Anterior cutaneous nerve entrapment syndrome as a cause of abdominal pain

The sensation of shooting pain between the ribs on the side will cause concern in any person. The first thing that comes under suspicion is the heart. But a disease such as intercostal neuralgia has a similar localization. To correctly diagnose pathology, it is important to know its causes and symptoms. What is included in the complex of treatment and prevention, read on.

Causes of pathology

The reasons for the development of neuralgia can be different: inflammatory processes, injuries, bacteria and viruses, poisoning with drugs and various substances, autoimmune diseases, circulatory disorders in the vessels supplying the nerve.

• infections such as shingles, Lyme disease, or HIV
• pressure on bone nerves, blood vessels or tumors
• kidney disease or diabetes
• age

What are the symptoms of intercostal neuralgia?

• Sudden episodes of severe shooting or stabbing pain that follows the path of a damaged or irritated nerve. Symptoms appear on either the right or left side. The pain intensifies with any movement.
• Constant aching or burning pain.
• Tingling or numbness.
• Muscle weakness.
• Loss of muscle mass or atrophy.
• Involuntary muscle twitching or spasms.

In children, characteristic pain occurs during a period of intense growth, when the skeleton is growing rapidly. Severe pain in the affected areas and cramps are the main symptoms of neuralgia by which the disease is recognized in children. Additional signs include profuse sweating, increased excitability, tearfulness, sleep disturbance and stuttering.

The main goal of treatment is to distinguish this disease from others. It is important to distinguish attacks of neuralgia from manifestations of heart attack and angina. With neuralgia, there is no fever, shortness of breath, difficulty breathing, or blue discoloration of the skin.

Main causes of lower back pain

Unfortunately, many people try to get rid of back pain on their own without knowing exactly its source. Erroneously assuming that the paravertebral muscles are overloaded, patients take a steam bath and rub in warming ointments. Such self-medication can be dangerous to health. Lumbar pain often indicates inflammation and tumors of the digestive, urinary, and reproductive systems. From the back, pain in the ribs can occur due to neurological disorders, spinal deformities, and heart failure. Visceral pain is carried out by sympathetic fibers that innervate the internal organs. The signal arrives along the spinal projection tracts - from the spinal cord to the central nervous system. The main triggers for the occurrence and transmission of a pain impulse are a sudden increase in pressure in hollow organs or stretching of their walls (fibrous capsules).

Shpidonov Gennady Stanislavovich

Neurologist

Rostov State Medical University (neurology)

10 years of experience

Gastrointestinal tract

Relapse of chronic diseases leads to irritation of the nerves innervating the gastrointestinal tract. Pain in the ribs appears during exacerbation of:

• Stomach ulcers. The disease develops due to damage to the mucous membrane by Helicobacter pylori bacteria, as well as against the background of alcohol abuse, stress, unhealthy diet, and advanced hyperacid gastritis. Particularly intense pain is caused by a penetrating (complicated) ulcer involving adjacent tissues.
• Pancreatitis is inflammation of the pancreas (PG). The pain covers the epigastrium, left hypochondrium, extends under the scapula, into the left arm, intensifies after eating, in a lying position, often accompanied by febrile temperature (38-39℃), stool upset, increased gas formation, nausea with the release of vomit containing bile.

Triggers for the development of inflammation can be gallstones, advanced duodenal ulcers, and alcoholism. You can get sick due to incorrect intake of steroid hormones, addiction to foods rich in animal fats.

Oncological tumor of the pancreas

Cancer of the head of the pancreas is painful. The neoplasm is localized primarily in the ducts, and as it grows, it compresses the nerves, causing intense pain in the upper half of the abdomen, radiating to the lower back.

Intestines

Sacrodynia - aching, referred pain at the lumbosacral level is initiated by colitis or enterocolitis. Both diseases are associated with inflammatory processes occurring in the intestines. Severe pain is observed during an attack of appendicitis. Especially if the inflamed appendix of the cecum (appendix) has a low or retrocecal, that is, posterior anatomical location. In addition, sacrodynia is a concern in cases of cancer and mucocele of the appendix - an abnormal expansion of the lumen of the appendix with excessive accumulation of mucus.

Intercostal neuralgia

Spinal pain (dorsalgia) begins suddenly, like a “lumbago”, spreading along the thoracic spinal nerves, encircling the body. The intensity of sensations increases sharply with any twisting of the torso, coughing, or taking a deep breath. Strong pain in the pit of the stomach, under the shoulder blades, in the lower back. The cause of back pain under the ribs is:

• neuromuscular inflammation, against the background of reactivation of the herpes virus, “dormant” in the body. Exacerbation is facilitated by decreased immunity, hypothermia, prolonged stress, and infection with ARVI.
• compression of nerve fibers. Infringement of the spinal roots occurs due to involuntary contraction of the vertebral muscles during osteochondrosis and its complications.

