Causes of pain in the thoracic spine - see a neurologist

Although the thoracic spine is considered the most stable, young people are increasingly complaining of pain in this area.

A sharp decrease in the age when patients first feel pain in the thoracic spine, and the increased incidence of complaints are due to an unhealthy lifestyle.

Often, the pain syndrome is completely unrelated to the spine, and the lack of timely medical assistance is fraught with serious consequences.

Causes of pain in the thoracic back

Acute pain in the chest

Acute pain in the thoracic spine may indicate:

• about a pinched nerve in the thoracic region;
• about acute myocardial infarction;
• about worsening angina pectoris;
• about perforation of the ulcer.

Severe back pain in the thoracic spine

Severe back pain in the thoracic region will become symptoms of diseases such as:

• heart disease (angina pectoris, acute myocardial infarction, various cardialgia);
• lung diseases (pneumonia, pleurisy);
• diseases of the gastrointestinal tract (peptic ulcer of the stomach or duodenum, perforation of the stomach or duodenum, acute or exacerbation of chronic pancreatitis, intestinal colic, diseases of the esophagus).

Pain in the chest and stomach

Pain in the thoracic region and stomach will lead the doctor to think about the possibility of a peptic ulcer of the stomach or duodenum, complications of a peptic ulcer (perforation, penetration of the ulcer).

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Aching pain in the chest

Aching pain in the thoracic spine may be a symptom of:

• worsening of the course of coronary heart disease - angina pectoris;
• pinched nerve;
• worsening of osteochondrosis;
• strangulated intervertebral hernia.

During pregnancy, pain in the thoracic region can be triggered by worsening osteochondrosis in the thoracic spine due to additional stress on the back. The main neurological cause of pain in the thoracic spine is tension and painful muscle spasms. Spasm usually leads to disruption of microcirculation, accumulation of lactic acid, irritation of nerve endings, and this causes pain. Muscle spasms are diagnosed during a neurological examination, when the doctor palpates certain areas and identifies trigger points of pain. Muscle spasm itself can develop due to:

• drafts;
• incorrect posture;
• presence of scoliosis;
• the presence of osteochondrosis, hernia and other degenerative changes in the spine;
• incorrect approach to lifestyle (numerous jerking loads on the back, excessive static loads, continuous sitting at the computer, unevenly distributed weight when working out in the gym).

Sharp pain in the chest

Complaints of sharp pain in the thoracic region are typical for diseases such as:

• peripheral nerve entrapment;
• acute myocardial infarction;
• worsening of angina pectoris;
• perforation of the ulcer.

Methods for diagnosing intercostal neuralgia

If you suspect intercostal neuralgia, you should consult a neurologist.

In most cases, the diagnosis is established based on the patient’s complaints, medical history and examination of the patient directly at the appointment. The doctor pays attention to the patient’s posture: in an effort to reduce pain by reducing pressure on the affected nerve, the patient tilts the body in the opposite direction. The intercostal spaces are palpated in the area where the pain is located. Loss of sensitivity and blanching of the skin is established.

Sometimes instrumental and laboratory diagnostics may be required:

ECG

An ECG is performed in case of pain on the left side. The goal is to rule out heart problems. In combination with an ECG, echocardiography (ultrasound of the heart) may be prescribed. More information about the diagnostic method

Chest X-ray

A chest x-ray is performed to exclude diseases of the lungs and pleura.

More information about the diagnostic method

Ultrasound of the abdominal organs

A survey ultrasound examination can exclude diseases of the abdominal organs.

More information about the diagnostic method

Neuromyography

Electroneurography is prescribed, as a rule, if the traumatic nature of intercostal neuralgia is suspected.

X-ray of the spine

X-ray of the thoracic spine allows us to determine the causes of radicular syndrome. A CT scan or MRI may also be ordered to evaluate the condition of the spine.

More information about the diagnostic method

Blood test for antibodies to the herpes virus

It is carried out if there is a suspicion of a viral origin of intercostal neuralgia.

