Intercostal neuralgia on the left: how dangerous is the disease?

Pain in the region of the costal arches is a fairly common symptom and intercostal neuralgia often has to be differentiated from pain of a cardiogenic nature. The term intercostal neuralgia means the involvement of the intercostal nerves and the presence of pain. The causes of intercostal neuralgia can be various diseases that lead to damage to nerve fibers. First of all, these are degenerative diseases of the spine (osteochondrosis, hernia, disc protrusion, spondylosis), rheumatological diseases such as ankylosing spondylitis, infectious diseases (herpes zoster, brucellosis, tuberculosis).

These may be diseases of the nervous system such as multiple sclerosis, polyradiculoneuropathy, systemic diseases (diabetes mellitus, hepatitis), vitamin deficiency due to alcoholism or malabsorption in the gastrointestinal tract. Damage to the intercostal nerves is possible due to intoxication (heavy metals, some drugs).

When the blood supply to the nerves is disrupted, hypoxia of the nerve trunks occurs and this occurs in cardiovascular diseases (hypertension, atherosclerosis) and anemia. Disturbances in the endocrine system can lead to changes in the spine, which in turn lead to intercostal neuralgia (thyrotoxicosis, adrenal diseases, endocrine system disorders in postmenopausal women). So there are quite a lot of factors contributing to the development of intercostal neuralgia and, as a rule, a combination of factors is important, and not just one factor. Intercostal neuralgia occurs most often in elderly people, when there are involutional changes in the spine and in the body

Symptoms

The main symptom of intercostal neuralgia is pain in the ribs, which has an acute burning character, sometimes dull. The pain can develop in paroxysms or appear periodically. During attacks, the pain can be intense and intensify with coughing, sneezing, and body movements. The pain is usually localized in the area of ​​the lower ribs and can radiate to the shoulder or arm, which often makes such attacks of pain similar to cardialgia. Pain with intercostal neuralgia from pain in the heart in the more constant nature of the pain intensity, and in the absence of changes in the cardiovascular system (changes in pulse, pressure). In addition, cardiogenic pain does not increase with trunk movement and there is no local tenderness in the rib area. Pain during intercostal neuralgia may be accompanied by vegetative manifestations (pallor or redness of the skin, sweating), fasciculations of muscle groups, impaired sensitivity in the area of ​​pain (numbness). Palpation of the area of ​​paravertebral points in the intercostal spaces in the area of ​​attachment of the ribs to the sternum can be painful. Sometimes pain with intercostal neuralgia can radiate to the lower back and simulate renal colic.

Treatment of intercostal neuralgia

Treatment of a disease such as intercostal neuralgia is aimed, first of all, at eliminating the causes that cause it, relieving pain and alleviating the patient’s condition. During the acute period of the disease, it is recommended to adhere to bed rest. It is advisable for the patient to lie on a hard, flat surface, preferably on an orthopedic mattress, or with a shield under the mattress.

Light, dry heat will help alleviate the patient’s condition with intercostal neuralgia; for this you can use sand heated in bags, an electric heating pad, mustard plasters, pepper plaster on the painful area, or a woolen scarf. The patient should avoid sudden movements, bending and turning the body, prolonged sitting, and heavy lifting.

Wearing a corset helps, but not for long, to avoid the development of muscle weakness.

Drug treatment

To treat intercostal neuralgia, it is necessary to carry out active anti-inflammatory measures. When treating intercostal neuralgia, the patient may be prescribed drug treatment with drugs from the following groups:

• anti-inflammatory non-steroidal drugs that relieve pain and have a pronounced anti-inflammatory effect;
• muscle relaxants, reducing muscle spasms;
• calming nervous system, herbal remedies;
• B vitamins - milgamma, neurorubin, neurobion and other drugs that restore damaged nerve structures and improve the passage of impulses.

For local treatment, the doctor may prescribe ointments and gels with NSAIDs - fastum-gel, dolobene and others. Preparations are also prescribed - solutions and ointments that do not contain non-steroidal anti-inflammatory drugs, but have

analgesic effect - finalgon, capsicam, menovazin.

There is also a relatively new dosage form for the treatment of this pathology - transdermal patches, which have a pronounced anti-inflammatory and analgesic effect.

