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What is Intercostal Neuralgia? Symptoms, Causes and Treatment

Intercostal neuralgia can be defined as a very common ailment that affects people of all ethnicities and ages. It is characterized by the appearance of pain in the costal and thoracic region of the cramping type, comparable to that caused by sciatica. This is caused by compression, irritation or malfunction of the intercostal nerves.

As reported by epidemiological studies, around 15% of the population suffers this type of pain at any given time. There are multiple causes of intercostal neuralgia, but the symptoms are quite characteristic and uniform. Here we tell you everything you need to know about this pathology and how to approach it.

Symptoms of intercostal neuralgia

We begin by highlighting the most common clinical signs that occur during this pathology. The most common symptoms are the following:

  • Transverse pain in the rib cage, as if a belt were tightening a series of specific muscles. It can appear on both the left and right side of the body.
  • Abdominal pain.
  • Discomfort or pain in any part of the upper limbs.
  • Less common signs: fever, itching, lack of sensation, tingling, and restricted mobility.

Symptoms are usually sensitive, but motor function can also be compromised in the most severe cases. This pain is intermittent or constant and, unfortunately, it can remain long after its underlying cause has disappeared.

What Causes Intercostal Neuralgia?

The United States National Library of Medicine defines neuralgia as acute pain that follows the path of a nerve and is due to irritation or damage. In this case, the nerve endings that are affected are those between the ribs.

Sources already cited show us the possible causes of intercostal neuralgia. Among them we find the following:

  • Surgical interventions: approximately 43% of patients with intercostal neuralgia have undergone surgery before. Thoracotomy and thoracoscopy are the procedures with the highest risk of resulting in this type of pain.
  • Herpes-zoster virus: approximately 30% of patients have had a herpes-zoster infection. According to the Mayo Clinic, during a herpes outbreak the nerve fibers underneath the shingles can be damaged. This makes the signals sent by them exaggerated and confusing.
  • The rest of the cases cannot be attributed to a specific cause, but among the suspected factors we can find fractures or sprains, osteoarthritis, lung conditions, postural problems, tumors, pregnancy and other viral infections.

As you can see, one of the most common causes of intercostal neuralgia is herpes-zoster infection. Up to 10% of patients with the initial disease come to suffer it in the future. Although gallbladder lesions heal, post-herpetic pain can linger for months or years.

How can intercostal neuralgia be diagnosed?

Diagnosis is based on detecting the underlying disease that is causing the intercostal nerve discomfort. As basic as it may sound, the anamnesis is key in this process: multiple questions are asked of the patient, especially focused on their medical history.

After this, a physical examination is also vital. A palpation of the intercostal area will be performed and, after that, imaging tests such as X-rays or musculoskeletal ultrasounds can be used. Electromyography and nerve conduction tests help to quantify the functionality of the affected nerves.

Treatments available

Treatment must be approached from two broad fronts: medication and physical therapy. We break down each of them in the following sections.

Medical treatment

Treatment will depend on the causative agent, since a viral infection has nothing to do with a tumor that is pinching the affected nerves. Still, there are a number of common medications that can be prescribed:

  • Intercostal nerve blockers: injection of anesthetics or application of corticosteroids in the affected area.
  • Non-steroidal anti- inflammatory drugs (NSAIDs): a group of drugs used to manage pain. Drugs such as ibuprofen or naproxen can help reduce inflammation in the affected area.
  • Radiofrequency ablation: part of the affected nerve is cut using the heat generated by an alternating current of medium radiofrequency.
  • Medicine for neuropathic pain: Some drugs, such as gabapentin, also used to manage epileptic seizures, may prove to be useful in the management of postherpetic neuralgia.


This pathology must also be addressed through physiotherapeutic treatment. Physiotherapeutic therapy aims to decrease the tone of the muscles in relation to nerve impingement and the mobilization and release of the joints that may be compromising it. In addition, a functional bandage can be made to reduce symptoms in the affected area.

Possible complications of intercostal neuralgia

The complications of intercostal neuralgia will depend on the causative agent. If the nerve impingement is caused by a tumor, for example, the development and spread of the tumor mass can be life-threatening.

Among the signs that accompany intercostal neuralgia and represent a medical emergency are the following:

  • Chest pain that radiates to the left arm, neck, jaw, and back. This could be a sign of a heart attack.
  • Appearance of greenish-yellow sputum.
  • Heart palpitations or a feeling of tightness in the chest.
  • Difficulty in breathing.
  • Sudden confusion, accompanied by dizziness and changes in consciousness.

All of these clinical signs, accompanied by the excruciating pain of intercostal neuralgia, indicate a medical emergency. If you feel any of them go quickly to an emergency center.

Living in Pain is not Normal

Intercostal neuralgia can be very unpleasant. The causes are multiple and varied and, unfortunately, in many cases no clear underlying reason is found.

Even so, there are various drugs and physiotherapeutic treatments that can alleviate this symptomatology. Living in pain is not normal. If you feel persistent discomfort in your back or anywhere, see a medical specialist.

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