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Intercostal Neuralgia: Symptoms and Treatment


Intercostal neuralgia Intercostal neuralgia is a collective concept that is used to denote conditions involving pain in the chest. This type of pain syndrome can be observed in various pathological conditions resulting from the defeat of various systems and organs.

In the thoracic spinal cord there are 12 pairs of nerves (as many as the spinal vertebral segments). They are presented in the form of interconnected nerve bundles emerging from the front and back of the spinal cord. The first perform the motor function, and the second - sensitive. Each nerve exits the spinal canal through the intervertebral foramen, being divided into 2 bundles - the posterior one, which goes to the spinal muscles, and the anterior one, which is the intercostal nerve. The first intercostal nerve passes along the edge of each rib, and the rest fills the intercostal spaces, being in the intercostal muscles. In the event that, for one reason or another, irritation or squeezing of nerve endings occurs, intercostal neuralgia develops.

The intercostal nerve includes three types of nerve fibers: autonomic, motor and sensory. The vegetative fibers control the functions of the sweat glands and blood vessels, the motor fibers provide respiratory movements, innervate the diaphragm and intercostal muscles, and the sensory ones are responsible for various types of sensitivity.

Based on the foregoing, the conclusion is that the intercostal neuralgia is the result of changes in the intercostal nerves.

Causes of intercostal neuralgia

  • Hypothermia of the body;
  • Pathology of the thoracic spine (osteochondrosis, scoliosis, herniated intervertebral disk, deforming spondylosis);
  • Diseases of the nervous system (polyradiculoneuritis, multiple sclerosis);
  • Intoxication of the body due to the intake of certain medications, as well as the effect of heavy metal salts;
  • Diseases of the internal organs;
  • Injuries to the chest and back;
  • Transferred infectious diseases;
  • Allergy;
  • Weakened immunity;
  • Malignant neoplasms in the lungs or pleura;
  • Cardiovascular pathology;
  • Hormonal disorders;
  • Exposure to bacterial toxins;
  • Diabetes;
  • Violation of vitamin metabolism in diseases of the digestive tract;
  • Anemia;
  • Abuse of alcoholic beverages.

Symptoms of intercostal neuralgia

The most characteristic symptom of intercostal neuralgia is pain, located in the left or right side of the chest. As a rule, it extends along the intercostal spaces and has paroxysmal, shingles. When turning the body, coughing or sneezing pain increases.

Often, the pain syndrome can cause overstressing of one or several muscles of the chest, shoulder blade or shoulder. In this case, the pain becomes more intense when bending forward or when moving with your hand or scapula. However, pain in intercostal neuralgia may be accompanied by burning or numbness along the nerve trunk (or its branches), and the pain may be given to the lower back, back, under the scapula, or directly to the region of the heart.

With the infringement, irritation or damage to the pectoral nerves emerging from the V-VII vertebrae, the pain syndrome is localized in the xiphoid process and resembles gastritis pain. In the presence of degenerative processes in the X-XII vertebrae pains are observed, as in appendicitis. With the defeat of the upper thoracic segments, patients complain of a feeling of a foreign body in the throat and behind the sternum. Often, this condition becomes a cause of violation of the process of swallowing.

Differences of intercostal neuralgia from heart pain

In the case of intercostal neuralgia, pain increases with deep inhalation and exhalation, changing body position, coughing or sneezing, walking, as well as palpation of the intercostal spaces, in a state of excitement and stress. Such pain cannot be eliminated with nitroglycerin.

The intensity of heart pain does not change with a deep breath or exhale, with a change in body position. As a rule, the pathological condition is accompanied by a jump in blood pressure and the pulse (heart rate) is often disturbed. Pain can be eliminated with nitroglycerin.

Clinical options for intercostal neuralgia

  1. Irritation or squeezing of nerve endings that occurs in the lowest part of the spine. In this situation, the pain appears in the upper chest, under and above the collarbone. The painful sensations are aggravated by bending the trunk and turning the head, the pain may radiate to the neck, arm or shoulder.
  1. Neuralgia of the upper thoracic spine is accompanied by prolonged aching pain in the chest region (cardialgia). It can join the pain between the shoulder blades.
  1. Scapular-rib neuralgia. This condition is accompanied by prolonged or short stitching or aching pains. They can develop in the interscapular region, just below the axillary fossa, in the left side or in the nipple area. In such a situation, pain is observed both during inhalation and exhalation.
  1. Intercostal neuralgia, developing in the anterior part of the chest wall. Accompanied by prolonged aching pain, localized near the sternum or in the axillary line.