Non-drug treatment

After acute pain has been relieved, non-drug treatment methods can help quickly restore the functions of the affected areas, such as:

• therapeutic massage that provides muscle relaxation, relieves pain, improves metabolic processes in the paravertebral muscles, and reduces swelling;
• vacuum therapy – cupping massage to further enhance soft tissue drainage;
• manual therapy to normalize intervertebral connections, eliminate pinched nerves;
• Exercise therapy to strengthen the muscular corset of the spinal column;
• physiotherapy: electrophoresis, phonophoresis, electrical myostimulation of muscles, magnetic therapy, laser therapy;
• acupuncture;
• hirudotherapy.

Intercostal neuralgia, which often occurs during pregnancy, is a fairly serious problem that requires increased attention to the patient. The cause of intercostal neuralgia in the second half of pregnancy is an increase in pressure caused by a restructuring of the usual arrangement of organs on the chest, ribs, intercostal spaces, and nerves. The doctor must competently select such an individual complex treatment regimen in order to avoid complications for the mother and child. Properly selected and timely treatment of intercostal neuralgia leads to a fairly rapid recovery and does not cause long-term problems for a pregnant woman.

Treatment with folk remedies

To alleviate the patient's condition with intercostal neuralgia, traditional medicine methods are also used, which have a good effect, in combination with the treatment prescribed by the doctor.

Ointments based on snake and bee venom have long been known; after rubbing them into the affected area, the application site must be insulated with a woolen scarf. It will also help to treat intercostal neuralgia using a pepper patch, before using which you need to wipe the skin with an alcohol solution or cologne and then wipe it dry. The patch should be removed when intense burning occurs.

An effective remedy is rubbing an alcohol solution of mumiyo into diseased areas and taking 20 grams of mumiyo orally before meals.

It must be remembered that for a successful recovery it is important not only to relieve pain, but much more important is to identify the cause of the disease and its comprehensive treatment.

Diagnostics

With classic manifestations, the diagnosis of intercostal neuralgia is not difficult (for example, with the consequences of herpes zoster). But given the possibility of pain in the rib area due to numerous diseases, it is often necessary to conduct a thorough examination. The diagnosis of intercostal neuralgia can be made based on the patient’s history of complaints (nature of pain, localization, intensity, duration of pain, presence of irradiation, increased pain with body movements), external examination (presence of spinal deformities), presence of pain on palpation in the area of ​​attachment of the ribs to the sternum or paravertebral points in the thoracic spine. If it is necessary to differentiate with the cardiac nature of pain, an ECG is necessary. To identify degenerative changes in the spine, instrumental research methods such as radiography, CT, and MRI are used. In addition, densitometry is necessary to diagnose osteoporosis. EMG can be used to determine the extent of nerve fiber damage. Laboratory tests and ultrasound may be ordered to diagnose both rheumatological diseases and endocrine disorders or kidney diseases. The approach to diagnosing intercostal neuralgia should be based on the exclusion, first of all, of somatic causes of pain (heart disease, kidney disease, endocrine diseases).

Types of intercostal neuralgia

Typically, intercostal neuralgia affects one intercostal nerve on one side of the body. But sometimes the disease forms a wider pathological zone, occupying two or three intercostal spaces, and several nerve roots on one side are affected.

In addition to unilateral lesions, there is bilateral intercostal neuralgia, which can be caused by diseases with a pronounced decrease in immunity, such as herpetic neuralgia caused by HIV infection in the AIDS stage, or other diseases, for example, radiation sickness.

Causes

Intercostal neuralgia is a secondary disease that is caused by pathological changes occurring in the body.

The main causes of left-sided thoracalgia include factors such as:

• spinal deformities in the chest area (osteochondrosis, kyphosis, spondylolisthesis);
• CNS disorders (neuritis, multiple sclerosis);
• diseases caused by infections (ARVI, influenza, tuberculosis);
• tumor formations in the area of ​​the spinal column;
• intoxication with medications during prolonged use;
• spinal injuries;
• changes associated with age;
• lack of B vitamins;
• menopause in women;
• overstrain of the spinal muscles;
• hypothermia of the body;
• regular stress and anxiety;
• excessive alcohol consumption;
• wearing underwear that is too tight for women.

