What is intercostal neuralgia?
Let's start with the fact that intercostal neuralgia is not a disease.
This is the name for pain that occurs when the intercostal nerves are exposed to various pathological factors, for example, herpetic infection, tumors, injuries, disc herniation, protrusion, osteochondrosis, etc. In other words, thoracic intercostal neuralgia can be called not all chest pain, but only that where intercostal nerves are involved. And this needs to be clearly understood so that the confusion that you often encounter at the everyday level does not arise when you hear people using the term intercostal neuralgia, but at the same time they mean a completely different pathology. By the way, even some doctors sometimes make the diagnosis of intercostal neuralgia erroneously, while in reality it most often turns out to be myofascial syndrome. Intercostal neuralgia, myalgia, myositis, myofascial syndrome, osteochondrosis, disc herniation, protrusion and many other terms are not synonymous. These are the names of specific pathologies that have their own characteristics and differences. And, since they are different, it means that the approach to them must also be different, otherwise there will be no sense in the treatment.
In general, the term intercostal neuralgia should not be used haphazardly, and it is not worth calling all pain in this area that way.
Neuralgia of the intercostal space
Intercostal neuralgia is closely associated with the manifestation of pain in the chest. This can happen due to a deterioration in the full functioning of the intercostal nerve fibers against the background of pinching, infections, or hypothermia. This problem can arise at any age, but still the largest percentage of patients is recorded among older people.
Intercostal neuralgia
Such a pathology can also occur due to the presence of pathologies in the patient such as osteochondrosis, hernia of the thoracic ridge or herpes zoster. Often neuralgia is a symptom of more serious diseases - for example, pleurisy or various types of oncology. In addition, neuralgia on the left side of the chest can cause symptoms associated with heart disease. The presence of symptoms that are closely related to the manifestations of other various diseases often requires additional examination by specialists in related fields of medicine, such as cardiology, oncology or pulmonology.
Intercostal neuralgia in women & Intercostal neuralgia in men.
Intercostal neuralgia in men occurs as often as in women, but at the same time, intercostal neuralgia in women has its own characteristics. For example, women often perceive pain due to intercostal neuralgia as a manifestation of breast disease, and not as neuralgia. And it is clear that such thoughts can only cause additional anxiety and worry. But there is one consolation - although pathology of the mammary glands is indeed common, even if it is present, the vast majority of pain is not associated with it, but with the spine, nerves and muscles. This does not cancel periodic examinations with a mammologist, but it does mean that you should never panic. And most importantly, keep in mind that in medicine there is such a concept - a disease “in disguise”, when one disease is masked by another. Let's look at the insidiousness of this problem using our example. Pathology of the mammary glands is a psychological dominant that causes much more concern than intercostal neuralgia. Accordingly, if a woman simultaneously has thoracic intercostal neuralgia and pathology of the mammary glands, then all her thoughts will be focused on the glands. The rest will fade into the background. And it is quite natural that in this situation a woman, first of all, will turn to a mammologist. If the mammologist turns out to be knowledgeable, he will quickly figure out what is causing the pain: glands or neuralgia. And, if it is neuralgia, he will refer the patient to a chiropractor. By the way, it is the chiropractor who is the main doctor for intercostal neuralgia (but we’ll talk about this later). And if a mammologist comes across an inexperienced or over-insurer, what will he do? Most likely, having discovered his own profile pathology in the patient, he will also focus on this pathology and will not “dig” deeper. Consequently, if in reality the patient was bothered by pain due to intercostal neuralgia, and the pathology of the mammary glands was only a background that did not cause pain, then treatment by a mammologist will not solve the problem. The pain will remain. And this will cause the woman even more anxiety. Her faith in doctors will suffer. Your nerves and time will be wasted. This is what the disease turns out to be “under the mask.” Meanwhile, intercostal neuralgia in women very often occurs under the guise of mammary gland pathology. Be sure to remember this!
Dear women, the best advice for pain in this area is to contact two specialists at once. A mammologist will give you confidence and relieve fears, and a chiropractor will cure intercostal neuralgia. After all, as we have already said, a chiropractor is the key doctor for intercostal neuralgia. This approach is the most reasonable. It will save you both time and nerves.
