What Causes Intercostal Neuralgia?

Intercostal neuralgia can be caused from various different things such as infection, inflammation, and simple muscle strains. Read below to learn more.

The nervous system spreads throughout the human body and allows us to perceive and react to the world around us. Yet like branches of a tree, individual parts of the system can be compromised, becoming inflamed, compressed, or damaged. When a particular nerve or series of nerves malfunctions and causes pain, this is called neuralgia (nerve pain). Intercostal neuralgia is a form of neuralgia centered around the intercostal nerves innervate the back, ribs, and chest.

There are multiple different causes and symptoms in cases of intercostal neuralgia. The common thread is muscular chest and back pains, often in the form of burning or spasmodic pains and often triggered episodically by intense activity, laughter, coughing, or sneezing.

Feeling pain or tightness in or around your ribs does not always mean that there’s something wrong with your nerves. If you have unbearable pain or pain that isn’t going away, be sure to consult a medical professional and get a thorough checkup. Intercostal neuralgia is one possible diagnosis for rib pain, but many diseases and conditions can cause or include rib pain as part of their symptoms.

Explaining Intercostal Neuralgia

“Intercostal” refers to “between your ribs,” where costa is the Latin for rib. We have intercostal muscles, intercostal veins, intercostal arteries, and intercostal nerves. Intercostal muscles are woven between your ribs, and they play an essential role in inhalation and exhalation, and rib movement.

Alongside veins and arteries, your intercostal muscles are innervated by nerves connected to the thoracic portion of your spine. Imagine several branches originating at root points near the vertebrae of your upper back and hugging around you along the bottom of each rib.

Where the muscles play a role in inhalation and exhalation alongside the diaphragm, the 11 intercostal nerves that branch out of your back and end around your chest are responsible for bringing feeling and sensation to the muscles and skin surrounding your ribcage.

When these nerves are compressed, inflamed, damaged, or otherwise hurt, they can cause a great deal of pain that might be felt in different ways. This nerve pain can be primary, in the sense that it is the only symptom being felt or secondary, in which case a disease, infection, or condition in another part of your body may be causing inflammation or damage in your intercostal nerves.

What Does Intercostal Neuralgia Look Like? 

The signs and symptoms of intercostal neuralgia can vary from case to case. The main thing to look for when suspecting intercostal neuralgia is the location and nature of the pain.

Most examples of intercostal neuralgia are episodic, meaning the pain comes and goes. Some patients describe it as an aching or gnawing feeling, while others experience sharp pains and spasms, and others yet describe an intense burning feeling or just a tender and bruised sensation in the area. Some common signs of intercostal neuralgia include:

• Chest pain.
• Difficulty breathing without pain.
• Pain increases with heavy breathing, laughter, coughing, sneezing, twisting, or lifting.
• The pain may extend throughout the abdomen.
• Fever.
• Numbness instead of pain near the ribs.
• A tingling feeling in the ribs, chest, and upper back.
• “Reflected” pain, like a string connected between the shoulder and loin, for example.
• “Belting” pain, like the pain, forms a strap around your chest and back.

Doctors check for intercostal neuralgia through a basic physical examination. Patients are asked to stay seated while the doctor examines for signs of neuropathy or inflammation and swelling. Patients will be asked to stretch, twist, or move in specific ways to diagnose the origins of the pain and indicate which thoracic levels or ribs are affected.

There are rarely further diagnostics needed when dealing with intercostal neuralgia. But suppose the pain or tingling is compounded with other symptoms. In that case, a doctor may utilize imaging technology such as x-rays to get a closer look at the ribs, especially if the patient has a history of chest and rib injuries, osteoporosis, or recent physical trauma. 

In cases where intercostal neuralgia may point to a bigger problem, other diagnostic tests include physical stress tests, bloodwork, and an ECG.

Causes of Intercostal Neuralgia

Intercostal neuralgia may be caused by:

• A viral infection
• Entrapment of the nerve
• Nerve inflammation
• Post-operative pain
• Muscle strain
• A tumor or mass pressing on the nerve

Suppose the cause of your intercostal pain is not clear yet but doesn’t appear to be life-threatening. In that case, your doctor may diagnose you with idiopathic intercostal neuralgia and give you medication for the pain. Idiopathic conditions are conditions with no apparent or identified cause.

There are a few ways to reduce the likelihood of experiencing intercostal neuralgia again or to begin with. Be sure to:

• Get vaccinated for shingles. This viral infection is most associated with intercostal neuralgia.
• Wear protective gear during sports or reduce your contact sports training frequency until the pain completely subsides.
• Avoid reckless driving or speeding (to avoid braking too hard, too often).
• Visit the doctor if your pain returns or becomes worse.

When to Call the Doctor

Intercostal neuralgia could be a herald for something worse. Chest and rib pain might not necessarily have to do with your intercostal nerves and can be indicative of a life-threatening situation. Be sure to seek out emergency care if: 

• You have a tight and painful chest. You have severe abdominal pain. 
• You are coughing up green mucus. 
• Your pain spreads through the jaw, shoulder, back, and arm. 
• You are experiencing sudden confusion alongside your chest pain. 
• You feel a fluttering in your rib cage. 

It’s no secret that heart disease is one of the most common causes of death in the US. Even relatively minor chest pain is something you should consider calling your doctor over – even if it ends up being a simple muscle strain from overstretching the day earlier. It is always better to be safe rather than sorry.

Treatment and Care

The treatment for a case of intercostal neuralgia depends on the cause. Viral infections and anti-inflammation are typically treated differently. Still, one way or the other, your doctor may recommend over-the-counter painkillers and NSAIDs or may prescribe different pain medications.

Antidepressants are another common first-line treatment course, especially if the pain has been ongoing for some time. Mood and pain correlate heavily, and mood stabilizers such as SSRIs can help keep pain levels lower.

If the pain is not subsiding and has become chronic, your doctor may recommend you to a pain clinic. Nerve pain can be addressed through non-invasive interventions, such as radiofrequency ablation and chemical nerve blocks. Both can numb or destroy nerve cells acting erratically and sending off false pain signals. These nerves grow back after some time.

Different cases may require additional treatments, and doctors will always opt for the most conservative treatment first. If you have questions or reservations about any given treatment a doctor may try to help you, always be sure to ask them directly.