Diagnosis of intercostal neuralgia

Diagnosis of intercostal neuralgia is quite difficult, since it must be differentiated from a number of diseases that have similar symptoms. A cardiologist or pulmonologist may be involved in the diagnostic process. Specialists at the CELT Pain Clinic conduct an examination and collect anamnesis, and also determine the presence or absence of the disease in the following ways:

• chest x-ray;
• CT scan;
• myelography;
• Magnetic resonance imaging;
• spondylography;
• electro- and echocardiography;
• examination of the gastrointestinal tract.

If diagnostic studies do not reveal diseases of the lungs, gastrointestinal tract and cardiovascular system, the patient is referred to a neurologist who develops a treatment plan.

Complications of the disease

Complications arising from neuralgia can be successfully treated in the early stages of the development of the disease. But in advanced cases, when the patient experiences pain for quite a long time, the “problem” nerve may even die. Then the excruciating pain disappears, but this is the first sign of the disease moving to a new stage, for which the characteristic symptoms are shortness of breath and the appearance of a feeling of heaviness in the chest.

Finding a person in a constant sitting position or other static position can result in dysfunction of the spinal canal and the development of osteochondrosis and other related pathologies. The occurrence of complications can only be prevented by timely treatment and prevention.

Forecast

Prognosis for the cure of left intercostal neuralgia directly depends on the disease that provoked the disease . A competent approach to the treatment of the disorder that caused thoracalgia allows one to eliminate the main symptoms, stop pathological processes and reduce the severity of pain.

If the cause of neuralgia is an increase in malignancy or a consequence of tuberculosis, then you cannot always count on a complete recovery. A disease caused by dystrophy or degeneration of the structures that create the body frame can also have a very serious prognosis.

Structure of nerves

Intercostal nerves consist of several types of fibers: motor, sympathetic and those responsible for sensitivity. Each of these nerve endings is located in the intercostal space and runs along the lower edge of each rib. The closing pair of nerve roots is called “subcostal” and is located under the 12th rib.

Each pair of nerve fibers is covered by a special pleura, starting from the spinal canal to the corners of the ribs. The intercostal nerves are responsible for the sensitivity of the muscle tissue of the chest, abdomen and mammary glands, and also innervate the skin in these areas of the body.

Types of neuralgia

Medical professionals divide neuralgia into categories based on the areas of the body that it affects. The following are some common types of neuralgia :

Trigeminal neuralgia

TN can cause shooting pain in the face.

Trigeminal neuralgia (TN) involves the trigeminal nerve in the head. It has three branches that send signals from the brain to the face, mouth, teeth and nose.

TN is divided into two divisions: type 1 and type 2.

Type 1 TN causes a painful burning or electric shock sensation in some parts of the face. People with type 1 TN experience irregular episodes that come on suddenly.

The duration of these episodes varies among individuals, but can last up to 2 minutes, according to the National Institute of Neurological Disorders and Stroke.

Type 2 TN produces a constant, dull, aching sensation on the face.

The exact cause of TN remains unclear. However, pressure from the enlarged blood vessel can irritate or even damage the trigeminal nerve.

Multiple sclerosis (MS) can lead to TN. MS is a neurological disorder that causes inflammation that damages the myelin sheath surrounding nerve fibers in the central nervous system.

Postherpetic neuralgia

Postherpetic neuralgia (PHN) is a painful condition that affects the nerves of the skin.

According to the Centers for Disease Control and Prevention (CDC), PHN is the most common complication of shingles, affecting about 10–13% of people who develop it.

Shingles is a viral infection that causes blisters and a painful skin rash. The varicella zoster virus, which causes chickenpox, remains dormant in the nervous system and becomes active later in life, causing shingles.

When the virus is reactivated, it can cause inflammation of nerve fibers. This inflammation can lead to permanent nerve damage, which causes pain even after the infection subsides.

Occipital neuralgia

This form of neuralgia affects the occipital nerves, which originate in the neck and send signals to the back of the head.

Occipital neuralgia causes throbbing or shooting pain that begins at the base of the skull and spreads along the scalp. Pain in occipital neuralgia may flow to the back of the eyes.