Intercostal neuralgia in men also has its own characteristics, and these are not always differences. For example, very similar psychological aspects. So, if in women intercostal neuralgia often occurs under the guise of mammary gland pathology, then in men it occurs under the guise of heart disease. By the way, it is precisely the “disguise” as heart disease that distinguishes left intercostal neuralgia from intercostal neuralgia on the right side. Do you know how to distinguish intercostal neuralgia from a heart attack at home? Very simple. Heart pain is relieved by nitroglycerin, but neuralgia is not.
According to statistics, intercostal neuralgia on the left in the heart area equally often causes a false alarm in both men and women. Moreover, in women, both the heart and the mammary gland come under suspicion. But, right intercostal neuralgia is “suspicious” only for women. Men immediately understand that this is intercostal neuralgia.
The human nervous system is very well developed. When “trouble” happens to her, it makes itself felt, causing certain symptoms. A fairly common pain syndrome is intercostal neuralgia . The word neuralgia itself combines two concepts. "Nevron" meaning "nerve" and "algos" meaning "pain". Accordingly, the disease is pain in the nerves located between the ribs (intercostal nerves).
SYMPTOMS OF INTERCOSTAL NEURALGIA
There are certain symptoms that make it possible to “recognize” this disease. How to recognize it, after all?
The most important symptom indicating the presence of intercostal neuralgia is pain localized between the ribs - in the intercostal spaces. The area of the chest from the fifth to the ninth ribs is most often affected. The pain itself is quite varied, it either appears in attacks, or constantly bothers the person, while preventing him from making the usual movements of the upper half of the body. Many patients even get used to it, so they often remember its existence only during an exacerbation.
What triggers an attack of pain?
It can occur with any movements that promote stretching of these same intercostal spaces. Very often, pain can occur (or intensify) during a deep breath, or when a person tries to talk loudly. Coughing and sneezing are also accompanied by chest pain. If you press on the area between the ribs, it is painful. Sometimes patients feel as if their chest is burning or “stabbing,” and some, touching the “sore” area, simply do not feel anything, because numbness along the intercostal nerves is also a sign of their damage.
Patients can take an antalgic position, one in which pain decreases or disappears. In this case, the patient can tilt the upper body in the direction opposite to where the pain is localized.
The intercostal nerves are highly branched, their branches are directed in different directions, so the pain with intercostal neuralgia may resemble pain with other diseases.
Considering the possible sharp nature of the onset of an attack of pain, it can imitate an attack, for example, with angina pectoris. The patient can independently determine whether the heart or nerve endings hurt.
If this is angina pectoris, then the pain is necessarily localized behind the sternum, it presses, pulsates, in addition, there are disturbances in the pulse, pressure, and when the posture changes, the pain does not change its character.
If it is intercostal neuralgia
, then the pressure and pulse are normal, but the nature of the pain changes with the slightest stretching of the intercostal spaces. The branches of the intercostal nerves even reach the lower back, so you can often confuse an attack of neuralgia with an attack of colic in the kidneys. If a patient experiences pain in the area of the shoulder blades, along the spine or in the shoulder, as if being injected or cut with a knife, this may also indicate intercostal neuralgia. In addition, if the pain intensifies when the muscles of these areas are stretched, then this once again confirms the diagnosis.
CAUSES OF INTERCOSTAL NEURALGIA
Painful sensations can arise due to a certain reflex on the part of the intercostal nerves, provoked by the action of exogenous (formed outside the body) and endogenous (formed in the human body) factors. Under the influence of provoking factors, the nerves are irritated, which causes pain. Depending on how strong the irritating factor is, the pain will be so intense.
Progressive thoracic osteochondrosis is the most common cause of the development of the disease, since in this case the following is observed:
- spinal instability - displacement of the vertebrae, which causes pinching of the spinal nerve roots and disrupts their proper functioning,
- Protrusions or herniated discs form between the vertebrae, and they can cause compression (pressure), i.e. irritate the intercostal nerves, namely their roots, damaging them, which causes pain at the site of pinching (irritation) and along the course of the nerve.