Shpidonov Gennady Stanislavovich

Neurologist

Rostov State Medical University (neurology)

10 years of experience

Osteochondrosis and intervertebral hernia

Osteochondrosis is degenerative-dystrophic changes in articular fibrocartilaginous discs and bones. The interval between adjacent vertebrae gradually decreases. They shift from their anatomical positions, pinching blood vessels, as well as nerve endings at the site of their exit from the spinal canal. Transformation occurs when the trophism of the vertebral structures is disrupted due to incorrect posture and irrational physical activity. Vertebrogenic pain syndrome is caused by compression of the spinal nerve roots. Intervertebral hernia is a complication of osteochondrosis, characterized by separation and bulging of the disc between the vertebrae, and even more severe compression of the spinal roots.

Cardiac dysfunction

Burning and pain in the chest (thoracalgia), with reflection in the solar plexus, left arm and neck - a sign of an attack of angina or myocardial infarction. The condition aggravates the patient's physical and emotional stress. At the same time, the following appear:

• dyspnea;
• cold sweat;
• nausea;
• tachycardia;
• weakness;
• dizziness;
• high anxiety, fear of death.

The vast majority of such cases are provoked by coronary atherosclerosis. Due to blockage of the coronary arteries by cholesterol plaques, the heart muscle does not receive nutrients and oxygen. Circulatory failure leads to organic and functional inferiority of the myocardium, replacement of functional tissue with connective fibers. With occlusion (absolute obstruction of the vessel), cardiac activity stops. Lack of emergency resuscitation leads to the death of the patient.

Hepatobiliary system

Visceral girdling pain in the back and in the rib area is characteristic of cholelithiasis and inflammation of the gallbladder (cholecystitis). Acute pain in the right hypochondrium with irradiation under the scapula and into the epigastrium is called hepatic colic. It occurs when the flow of bile stops and intravesical pressure increases. The cause is the movement of stones that clog the bile ducts. In cholecystitis without stone formation, pain is initiated by infection with pathogenic bacteria.

Liver pathologies are painless for a long time, since there are no nerve endings in its parenchyma. With progressive cirrhosis and hepatosis, pain appears at the stage of liver enlargement. This leads to stretching of the fibrous membrane innervated by the intercostal nerves. Before discomfort appears in the right side, you need to pay attention to symptoms such as:

• constant bitterness in the mouth;
• sudden hematomas on the body without traumatic injuries (bruise, blow);
• yellowing of the eyeballs, mucous membranes, and skin.

Hepatobiliary disorders have a multifactorial etiology - from genetic abnormalities to errors in diet.

Gynecology

In women, lower back pain is accompanied by pronounced hormonal fluctuations, especially during the premenopausal and premenstrual periods. During pregnancy, the lower back is pulled due to an increase in body weight, as well as due to compression of the abdominal organs by the uterus, which is growing in volume. Lumbodynia - aching subacute or chronic lumbar pain, is well known to women with salpingitis, salpingo-oophoritis, prolapse and uterine tumors (myoma, fibroma). Progressive pain in the projection of the fallopian tubes during an ectopic pregnancy radiates to the sacral region.

Urology

With urological problems, severe lumbodynia accompanies:

• dysfunctional disorders of urine storage, filtration and excretion;
• infectious and inflammatory lesions of the urinary tract and kidneys (pyelonephritis, glomerulonephritis, cystitis).

Unbearable pain - renal colic - appears when stones move through the ureter. As a result, the stone clogs the urinary tract, stopping the flow of urine. In this case, the intrapelvic pressure sharply increases, a spastic contraction of the ureteral muscles occurs, swelling of the parenchyma and stretching of the fibrous capsule, where the sensory receptors are concentrated.

Shpidonov Gennady Stanislavovich

Neurologist

Rostov State Medical University (neurology)

10 years of experience

Most urological pathologies develop as a result of bacterial infections, metabolic failure, and intoxication.

Lungs

Pain in the back of the ribs is one of the symptoms of pleurisy. The patient feels sharp painful injections in the back, which intensify when trying to take a full breath, and decrease when lying on the side where the damaged lung is located. Thoracalgia and nagging pain in the shoulder blade area accompany pneumonia, when severe coughing causes damage to the pulmonary vessels and muscle strain. The most common etiology of pneumonia and pleurisy is the penetration of pathogenic bacteria and viruses into the lung tissue.

Spleen

Visceral back pain is accompanied by:

• formation of an abscess, areas of necrosis;
• mechanical damage due to blunt trauma to the abdominal cavity;
• tissue rupture with profuse internal bleeding;
• splenomegaly - proliferation of parenchyma due to liver problems, infectious mononucleosis;
• thrombosis of the splenic vein.

Patients with congenital anomalies of the spleen experience constant discomfort.

Diagnostic methods

You need to see a general practitioner. After examination and exclusion of other pathologies, the therapist refers to a neurologist who determines the symptoms and treats intercostal neuralgia. The doctor examines the images, prescribes tests and medical examinations.

