulties can be a sign and symptoms of intercostal neuralgia.
- Acute abdominal pain.
- Acute pain in chest with breathing or coughing is yet another sign and symptoms of intercostal neuralgia .
- Sudden confusion, dizziness or change in level of consciousness.
- Paralysis and atrophy of muscles.
Causes and Risk Factors of Intercostal Neuralgia
Intercostal neuralgia can be caused due to a variety of conditions like infection, inflammation, trauma, or other processes. One of the most common cause of intercostal neuralgia is a surgical procedure which involves the thoracic cavity since this sort of procedure involves spreading of the ribs which may cause damage to intercostal nerves.
Some of the Causes of Intercostal Neuralgia are:
- Injured chest or rib can cause intercostal neuralgia.
- Entrapment of intercostal nerves.
- Degeneration of the nerves can also cause intercostal neuralgia.
- Pregnancy, which causes rib cage to expand in order to make room for fetus.
- Strain to the muscles of chest wall, shoulders, or back.
- Rib infections.
- Surgical procedure in and around the thoracic cavity can lead to intercostal neuralgia.
- Intercostal neuralgia can be caused due to tumors around the chest or abdomen pressing on intercostal nerves.
Some of the Risk Factors for Intercostal Neuralgia are:
- Varicella Zoster infection.
- Participation in sporting activities involving great speed like skiing, snowboarding, football, etc. puts you at risk for sustaining intercostal neuralgia
- Trauma due to motor vehicle accidents resulting in injury to ribs and intercostal nerves.
Treatment for Intercostal Neuralgia
- Depending on cause of pain associated with ntercostal neuralgia, a treatment plan is designed. Intercostal neuralgia can also resolve on its own but generally requires treatment.
- Sometimes in patients where intercostal pain is frequently recurring, the specific portion of nerve causing pain needs to be destroyed.
- In cases where the nerve is entrapped in an abdominal scar, then the suture needs to be excised in order to treat intercostal neuralgia.
- Medications like neuropathic pain medications and capsaicin cream help in relieving pain associated with intercostal neuralgia.
- TENS unit also helps.
- Epidural injections and sleeve injection of nerve root can also be given to treat intercostal pain.
- Pulse Radiofrequency treatment is also given sometimes.
- Intercostal nerve blocks using local anesthetic or corticosteroid may be given around the affected intercostal nerve.
- NSAIDs help in calming down pain and reducing inflammation.
- Antidepressant medications for intercostal neuralgia help in calming down nerve pain. Antihistamines are used for relief of itching. Antiviral medications reduce the severity and duration of symptoms.
- Corticosteroids help in reducing risk of postherpetic neuralgia.
- Other treatments for intercostal neuralgia include cold therapy, acupuncture, yoga etc.
- Intercostal neuralgia can also occur as a result of entrapment of a like than in sciatica so treatments similar to that of sciatica can be given for relief from pain.
- Lifestyle modifications such as driving safely, getting vaccinated with chickenpox, herpes zoster, and shingles vaccine, and wearing protective gears like helmets and padding when participating in high impact sports can help in the prevention of intercostal neuralgia.
Investigations to Diagnose Intercostal Neuralgia
- Detailed neurological examination in done to identify the cause of pain.
- Pain questionnaire.
- Radiological studies like x-ray or MRI.
- Consultation with a pulmonologist.