Herpes zoster (popularly known as shingles) is also a fairly common cause.
Intercostal neuralgia
may be a consequence of a certain disease of the spine, and under the influence of certain irritating factors it externally manifests itself as pain along the intercostal nerves. Such diseases include spondylitis, spondyloarthritis, ankylosing spondylitis, and various neoplasms (benign or malignant tumors) localized in the spine can also irritate the nerves.
In principle, any type of factor can cause an attack of pain: physical, chemical, biological. As mentioned earlier, when performing sudden or unusual physical exercises without specific preparation, the muscles in the intercostal spaces suddenly stretch, which leads to irritation of the nerve endings. In addition, normal hypothermia, or the flu or the herpes virus (which causes shingles) can also irritate the nerve endings. Irritating factors also include intoxication of any origin (viral, alcohol, intoxication with paints and paints, etc.), excessive emotional excitability or chest injury. But symptoms indicating neuralgia of the intercostal nerves can not only be a consequence of the direct action of the irritant on these nerve endings, they can also reflect pathological processes in nearby organs and tissues.
Thus, intercostal neuralgia can “copy” the clinical picture of an inflammatory disease of the pleura (pleurisy), narrowing of the part of the aorta located in the thoracic region, mediastinal neoplasms (benign or malignant), any inflammatory or deforming processes of the spine, and so on.
Therefore, given the fact that a huge number of diseases of both the musculoskeletal system and other systems, individual organs and tissues of a person can cause symptoms similar to intercostal neuralgia, it is not worthwhile to independently determine what kind of disease it is, much less try to treat it, since how, while curing, as you believe, the true cause of the disease, you can miss or aggravate another - the main cause, which can lead to unpleasant and dangerous consequences that will have to be dealt with for a long time. Therefore, if you discover the first signs of damage to nerve endings, immediately consult a doctor.
PREVENTION OF INTERCOSTAL NEURALGIA
General prevention methods are quite simple and are aimed at preventing irritation of the intercostal nerves. You need to regularly do morning exercises, it is advisable to visit the pool, try to limit yourself in physical activities, especially heavy ones, dress warmly, avoid drafts, so as not to get too cold and catch a cold. And, of course, if there is an underlying disease (from viral infection to the final stage of osteochondrosis), treat it.
DIAGNOSIS OF INTERCOSTAL NEURALGIA
First of all, you can do the diagnosis yourself, which will only allow you to suspect the disease, after which you should immediately consult a doctor.
How is this done?
Firstly, it is worth trying to determine exactly what kind of pain this is, where it is located and why, in fact, it arose. The pain may persist for a long time, or may disappear, manifesting itself in attacks. You can palpate (feel) the ribs, and most importantly, the spaces between them. If this is a lesion of the intercostal nerves, then it is the intercostal spaces, and not the ribs themselves, that will hurt. You can try bending your upper body in different directions, spinning around, trying to cough or even scream. All this leads to stretching of the muscles located between the ribs and irritation of the endings. If the symptoms are similar to the disease you are looking for, you should try to remember or associate this pathology with any previous disease. For example, does the patient have musculoskeletal diseases, has he recently had a cold, has he been hypothermic, has he suddenly gone to the gym after a long break, or were there any factors contributing to the development of intoxication (drinking alcohol, inhaling varnishes or paints, etc.).
Next, the doctor will conduct the examination. First of all, he conducts a detailed questioning of the patient. The doctor asks about the nature of the pain (cutting, burning, dull, pressing, aching pain, etc.), about its location (at a certain point or throughout the chest), whether the pain radiates to the shoulder blade, lower back, perhaps to other parts bodies. It is also important to find out the cause of its occurrence. In addition to the fact that the patient himself will tell you about all his previous diseases, the doctor asks to bring the results of examinations (if available): x-rays, results of ultrasound examination (ultrasound), computed tomography (CT), magnetic resonance imaging (MRI). All this will help in identifying the cause of the pain. It is also important to ask the patient whether the patient had relatives with similar symptoms or, at least, with diseases of the musculoskeletal system, since many of them are inherited.
