Intercostal neuralgia: symptoms and treatment
- Causes of intercostal neuralgia
- Symptoms of intercostal neuralgia
- Differences between intercostal neuralgia for cardiac pain
- Clinical variants of intercostal neuralgia
- Localization of pain in intercostal neuralgia
- Treatment of intercostal neuralgia
- Prevention of intercostal neuralgia
Intercostal neuralgia is a collective concept, which is used to denote conditions accompanied by pain in the chest area. This type of pain syndrome can be observed with various pathological conditions arising from the defeat of various systems and organs.
In the thoracic spinal cord there are 12 pairs of nerves (the same number as the spinal vertebral segments). They are represented in the form of combined neural bundles emerging from the anterior and posterior parts of the spinal cord. The former perform the motor function, and the second - the sensitive one. Each nerve leaves the spinal canal through the intervertebral foramen, dividing into 2 fascicles - the posterior one, directed towards the dorsal muscles, and the anterior one, which is the intercostal nerve. At the edge of each rib passes the first intercostal nerve, and the rest fill the intercostal spaces, being in the thickness of the intercostal muscles. In the event that, for one reason or another, irritation or compression of nerve endings occurs, intercostal neuralgia develops.
The intercostal nerve consists of three types of nerve fibers: autonomic, motor and sensitive. Vegetative fibers control the functions of the sweat glands and blood vessels, the motor fibers provide respiratory motion, innervate the diaphragm and intercostal muscles, and the sensitive fibers are responsible for various types of sensitivity.
Causes of intercostal neuralgia
- Subcooling the body;
- Pathologies of the thoracic spine (osteochondrosis, scoliosis, herniation of the intervertebral disc, deforming spondylosis);
- Diseases of the nervous system (polyradiculoneuritis, multiple sclerosis);
- Intoxication of the body as a result of taking some medications, as well as the influence of heavy metal salts;
- Diseases of internal organs;
- Chest and back injuries;
- Postponed infectious diseases;
- Weakened immunity;
- Malignant neoplasms in the lungs or pleura;
- Cardiovascular pathologies;
- Hormonal disorders;
- Effects of bacterial toxins;
- Violation of vitamin metabolism in diseases of the digestive tract;
- Abuse of alcoholic beverages.
Symptoms of intercostal neuralgia
The most characteristic symptom of intercostal neuralgia is pain localized in the left or on the right side of the chest. As a rule, it spreads along the intercostal spaces and has a paroxysmal, shingling character. With torso, coughing, or sneezing, soreness increases.
Often, pain syndrome can cause overstrain of one or more muscles of the chest, shoulder blade or shoulder. In this case, the pain becomes more intense when tilting forward or when moving with the hand or shoulder blade. At the same time, painful sensations in intercostal neuralgia can be accompanied by burning or numbness along the nerve trunk (or its branches), as well as pain in the back, back, under the scapula or directly into the heart.
When infringing, irritating or affecting the thoracic nerves emerging from the V-VII vertebrae, the pain syndrome is localized in the region of the xiphoid process and resembles pain in gastritis. In the presence of degenerative processes in X-XII vertebrae, pain is observed, as in appendicitis. When the upper thoracic segments are affected, patients complain of a foreign body feeling in the pharynx and behind the breastbone. Often, this condition becomes a cause of disturbance of the swallowing process.
Differences between intercostal neuralgia for cardiac pain
In the case of development of intercostal neuralgia painful sensations increase with deep inspiration and exhalation, change in body position, coughing or sneezing, walking, as well as palpation of intercostal spaces, in a state of excitement and with stress. Such pain can not be eliminated with nitroglycerin.
The intensity of heart pain does not change with a deep inspiration or exhalation, with a change in the position of the body. 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 variants of intercostal neuralgia
- Irritation or squeezing of nerve endings, which occurs in the lowest part of the spine. In this situation, the pain appears in the upper chest, under and above the clavicles. Painful sensations are enhanced by tilting the body and turning the head, pain can radiate to the neck, arm or shoulder.
- Neuralgia of the upper thoracic spine is accompanied by a prolonged aching pain in the retrosternal region (cardialgia). To her can join the pain between the shoulder blades.
- Spade-rib neuralgia. This condition is accompanied by long or short-term stitching or aching pains. They can develop in the interscapular region, just below the axillary fovea, in the left side or near the nipples. In this situation, painful sensations are observed both during inspiration and exhalation.
- Intercostal neuralgia developing in the anterior thoracic wall. It is accompanied by a prolonged aching pain, localized near the sternum or in the axillary line.
Localization of pain in intercostal neuralgia
It can be caused by any pathological process aimed at the pain receptors of various tissues, muscles, ligaments, skin, tendons, bones, articular joints, etc. In this case, the pain develops directly in the area of injury.
The mechanism of development of this pain has not been fully studied to date. According to experts, the departments of the nervous system can misinterpret the source of pain due to the presence of common ways in which both visceral and somatic pain is carried out. Irradiating pains, which are the result of stretching, irritation or squeezing of the somatic nerve or nerve root, are more intense. During physical exertion, sneezing or coughing, pain can be intensified, and it can also often spread to the affected area of the body.
Reflected pain, as a rule, is a consequence of the development of the pathological process in the internal organs (diseases of the retroperitoneal space, aneurysm of the aorta, pathology of the digestive tract, IHD).
In connection with the fact that the pains provoked by intercostal neuralgia are quite similar to the pains developing in diseases of the lungs or cardiovascular pathologies, for the correct diagnosis it is necessary to seek help from a cardiologist or pulmonologist.
In this situation, diagnostic activities include:
- chest X-ray;
- computed tomography;
- X-ray examination of soft tissues of the spinal cord (myelography);
- functional diagnostics of the heart (echocardiography, electrocardiography, etc.);
- diagnostic examination of the digestive system.
Treatment of intercostal neuralgia
Intercostal neuralgia is a pathological condition requiring pathogenetic and symptomatic treatment. At the moment, 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 a significant improvement in the patient's condition is observed.
As a drug therapy it is recommended to use non-steroidal anti-inflammatory drugs and muscle relaxants (drugs that relieve muscle spasm).
With severe pain, injection of drugs that have a more rapid effect is indicated.
Note: Injectable medications are ideal for patients with gastrointestinal diseases. They are absorbed into the blood, bypassing the digestive tract, and do not exert their negative effects 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, rationally and nutritionally balanced, avoid mono-diet and starvation, take B vitamins, if possible, give up alcoholic beverages. Also, a prophylactic massage with special warming ointments, which improves blood circulation and lymphatic drain, proved itself well.