Causes of Intercostal Neuralgia and How to Get Relief

Intercostal neuralgia is nerve pain in the chest and upper trunk that radiates from the upper back. The pain comes from the intercostal nerves along the ribs, chest, or abdomen. It can feel like a sharp or stabbing pain or like burning or aching pain. It can also cause additional symptoms like numbness and tingling.

Here is what you need to know about intercostal neuralgia, including symptoms, potential causes, diagnosis, treatment, and prevention.

What Does Intercostal Neuralgia Feel Like?

The main symptom experienced by people with intercostal neuralgia is pain in the rib cage area. People who experience this type of rib pain may describe the pain as:

• Stabbing
• Sharp
• Tender
• Aching
• Gnawing
• Burning
• Spasm-like

You may feel this pain around your ribs or in your upper chest or back. The pain might cover the entire chest or radiate from the back towards the chest. Sometimes the pain can be felt along the length of the ribs. Pain episodes tend to be sporadic and may intensify with activity, including:

• Lifting
• Turning and twisting the torso
• Coughing
• Sneezing
• Laughing
• Breathing deeply

Other symptoms of intercostal neuralgia may include: 

• Abdominal pain
• Fever
• Itchiness
• Numbness
• Tingling
• Restricted mobility of shoulders and back
• A squeezing sensation from the front of your chest to your back

Some people may also experience referred pain, which is related pain that appears in an unaffected part of the body. In people with intercostal neuralgia, the shoulder blade and lower pelvis are common sites for this type of pain.

When to Call Your Healthcare Provider 

There are times when rib and chest pain may indicate a life-threatening condition. Intercostal neuralgia can cause severe and debilitating pain that makes it hard to breathe. Sometimes, rib cage pain or chest area pain can be a sign of a condition that may require emergency medical treatment. For example, chest pain may indicate a heart attack.

Other symptoms that may indicate a medical emergency include: 

• Chest or rib pain that spreads into the left arm, jaw, shoulder, or back
• Chest pressure or tightening in the chest
• Coughing up yellow-green colored mucus
• Heart palpitations or a fluttering feeling in the chest
• Breathing problems, such as shortness of breath or inability to take a full breath
• Severe abdominal pain
• Severe chest pain with breathing or coughing
• Sudden confusion or dizziness, or changes in consciousness, such as passing out or unresponsiveness

Causes

Intercostal neuralgia is caused by inflammation and irritation in or compression of the intercostal nerves. Causes of intercostal nerve pain can vary from injury to the bones or muscles to a problem with the nerves.

• Chest trauma or muscle injury. Chest trauma such as a broken rib or bruised chest can cause intercostal neuralgia. You may also experience this type of pain if you pull or strain a muscle in the chest wall, shoulders, or back.
• The shingles virus. A shingles infection can cause a type of intercostal neuralgia known as postherpetic neuralgia. People with this shingles complication may experience pain in the part of the body where shingles symptoms appeared. The pain may last for longer than 3 months and can continue even after the rash has disappeared. Postherpetic neuralgia can also cause extreme sensitivity to touch or temperature resulting in a burning sensation on the skin.
• Intercostal nerve entrapment. This is when the intercostal nerve is compressed between other structures in the body such as a ligament and a bone. When these structures rub against the nerve, they can cause permanent damage leading to neuropathy symptoms.
  
• Neuritis. An inflammation of the intercostal nerves can happen as a result of injury or infection. It may also have no known cause.
• Post-thoracotomy pain syndrome (PTPS). This is a complication of a surgical procedure that involves opening the chest to access the throat, lungs, heart, or diaphragm.
• A tumor. A tumor in the chest or abdomen can press on the intercostal nerves. These tumors can be benign (not cancer) or cancerous.
• Pregnancy. Intercostal neuralgia can sometimes develop during pregnancy, though this is not common. Research suggests that this might happen as the growing uterus puts pressure on intercostal nerves. In most cases, the condition goes away after delivery.

Sometimes, intercostal neuralgia has no known cause. If your healthcare provider is unable to determine a cause, you may be diagnosed with idiopathic intercostal neuralgia. The term “idiopathic” is used to describe medical conditions that have no identifiable or clear cause.

Risk Factors

There are a number of risk factors that increase the chance of developing intercostal neuralgia.

Risk factors include:

• Infection with the varicella-zoster virus, the virus known for causing chickenpox and shingles
• Participation in high speed or contact sports, such as skiing, snowboarding, football, and wrestling
• Unsafe driving and automobile accidents, which may lead to injury to the intercostal nerves or ribs
• Having a condition that causes systemic inflammation, such as inflammatory arthritis
  

Diagnosis

The majority of people with intercostal neuralgia first seek medical care because they think they may be having a heart attack or other cardiac problem.

The physical exam is an important part of the intercostal neuralgia diagnosis. It involves inspecting the area where the intercostal nerves are located. Pain produced from simple light pressure can help to assess the extent of pain.

To rule out other potential causes of chest wall pain, rib pain, or back pain, additional testing will be done. This will help your healthcare provider determine if the intercostal nerves are the source of pain or if there is another reason for your chest pain, such as lung or cardiovascular disease.