Localization of pain in intercostal neuralgia

Local pain

It can be caused by any pathological process aimed at pain receptors of various tissues, muscles, ligaments, skin, tendons, bones, articular joints, etc. In this case, pain develops directly in the area of ​​damage.

Irradiating pain

The mechanism of development of this pain today is not fully understood. According to experts, the nervous system may misinterpret the source of the pain due to the presence of common ways in which both visceral and somatic pain is carried. Irradiating pains resulting from stretching, irritation or squeezing of the somatic nerve or nerve root, are more intense. During physical exertion, sneezing or coughing, the pain may increase, and it can also often spread to the affected part of the body.

Reflected pain

Reflected pain is usually a consequence of the development of the pathological process in the internal organs (diseases of the retroperitoneal space, aortic aneurysm, pathology of the digestive tract, IHD).


Due to the fact that the pains triggered by intercostal neuralgia, are quite similar to pain developing in diseases of the lungs or cardiovascular pathologies, for a correct diagnosis, you should contact your cardiologist or pulmonologist for help.

In this situation, diagnostic measures include:

  • x-rays of the chest;
  • MRI;
  • computed tomography;
  • X-ray examination of the soft tissues of the spinal cord (myelography);
  • spondylography;
  • functional diagnostics of the heart (echocardiography, electrocardiography, etc.);
  • diagnostic study of the digestive tract.

If the diagnosis does not reveal pulmonary, digestive and cardiovascular pathologies, the patient is advised to consult a neurologist, who, if necessary, will recommend treatment.

Intercostal Neuralgia Treatment

Intercostal neuralgia is a pathological condition that requires pathogenetic and symptomatic treatment. Currently, the most effective methods include physical therapy, acupuncture, moxa therapy, spinal traction, massage and pharmacopuncture. With adequate treatment, as a rule, after 1-2 days the patient has a significant improvement in condition.

As a drug therapy, it is recommended to use non-steroidal anti-inflammatory drugs and muscle relaxants (means that relieve muscle spasm).

With severe pain, injection of drugs that have a more rapid effect is indicated.

Note: Drugs in the form of injections are ideal for patients with gastrointestinal diseases. They are absorbed into the blood, bypassing the digestive tract, and do not have a negative effect on the stomach.

Prevention of intercostal neuralgia

In order to prevent the development of intercostal neuralgia, you should constantly monitor your posture, avoid drafts and hypothermia, try not to lift weights more than 10-20 kg and regularly engage in recreational gymnastics, eat rationally and balanced, avoid B group vitamins, if possible, give up alcoholic beverages. Prophylactic massage using special warming ointments that improves blood circulation and lymphatic drainage has also proven itself well.

| 31 May 2015 | | 3 341 | Uncategorized
  • | Nina | November 20, 2015

    What pills for this disease can be, so that both pain and inflammation are removed? I can not even breathe hard, but I also can not go to the doctor (((

  • | Victoria | November 20, 2015

    Nina, why can't you go to the doctor? Better of course to turn. But Diclofenac retard tablets helped me very well in this case. You know, I began to drink them and on the second day, not such pains began. She began to breathe normally, but she was breathing with constraints due to pain. During the week with a little and everything went away.

Leave your feedback

Anna Lankin: i have swelling under my right boob (on the upper right big area) and it sometimes hurts to the touch :( and especially hurts when i twist to the left or stretch. :( any advice?

MJ Young: I pulled more than one rib muscle. Whilst hitting 1002 golf balls. I actually experience pain before starting with the 1000ball drill. I took 2 days off so far.....but its still bad. How long does recovery take?

robin vail: I fell on the ice and my elbow hit the bottom ribs and now thetes mote space between them on one side and its painfull and the pain is the same for two weeks.

Michael O'Donnell: I’m dealing with pain for 19 years now . Finally being told after seeing probably 50 doctors over the years that it’s a twisted rib leading to t-6 area. Any thoughts ? They told me because it’s been so long it will be very difficult to fix ot now . Pain is terrible daily . Thanks

Stack Bundles: This is my exact issue. Would be very helpful to know how to treat the issue I haven't been back to the gym in 8 weeks I need help my ribs are fine but the tissue isn't underneath