After a detailed questioning, the doctor independently examines and examines the patient: palpates painful areas, conducts a detailed examination of the musculoskeletal system and nervous system, while studying muscle tone and the presence or absence of sensitivity in certain parts of the body.
If necessary, the doctor can send the patient for tests or instrumental examination methods, depending on the suspected pathology.
Symptoms of intercostal neuralgia
It is believed that the main symptom of intercostal neuralgia is pain in the intercostal space. But how can one distinguish intercostal neuralgia from one symptom, even such a striking one? After all, pain in the ribs also occurs with other pathologies. Obviously, for an accurate diagnosis, more signs of intercostal neuralgia are needed. Therefore, we decided to talk about the symptoms and causes of intercostal neuralgia in more detail.
The name intercostal nerves speaks for itself. They are actually located between the ribs. Starting from the spine, they cover the chest on both sides. The intercostal nerve cannot suffer from a small or even moderate bruise, since it is located deep under the rib. Therefore, the mechanical cause of intercostal neuralgia can be serious injuries, for example, a fracture; a tumor compressing a nerve, or dystrophic pathology of the spine - osteochondrosis, hernia and disc protrusion.
In addition to mechanical ones, there are also infectious causes of intercostal neuralgia, most often a herpetic infection. Due to its characteristics, it often affects these nerves. Herpes, as a sign of intercostal neuralgia, is easily recognized by characteristic rashes that coincide with the area of pain.
Thus, the causes of intercostal neuralgia are infectious and mechanical. But, the connection between intercostal neuralgia and breathing is a myth. Remember, at the beginning of the article we talked about the difference between real intercostal neuralgia and what many people mistakenly consider to be such. For example, the appearance of intercostal neuralgia after a cold is not neuralgia at all, but myofascial syndrome. If you are not aware, myofascial syndrome is a muscle disease in which small painful areas - trigger points - form in the muscles. These points may remain in a latent state for a long time and not manifest themselves in any way. But as soon as they are activated, pain immediately arises. The most common factor in the activation of trigger points is overload of the affected muscles. The intercostal muscles are classified as respiratory muscles, as they are involved in the act of breathing. A cough is a forced exhalation. Therefore, intercostal neuralgia when coughing or after a cold is not neuralgia, as many people mistakenly think, but myofascial syndrome, provoked by overload of the respiratory muscles from coughing. By the way, an indirect sign of how to distinguish intercostal neuralgia from myofascial syndrome is the duration of the disease. True intercostal neuralgia takes a long time to heal. Especially if it is caused by a fracture or tumor. And myofascial syndrome has a shorter treatment period. But it is impossible to say exactly how long intercostal neuralgia lasts without seeing the patient. Firstly, you need to make sure that it is intercostal neuralgia and not some other pathology, and secondly, it all depends on the situation. Agree, neuralgia from herpes and from a fracture will have completely different treatment periods.
Separately, it is necessary to say about the so-called false symptoms of intercostal neuralgia. Muscle tension, muscle twitching, increased pain when coughing, sneezing, turning the body; forced body position to relieve pain, sweating, high blood pressure and a number of other symptoms are not signs of intercostal neuralgia, although they are often attributed to it. These symptoms refer to pathologies similar to neuralgia. Being able to distinguish between similar pathologies is one of the basic skills of a doctor, which is specially taught, and which allows the doctor to make an accurate and correct diagnosis. It remains only to remind you that a doctor for intercostal neuralgia is a chiropractor, or even better, a chiropractor-neurologist.
Diagnostics
A neurologist will help the patient identify the presence of thoracic neuralgia. A specialist can make a diagnosis based on examination data and a survey for complaints. During the examination, special attention is paid to the patient's posture. Indeed, with neuralgia, a person, trying to reduce discomfort, involuntarily tries to change the posture of the body in a “painless” direction. When you feel the problem points between the ribs, it is their lower edges that cause pain. And the skin in these irritated areas may partially lose sensitivity.