Other tests to help evaluate causes of pain related to the intercostal nerves include:

• Chest X-ray: Can look for sources of chest, rib, and back pain and find problems in the airways, bones, heart, or lungs.
• Nerve conduction velocity testing: Assesses nerve damage and dysfunction.
• Electromyography: Evaluates the muscles and nerve cells that control them.
• Musculoskeletal ultrasound: Involves more in-depth imaging than traditional X-rays or other imaging studies.

If you have risk factors for heart disease, such as diabetes, high blood pressure, a history of smoking, or a family history of heart disease, your healthcare provider will want to test your heart function. 

Testing may include:

• Exercise stress testing: Sometimes called a treadmill test, this test helps your healthcare provider figure out how much the heart can handle with exertion. As the body works harder, it needs more oxygen so it must pump more blood. The stress test can show if the blood supply to the arteries supporting the heart is reduced.
• Electrocardiogram: An electrocardiogram is a simple, painless test that measures the electrical activity of the heart.
• Echocardiography: This test uses sound waves to produce live images of the heart to help your healthcare provider understand how your heart and its valves are functioning.
• Bloodwork: Measures levels of certain cardiac enzymes. If cardiac enzymes are increased, this may indicate a problem with the heart.

Treatment

Treatment for intercostal neuralgia depends on the underlying cause and may include over-the-counter (OTC) and prescription medications and medical procedures.

OTC Medication

Over-the-counter (OTC) medication may help treat the pain associated with intercostal neuralgia. Some of these medications include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAID pain relievers, such as Advil (ibuprofen) and Aleve (naproxen), can help reduce inflammation and pain. 
• Capsaicin cream: Can help with pain relief.

Prescription Medication

If OTC medication doesn't help, talk to your healthcare provider about prescription medications such as:

• Anti-depressants: Tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors may be helpful for reducing and treating nerve pain.
  
• Anticonvulsants: Medications such as Neurontin (gabapentin), Tegretol (carbamazepine), and Lyrica (pregabalin) interfere with the transmission of pain signals in the body.
• Opioids: If your pain is severe, your healthcare provider may prescribe opioid medication to help relieve your symptoms.
  

Procedures

Certain medical procedures can also help treat intercostal neuralgia. These procedures involve blocking or destroying the nerves that are causing the pain:

• Intercostal nerve blocks: Injections of either a local anesthetic or a corticosteroid given around the affected intercostal nerves.
  
• Radiofrequency ablation: This treatment is usually offered to people who experience frequent episodes of intercostal nerve pain. It involves destroying the specific part of the nerve that is causing pain and other symptoms of intercostal neuralgia.
  

Complementary Therapies

Your healthcare provider may also recommend complementary therapies, such as:

• Acupuncture: This traditional Chinese medicine practice involves inserting fine needles into certain points on the body to relieve pain.
• Massage therapy: Massaging the related muscles, ligaments, and tendons may help relieve some of your pain.
• Yoga: Yoga and gentle stretching may help relieve pain. Try standing tall and raising your arms above your head. Clasp your hands together and then slowly lean to the right, then to the left. Hold the stretch for a few seconds on each side, or as long as is comfortable.
• Transcutaneous electrical nerve stimulation (TENS): A TENS device delivers a low-voltage electrical current to the affected part of the body.

These therapies are to be used in conjunction with traditional treatments, and not as lone therapies or as substitutes for medicinal therapies.

Does Intercostal Neuralgia Go Away?

Depending on the cause, intercostal neuralgia may go away in a few weeks to months with treatment. It is also possible for symptoms to resolve on their own without treatment. Some people, however, will continue to experience chronic pain for the long term.

If your pain is caused by PTPS, for example, you may still experience mild neuralgia symptoms for years after your surgery. 

Intercostal pain from a shingles infection can last for months or even years after the rash goes away. If you develop shingles, taking antiviral medication within 72 hours of the rash's appearance can help prevent postherpetic neuralgia.

Prevention

Some healthy lifestyle habits may prevent intercostal neuralgia and reduce your risk of developing the condition. 

Things you can do to reduce your risk are:

• Driving motor vehicles safely and wearing a seatbelt
• Getting vaccinated for chickenpox
• Getting vaccinated for herpes or shingles if you are age 50 and older
• Wearing protective sports equipment, including helmets and padding
• Working with your healthcare provider to manage symptoms of an inflammatory disease

Summary

Intercostal neuralgia is a type of nerve pain that's felt in the chest. It occurs when the intercostal nerves are inflamed, irritated, or compressed. The pain can have a number of possible causes, including chest trauma, shingles, or a pulled or strained muscle.

Intercostal neuralgia can sometimes be mistaken for a heart attack. If you're experiencing this kind of pain, your healthcare provider may want to test your heart function before diagnosing you.

Treatment for intercostal neuralgia may include pain medications, nerve blocks, anti-depressants, and more. It can often be prevented with safety precautions and getting a shingles vaccine.