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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.
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
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
- muscle atrophy
- pain that feels like a lightning bolt
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.
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.
There are several options for relieving intercostal neuralgia, and many people find that a combination of treatments works best.
Some over-the-counter topical treatments can provide temporary pain relief. These include:
Antidepressants are sometimes used to treat nerve-related pain. Common ones include:
- desipramine (Norpramin)
- duloxetine (Cymbalta)
- imipramine (Tofranil)
- nortriptyline (Aventyl, Pamelor)
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.
An intercostal nerve block is an injection that combines a local anesthetic with corticosteroids to reduce inflammation and relieve pain. Your doctor will use an X-ray to guide the injection into the area just under your rib cage. While it can take a few days to start working, intercostal nerve blocks can last for several months.
Your doctor can also give you a thoracic epidural injection, which involves injecting anti-inflammatory medication into the area around your spinal cord.
You can also try pulsed radiofrequency, a minimally invasive procedure that uses an electrode needle to provide short-term pain relief.
Other possible treatment options include:
- physical or occupational therapy
- cognitive and behavioral therapy
- relaxation therapy
Regardless of the treatment options you choose, try to remain as physically active as possible to keep your muscles strong and healthy.
Intracoastal neuralgia can affect people in very different ways. You doctor can give you a better idea of what to expect based on your symptoms and how well they respond to different treatments.
Untreated chronic pain can lead to several complications, including insomnia, low appetite, anxiety, and depression. If you’re having trouble finding the right treatment, consider asking your doctor to refer you to a pain management specialist. They can work with you to come up with a plan that’s both safe and effective.