An important task in diagnosing neuralgia is to determine the nature of pain, which is specific to thoracic neuralgia. In this case, the goal of a neurologist is to exclude heart diseases - for this, an electrocardiogram is prescribed and, if necessary, a consultation with a cardiologist is held.
To rule out heart disease in a patient, doctors perform an electrocardiogram.
In addition to the fact that the symptoms of neuralgia are similar to the manifestations of heart disease, they can often be put on a par with the manifestations of stomach diseases. For example, the symptoms of gastritis or stomach ulcers, as well as manifestations of acute pancreatitis (inflammation of the pancreas) are very similar to the symptoms of thoracic neuralgia. However, there are some nuances in the nature of the manifestation of pain. In gastrointestinal diseases, the painful condition is more prolonged and less severe. It is also often associated with food intake. With pancreatitis, pain has a pronounced bilateral manifestation and also mainly appears after eating. To exclude these diseases, additional studies are carried out, such as gastroscopy, determination of the amount of enzymes in the blood and other specialized examinations.
To exclude radiculitis from the possible causes of neuralgia, an x-ray is prescribed, and if a spinal hernia is suspected, an MRI is prescribed.
MRI and thoracic x-ray results can help determine the diagnosis.
Intercostal neuralgia of the thoracic region may be similar in its manifestations to pathologies of the respiratory system, such as pneumonia, pleurisy or lung cancer. To detect these diseases, radiography or computed tomography is used.
Treatment of intercostal neuralgia
Treatment for intercostal neuralgia depends on what causes it. Statistics say that the vast majority of pain in this area is caused by mechanical causes - pathology of the spine and muscles - osteochondrosis, disc herniation, protrusion, myalgia and myofascial syndrome. Therefore, the answer to the question of how to treat intercostal neuralgia is obvious. Since most of the reasons are mechanical, then they should be eliminated mechanically. This means that the best way to treat thoracic intercostal neuralgia is manual therapy. Moreover, not ordinary, but soft manual therapy, which is not only softer, but also much more effective than simple realignment of the vertebrae. Gentle manual therapy works extremely gently and delicately. Its main advantage is the safe elimination of muscle tension that “pinches” the nerve and stiffens the spine. This is why a chiropractor is the primary physician for intercostal neuralgia. In cases where the problem is advanced, manual therapy can be supplemented with medications and physical therapy.
Treatment of intercostal neuralgia with herpetic lesions requires parallel treatment by a dermatologist. Rare and severe forms caused by fractures and tumors require high-tech and expensive medical care, which is carried out under government programs in specialized clinics.
How to relieve pain from intercostal neuralgia if a person finds himself far from full-fledged medicine and only a pharmacy nearby? Pain in acute intercostal neuralgia is best relieved with the combined use of non-steroidal and steroidal anti-inflammatory drugs. But, we draw your attention - see a specialist as soon as possible. This must be done even if the pain stops completely. It is in your best interests to be sure that nothing more serious lies behind the pain and intercostal neuralgia.
Intercostal neuralgia: symptoms and treatment
Intercostal neuralgia is a pain syndrome in the intercostal spaces caused by a pathological condition of the peripheral nerves. Due to the location and nature of the pain, it can be confused with a heart attack, and therefore often leads patients into a state of panic. Intercostal neuralgia occurs in approximately 10% of the adult population.
MedEx offers to make an appointment with a neurologist. If necessary, the clinic can carry out all necessary diagnostic procedures and laboratory tests.
Consequences
Intercostal neuralgia on the left side does not pose a particular threat to the patient’s health, but it can cause a lot of discomfort, cause sleep disturbances, hypertensive crisis and other negative consequences. The main danger of thoracalgia is that its symptoms are similar to the manifestations of diseases of the internal organs, so neuralgia is often confused, for example, with cardiac disorders. At the same time, the disease can be caused by serious hidden pathologies, such as intervertebral hernia, diabetes mellitus, tumor .
Video: “Intercostal neuralgia: symptoms, treatment”