Neuralgia is a form of neuralgia that causes pain in the intercostal nerves. It is caused by the compression of one of the 24 nerves located between the ribs, at the level of the ribcage.
Definition of intercostal neuralgia
Intercostal neuralgia is characterized by pain in the chest, caused by inflammation or damage to an intercostal nerve, that is, a nerve that originates from the spinal cord and is located between the ribs.
Causes of intercostal neuralgia
Intercostal neuralgia can be caused by a variety of conditions such as infection, inflammation, chest or rib injury, or thoracic surgery. For example, surgical removal of the kidney can damage the intercostal nerves.
There are other causes such as:
- cracked or fractured rib following trauma.
- Degeneration of the intercostal nerves.
- Vertebral arthrosis that causes inflammation of a nerve.
- An abdominal distention.
- A pregnancy, which causes an increase in the ribcage.
- An infection such as shingles (postherpetic neuralgia caused by shingles).
- A benign or malignant tumor in the chest or abdomen that presses the intercostal nerves.
- Cutaneous, muscular and ligamentous lesions at the level of the vertebrae.
- Post-thoracotomy pain (after a surgical incision of the chest wall).
- Intercostal neuritis (pain in the chest)
In the case of acute pain, inflammation is observed with increased production of cytokines (molecules of inflammation) released by the damaged tissues. In the case of chronic pain observed in intercostal neuralgia, the mechanisms causing the pain are still poorly understood.
Who is the most affected?
Individuals engaged in high-impact sports are more likely to suffer from intercostal neuralgia.
Diagnosis of intercostal neuralgia
The diagnosis is done using:
- a detailed neurological examination to identify the cause of the pain,
- a questionnaire about pain,
- radiological examinations such as chest x-ray or MRI and
- a consultation with a respirologist to determine whether or not there is an infection.
In general, the context and the neurological examination are sufficient for the doctor to make a diagnosis.
Symptoms of intercostal neuralgia
Recognize intercostal neuralgia
The main symptom of intercostal neuralgia is pain in the thoracic area. This pain associated with intercostal neuralgia can be bilateral, like a stab. The pain is in and around the area of the chest on each side and may radiate from the back to the front of the chest. Sometimes the pain is felt evenly along the entire length of the ribs. In other cases, the pain appears with breathing, laughing or sneezing. The pain increases with the effort.
- Pain in the ribs, especially on the left side, which can be confused with heart pain or angina pectoris. Caution: Any intercostal neuralgia should be considered heart pain until proven otherwise.
- Numbness and / or tingling.
- Abdominal pain
- A loss of appetite.
- Pain in the arms and / or shoulders Pain on the left side of the shoulder and arm joints is often mistaken for heart pain or angina pectoris.
The most serious symptoms are:
- Chest pressure or tearing sensation in the chest
- A persistent cough with mucus.
- Heart palpitations.
- Breathing difficulties.
- Acute abdominal pain.
- Confusion, dizziness or lower level of consciousness.
- Paralysis and atrophy of the muscles.
Complications may include chronic chest pain, decreased range of motion, pneumonia, or respiratory failure.
There are certain risk factors such as:
- Infection with varicella virus and shingles. This virus can be reactivated after the age of 60 years.
- Participation in speed or contact sports activities such as skiing, snowboarding and football.
- Trauma caused by a road accident resulting in injuries to the ribs and intercostal nerves.
Treatment of intercostal neuralgia
Prevention involves reducing risk factors, for example by vaccinating against chicken pox and herpes zoster, by safer driving to avoid an accident. Protective devices can help prevent intercostal neuralgia. This includes wearing a helmet or using padding when participating in contact sports. Warm-up is also recommended before playing a sport.
How to treat intercostal neuralgia?
Depending on the cause of the pain, a treatment program can be designed. Neuralgia can also resolve itself, but it usually requires treatment.
- Drugs such as those used in neuropathic pain (eg capsaicin cream) help relieve the pain associated with intercostal neuralgia, as well as non-steroidal anti-inflammatory drugs (eg ibuprofen) or antidepressant medications that help calm nerve pain.
- Radiofrequency treatment.
- A local anesthetic or corticosteroid can be administered to the affected nerve. Corticosteroids help to reduce the risk of postherpetic neuralgia.
- Antihistamines are used to relieve itching.
- Antiviral drugs reduce the severity and duration of symptoms.
Other treatments against intercostal neuralgia may accompany conventional treatments and include massage, acupuncture and yoga.