Intercostal Nerve Block Injections
Intercostal nerve block injections are both a diagnostic tool and a treatment modality when addressing rib pain. The intercostal muscles are composed of multiple smaller muscles connected between your ribs, facilitating the movement of the ribcage.
Postherpetic neuralgia, other types of neuralgia, bruising, rib fractures, and strained intercostal muscles are different common causes of rib pain. An intercostal nerve block can help doctors determine where and what may be causing the patient’s pain, as well as provide an alternative to opioids and other strong analgesic drugs for short-term pain relief.
What is Intercostal Neuralgia?
Neuralgia is nerve pain. Nerve pain is not the only cause of rib pain. But aside from direct physical trauma and rib fractures, another common cause of rib pain is nerve damage or inflammation of the nerves.
The intercostal nerves originate from nerve roots around the thoracic portion of the spine or the upper back. This means that certain cases of rib pain may even be caused by an upper back injury, rather than a direct blow to the ribs, or inflammation between the ribs themselves.
Neuralgia can be complicated to identify and treat. Our entire body is innervated through the spine, and complications can arise from viral infections, compression on a nerve, inflammation, arthritis, other autoimmune diseases, diabetes, alcohol addiction, and more.
When it comes to rib pain, a common nerve-related culprit is shingles. Shingles is the reinfection of chickenpox, caused by the varicella-zoster virus. This virus, after causing chickenpox, can remain dormant in the tissue around the spine. It can reactivate in older individuals, and people struggling with a weaker immune system. Shingles-related nerve pain is often called postherpetic neuralgia because a shingles infection is also called herpes zoster.
A modern shingles vaccine can prevent recurring shingles symptoms in older individuals. It is often recommended for seniors and some other patients. For patients struggling with shingles, a nerve block can be a non-surgical, non-pharmacological option for pain relief, utilizing an analgesic agent injected directly near the afflicted nerve roots to cut down on pain signals being relayed to the brain.
When identifying the cause and nature of your nerve pain, your doctor will require a thorough personal and family medical history and may utilize different diagnostic tools, such as imaging technology (x-rays and MRIs) in addition to a physical examination.
How Do Nerve Block Injections Work?
Nerve block injections utilize certain drugs to affect the nerves in the injection site. In most cases, regardless of where a doctor is applying the injection, an x-ray or other type of imaging technique is used to first guide the needle to the target location. From there, the doctor will inject different medications depending on the purpose of the nerve block. In cases of swelling-related pain, an anti-inflammatory corticosteroid can help reduce swelling and temperature and cut down on pain.
Alternatively, an opioid analgesic can reduce pain for a short period of time, between multiple hours and some days. In cases where a more long-term solution is needed due to severe pain, doctors can inject a neurolytic agent, meaning a nerve killer, to temporarily destroy a section of peripheral nerves.
These can then regrow and regain sensation over time. Neurolytic agents range from ethanol to chemical freezing or chemical heating agents. Radiofrequency ablation works similar to a neurolytic nerve block but utilizes an electric current to heat the tip of a needle and destroy a portion of the nerve that way.
Because nerve blocks can be used to shut down pain signals for just a few hours, they are also a useful diagnostic tool. A doctor can confirm their suspicion by applying a nerve block to a specific nerve and seeing if the patient’s pain goes away. If it doesn’t, then the pain is being caused by something else.
Intercostal nerve blocks may be applied directly under the ribs, or via the thoracic spine, depending on the suspected cause and nature of the pain.
Other Sources of Intercostal Pain
Neuralgia or nerve pain isn’t the only source of rib pain. Rib pain can be caused by traumatic events like a car accident or a fall down the stairs, but it can also occur after a relatively mundane experience, such as stretching after waking up, coughing too hard, or turning too fast. In the case of severe pain following a sprain or fracture, a nerve block may still be recommended as an alternative to medication.
Intercostal muscle strains can cause pain and problems with deep breathing and even lead to bruising or swelling. If you are experiencing rib pain for more than a few hours, contact your doctor. If your pain symptoms are accompanied by fever or nausea, seek immediate medical help.
Indications for an Intercostal Nerve Block Injection
Intercostal nerve blocks are needed either as a diagnostic tool (with the pain relief lasting only as long as the analgesic used), or as a short- to long-term modality for rib pain, targeted either on the ribs themselves or through nerve roots on the upper back. Indications for intercostal nerve block injections can include:
- Post-surgical rib pain.
- Post-incision rib pain.
- Rib fractures.
- Chronic post-surgical pain.
- Postherpetic neuralgia.
- Rib pain after an upper back injury.
Other Treatments for Intercostal Pain
Aside from nerve blocks, rib pain is also addressed through topical treatments.
- Lidocaine or Capsaicin
- Opioid medication
- Over-the-counter pain medication
- Antidepressants and anticonvulsants
In severe cases of rib pain, nerve-related or otherwise, surgery may become necessary. Some hospitals also offer a neurectomy, or the removal of a nerve, as a long-term solution for severe intercostal pain in cases where all other more conservative measures didn’t work. Surgery is almost always the last resort when nothing else is helping.
Pain can be difficult to address. There are many different modalities for effecting change in a patient’s condition. There’s never a guarantee that one will work. Be sure to go over all available options with your doctor, and properly weigh the personal pros and cons together.