Instrumental diagnostic methods of examination:

• Radiography. Allows you to examine the bone structure. Makes it possible to determine the presence of non-traumatic or traumatic disorders. X-rays are taken in direct, oblique and lateral projections.
• CT scan. Examines bone and muscle structure in combination. More often used to detect pathological changes in bone structures.
• Myelography. A contrast agent is injected into the spinal canal. This is the main method for diagnosing soft tissue structures (nerve roots and spinal cord).
• Contrasting discography. During the procedure, a contrast agent is injected into the intervertebral disc.
• Magnetic resonance imaging. Allows you to obtain images of organs and tissues. Detects pathological changes in soft tissue structures: nerve tissue, muscles, ligaments, hernias and degenerative changes in intervertebral hernias.
• Electrospondylography. Using the computer diagnostic method, it is possible to assess the condition of the spinal column, identify the disease at an early stage, determine the extent of damage and monitor the course of the disease.

Types of back pain

The nature of referred back pain depends on the etiology. The most severe pain is caused by renal and hepatic colic. Unbearable cramping pain in the back radiates to the ribs, spreads to the mesogastric, ileal zone, as well as to the thigh and rectum.

Intense vertebrogenic pain is characteristic of intercostal neuralgia and intervertebral hernia. The patient has difficulty walking, breathing deeply, coughing, sneezing, and any change in body position causes unbearable pain.

Lumbodynia and sacrodynia in gynecological diseases, before critical days, are of a pulling nature.

When the heart malfunctions, thoracalgia is associated with a feeling of burning and constriction in the chest.

If the main pathological focus is located in the gastrointestinal tract, the pain is characterized as moderate but constant. The exception is acute conditions - appendicitis and relapse of chronic pancreatitis.

Methods for treating intercostal neuralgia

Drug therapy. There is a wide variety of drugs to eliminate pinched nerves: painkillers, anti-inflammatory drugs, those that increase the body’s defenses, injections, blockades. All drugs have a long list of side effects, so before using them you need to consult a specialist. Any medicine is selected depending on the severity, tendency to allergies, and the characteristics of the course of the disease.

• Anticonvulsants inhibit the conduction of pain impulses.
• Tricyclic antidepressants relieve tension in chronic pain syndromes.
• Venotonics and diuretics relieve swelling.
• Corticosteroid drugs are used in cases of severe inflammation.
• Vitamins B1, B6 and B1 accelerate the restoration of the nerve sheath, reduce inflammation and pain.

Compresses. They can be either hot or cold. They are used to reduce inflammation and also to reduce pain. This is only a temporary measure and has no therapeutic effect.

Other methods: gymnastics, shock wave therapy, massage, physiotherapy - alleviate your condition, ensuring complete recovery. And these procedures do not harm the body.

Physiotherapy and exercise therapy. Intercostal neuralgia is often caused by poor posture. The goal of physical therapy is to relieve the back muscles and open the chest. Therapeutic exercises should be performed 3-4 times a day.

Physiotherapy includes acupuncture, osteopathy, manual therapy, massage with warming creams and ointments, and kinesiotaping. They relax the fascia of the chest and back. Heat helps to temporarily relax muscles, relieve swelling, inflammation and acute pain.

Massotherapy. It should be done while sitting. When performing the procedure, the intercostal spaces are rubbed and stroked with your fingertips. In addition to this, they knead and rub the back muscles with both hands. During acupressure massage, use your fingers to press on active points associated with one or another affected organ. Acupressure can stimulate defenses and relieve pain.

Localization of pain under the ribs

Precise determination of the area where painful sensations are concentrated allows one to assume a particular diagnosis.

Treatment of intercostal neuralgia during pregnancy

During pregnancy, the presence of neuralgia is considered a fairly serious problem. It requires proper attention, which will help avoid complications for the expectant mother and baby.

All treatment that will be given to a pregnant woman for neuralgia must be prescribed by the attending physician. Self-therapy is extremely undesirable, as it can greatly harm the woman and the child in the womb.

Many patients prefer not to take medications. They limit themselves to vitamins and mineral complexes, use ointments and warm compresses, observe bed rest and perform simple physical exercises.

Gymnastics for neuralgic pain in pregnant women is very effective. Physical exercise does not allow blood to stagnate in the joints and parts of the spine.

If the pain becomes unbearable, novocaine blockades are prescribed with caution.

How to treat referred back pain, which doctor to consult

Therapy is prescribed by a specialized specialist. To start, you can see a therapist. Treatment tactics are selected based on the underlying disease that was the source of visceral pain in the ribs. The gastrointestinal tract is examined and treated by a gastroenterologist. A hepatologist specializes in hepatobiliary pathologies. Vertebrogenic pain due to neuralgia and spinal destruction is relieved by a neurologist or vertebrologist. A urologist deals with dysfunctions of the urinary system. A gynecologist helps solve “women’s problems”.

Prevention of intercostal neuralgia

The main preventive measure is gymnastics. It is necessary to perform exercises that promote muscle development, strengthening and mobility of the spine. Avoid drafts, uncomfortable positions and excessive physical activity. Everything should be in moderation.

It is important to control your posture, not lift excessive weights, eat a rational and balanced diet, take vitamins, and avoid fasting and mono-diet.

Do not forget to promptly treat diseases that can cause the development of neuralgia.