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Diagnosis of chest pain

If a person complains of pain in the thoracic region, the neurologist will immediately diagnose thoracalgia syndrome and begin a targeted diagnosis of the pathology that can give rise to these painful sensations. To do this, a differential diagnosis is carried out, during which the doctor excludes diseases such as:

• cardiac problems using an ECG study, if the patient has pain in the left thoracic region;
• lung diseases using fluorography, if the patient has a cough and sharp pain in the thoracic spine;
• pathologies of the esophagus and stomach using endoscopy, when the patient complains of pain in the thoracic region and stomach or acute pain in the cervicothoracic region.

In order to exclude serious abnormalities of the spine, for example: hernia, compression fractures of the vertebrae, tumor or tuberculosis of the spine, the neurologist will refer the patient for an MRI of the thoracic spine.

Symptoms of neuralgia on the right and left

Any neuralgia, including intercostal neuralgia, is primarily pain. Painful sensations can be of a different nature (aching, dull, sharp, piercing, burning) and have different intensity. Sometimes the pain is so severe that it forces a person to take a forced position and sharply limit physical activity. Intercostal neuralgia, which has pronounced symptoms, is described by patients as a lumbago or electric current discharge running from the spine to the sternum.

Thoracalgia often begins gradually, with a tingling sensation in the intercostal spaces, then acquires pronounced intensity. Less often it occurs suddenly. The pain can radiate to the scapula, epigastric area, heart, arm and lower back. Sometimes it takes on an encircling character. It intensifies with changes in body position, movements, coughing and deep breathing.

As a rule, painful attacks are constantly repeated, lasting from a few seconds to 2-3 minutes. Therefore, treatment of acute intercostal neuralgia on the right and left, first of all, always begins with the elimination of pain.

In addition to thoracalgia, a person may be bothered by characteristic local signs caused by the influence of sympathetic, sensory and motor nerve fibers. Intercostal neuralgia, depending on the damage to a particular nerve, will have characteristic symptoms on the right, left or both sides of the chest:

• impaired sensitivity, crawling sensation, numbness, tingling;
• muscle twitching;
• increased sweating;
• change in skin color.

If chest neuralgia appears against the background of a herpes infection, it may be accompanied by skin rashes. The latter appear 2-4 days after the onset of thoracalgia. Elements of the rash are located on the skin of the intercostal space in the form of small pink spots, which then turn into vesicles and then into crusts. Subsequently, traces of pigmentation may remain on the skin.

Treatment of pain in the thoracic spine

Pain in the thoracic region due to ordinary muscle spasms, not aggravated by complex degenerative-dystrophic changes in the spine, often does not require drug or neurosurgical treatment. After examining the patient, the neurologist may prescribe:

• physical therapy;
• medical massage;
• hirudotherapy;
• manual therapy;
• acupuncture;
• injections of anti-inflammatory drugs, muscle relaxants and B vitamins.

Sometimes simple lifestyle adjustments already help relieve pain. A person can independently:

• choose a comfortable and ergonomic place to sit and a mattress for sleeping;
• allocate sufficient time for sleep so that the muscles have time to relax and return to normal tone;
• ensure the absence of any drafts, hypothermia, avoid frequent wearing of high heels, because this leads to poor posture;
• start going to the pool to maintain tone in your back muscles.

If thoracalgia is associated with severe pain and occurs against the background of degenerative changes in the spine, then the neurologist may offer the patient:

• make a novocaine blockade;
• take a course of non-steroidal anti-inflammatory drugs that relieve pain and inflammation in the spinal structures or muscles;
• use neurorelaxants, the use of which leads to relief of muscle spasm;
• undergo treatment with various metabolic drugs, agents that improve microcirculation, B vitamins. The action of metabolic drugs is aimed at protecting the structure of the spinal cord roots.

Diagnostic procedures

To find out why the thoracic spine hurts and what needs to be done to get rid of the pain, consult a neurologist or orthopedist. The doctor will perform an examination and write directions for diagnostic tests, which may include:

• X-ray;
• MRI;
• CT;
• ECG;
• Ultrasound of internal organs;
• lab tests;
• and other procedures.

The examination will help identify all changes in the spine and nearby tissues: changes in the width of blood vessels, narrowing of the spinal canal, compression of the nerve roots, displacement of the vertebrae, the presence of protrusions and hernias. Multi-position images can detect spinal curvature: kyphosis, lordosis or scoliosis. ECG, ultrasound and tests are necessary to diagnose associated disorders, including infectious and inflammatory diseases.