Occipital neuralgia has many potential causes, including:

• sudden head movements
• tense neck muscles
• lesions or tumors in the neck
• inflamed blood vessels
• infections
• gout
• diabetes
• neck injuries

Peripheral neuralgia

Peripheral neuralgia, or peripheral neuropathy, refers to pain that occurs due to nerve damage in the peripheral nervous system. This includes all nerve fibers outside the brain and spinal cord.

Peripheral neuralgia can affect one nerve or entire nerve groups.

Sustained damage to the peripheral nervous system can affect the nerves that control muscle movement, transmit sensory information, and regulate internal organs.

Peripheral neuralgia can cause pain or numbness in the arms, legs, arms and legs. Other symptoms may include:

• involuntary muscle twitching or spasms
• loss of coordination
• difficulty performing complex motor tasks such as buttoning a shirt or tying shoelaces
• hypersensitivity to touch or temperature
• excessive sweating
• gastrointestinal problems
• difficulty eating or swallowing
• it's hard to talk

Intercostal neuralgia

Intercostal neuralgia affects the nerves that sit just below the ribs. Doctors call the muscles in this area the intercostal muscles.

Several potential factors may contribute to intercostal neuralgia, such as:

• injuries or surgical procedures involving the chest
• pressure on the nerves
• shingles or other viral infections

Intercostal neuralgia causes sharp, burning pain that affects the chest wall, upper abdomen, and upper back. Certain physical movements, such as breathing, coughing, or laughing, can make the pain worse.

Additional symptoms may include:

• tightness or pressure that envelops the chest
• tingling or numbness in the upper chest or upper back
• muscle twitching
• loss of appetite

Diabetic neuropathy

Diabetic neuropathy is the most common complication of diabetes. Because diabetes affects so many people, rates of peripheral neuropathy are now starting to rise.

Symptoms include loss of balance and numbness, tingling and pain. The best way to prevent diabetic neuropathy is to keep your blood sugar levels within an acceptable range.

Serious life-threatening symptoms

Severe, debilitating pain can make breathing very difficult. Pain can also occur for life-threatening reasons, such as a heart attack. You should seek help if any of these symptoms appear:

• Chest pain that may spread to the jaw, shoulder, left arm, or back.
• Pressure in the chest, cramps and a feeling of rupture.
• Cough with yellow-green mucus
• Cardiopalmus.
• Breathing problems, such as severe shortness of breath and inability to breathe deeply.
• Severe abdominal pain.
• Severe chest pain when breathing and coughing.
• Confusion, dizziness, fainting.

Complications

The insidiousness of intercostal neuralgia is that its symptoms can be confused with many other diseases. Sometimes the patient is in no hurry to get an appointment and begins to treat intercostal neuralgia with ointments, tablets or herbs. For any form of the disease, even mild, the patient must be examined by a doctor. In no case should you independently diagnose yourself and prescribe treatment - the lack of medical intervention for serious diseases mistakenly mistaken for intercostal neuralgia can cost the patient’s life.

After identifying the cause of the disease, the doctor will prescribe adequate treatment to minimize the risk of complications.

The main complication of intercostal neuralgia is the transition of the disease to a chronic form with frequent exacerbations.

Symptoms of neuralgia

The most common symptom of neuralgia is pain attacks. They can appear in the patient in conditions of complete rest and seemingly excellent health. However, the highest percentage of pain occurs after a sudden change in body position, for example, when turning or bending the body. A person may also experience pain during coughing attacks, and especially after running or other exercise, when breathing becomes more rapid. In this case, sensations of pain also occur during palpation of the intercostal areas of the chest.

The duration of pain attacks varies from several minutes to a couple of days. In this case, there may be a prolonged numbness of the torso area located above the inflamed nerve roots.

An attack of pain caused by thoracic neuralgia can last from several minutes to several days.

Having felt paroxysmal pain, the patient often tries to reduce its intensity by holding his breath or changing his body position to a more relaxed one. Often the patient may think that the nature of the pain is caused by heart problems. However, this can often be misleading.

The table below shows the differences between the symptoms of neuralgia and heart pain.

Often the symptoms of thoracic neuralgia are confused with manifestations of heart disease

Herpes zoster often “gives” symptoms of neuralgia of the region, additionally accompanied by the appearance of bubbles with fluid along the path of the nerve fiber. This disease is not contagious, but requires additional treatment.