Back pain under the ribs - causes, types of pain, treatment

Intercostal neuralgia is a pain syndrome that occurs due to damage to the intercostal nerves of various etiologies. It is one of the types of neuralgia that affects peripheral nerves and is characterized by pain symptoms in the affected area. The etiology of neuralgia is varied, ranging from traumatic injuries to severe colds. It itself can affect any part of the body and can be complicated by pathological changes in the nerve and lack of sensitivity.

The Algology Department of CELT invites you to undergo a course of treatment for neuralgia in Moscow. Our clinic is multidisciplinary and has been operating in the paid medical services market for the third decade. We have a powerful diagnostic and treatment base and provide treatment in accordance with international standards. Our specialists know how to relieve pain due to neuralgia, and have a number of specific means to relieve it. You can make an appointment with them online or by contacting our operators: +7 (495) 788 33 88

At CELT you can get advice from a specialist algologist.

Make an appointment

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.

Neuralgia: symptoms

Clinical manifestations of neuralgia include pain symptoms. It manifests itself in attacks and affects the area of ​​​​innervation. In addition, the patient may suffer from redness of the skin in the affected area, lacrimation, and convulsive muscle contractions.

Localization of pain under the ribs

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

What is an intervertebral hernia

If a tear forms on the spinal disc, and it itself shifts away from the spinal column, resulting in inflammation and swelling, this is an intervertebral hernia. It is often a consequence of osteochondrosis. It can be identified by the following symptoms:

• the pain is pinpoint, the location of the lesion is clearly defined, and is poorly relieved by painkillers;
• movements are constrained (for example, a turn cannot be performed in the usual volume);
• with physical activity the pain increases sharply;
• atypical reflexes when trying to stand up.

There are several stages of this disease: disc prolapse, protrusion, extrusion, sequestration.

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.

Prevention

The development of radicular syndrome in the lumbosacral spine can be prevented. To reduce the likelihood of developing this condition you should:

• Practice good posture while sitting and standing, including while driving.
• Use proper body mechanics when lifting, pushing, pulling, or performing any activity that places additional stress on the spine.
• Maintain a healthy weight. This will reduce the load on the spine.
• No smoking.
• Discuss your profession with a physical therapy doctor, who can analyze work movements and suggest measures to reduce the risk of injury.
• Muscles should be strong and elastic. It is necessary to consistently maintain a sufficient level of physical activity.

Establishing diagnosis

First of all, you need to establish the main cause of pain. The diagnostic complex may include:

• Physical examination of the patient - palpation (palpation of soft tissues), percussion (tapping), auscultation (listening).

• Laboratory blood tests. Biochemistry will detect disturbances in the functioning of the liver, gall bladder and pancreas. Microscopy will indicate the presence of inflammatory processes.
• Three types of urine tests - clinical (general), according to Zimnitsky (portioned collection of urine every three hours), daily diuresis. The tests are designed to look for problems with the kidneys, bladder and bladder ducts.
• FGDS (fibrogastroduodenoscopy) and colonoscopy. Instrumental methods help assess the condition of the gastrointestinal mucosa.
• ECG and EchoCG. Prescribed to assess heart function.
• Chest X-ray. The images reflect pathological changes in the lung tissue and elements of the spine. A more informative modern method of radiation diagnostics is CT (computed tomography).
• Ultrasound of the abdominal cavity. Detects structural deformations of the abdominal organs. Detects formed stones.
• Transvaginal ultrasound. Determines the structure, size, density, shape of the ovaries, uterus, endometrium, as well as the presence of a cyst or tumor.
• Electroneuromyography (ENMG). Performed to make neurological diagnoses.

Shpidonov Gennady Stanislavovich

Neurologist

Rostov State Medical University (neurology)

10 years of experience

Magnetic resonance imaging is considered a universal method. In combination with laboratory tests, MRI gives the most informative results.

MRI at SmartMed MC

Diagnostics

The primary diagnosis of radicular syndrome of the lumbosacral spine is made based on the symptoms of the medical history and physical examination (including a thorough examination of the neurological status). A thorough analysis of motor, sensory and reflex functions allows us to determine the level of damage to the nerve root.

If the patient reports typical unilateral radiating leg pain and there are one or more positive neurological test results, then a diagnosis of radiculopathy is very likely.

However, there are a number of conditions that may present with similar symptoms. Differential diagnosis must be carried out with the following conditions:

• Pseudoradicular syndrome
• Traumatic disc injuries in the thoracic spine
• Damage to discs in the lumbosacral region
• Spinal stenosis
• Cauda equina
• Spinal tumors
• Spinal infections
• Inflammatory/metabolic causes - diabetes, ankylosing spondylitis, Paget's disease, arachnoiditis, sarcoidosis
• Trochanteric bursitis
• Intraspinal synovial cysts

To make a clinically reliable diagnosis, as a rule, instrumental diagnostic methods are required:

• X-rays – can detect the presence of joint degeneration, fractures, bone defects, arthritis, tumors or infections.
• MRI is a valuable technique for visualizing morphological changes in soft tissues, including discs, spinal cord and nerve roots.
• CT (MSCT) provides complete information about the morphology of the bone structures of the spine and visualization of spinal structures in cross section.
• EMG (ENMG) Electrodiagnostic (neurophysiological) studies are necessary to exclude other causes of sensory and motor disorders, such as peripheral neuropathy and motor neuron disease

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”.

Conservative treatment:

• Rest: avoid activities that cause pain (bending, lifting, twisting, turning or bending backwards. Rest is necessary for acute pain syndrome
• Drug treatment: anti-inflammatory, painkillers, muscle relaxants.
• Physiotherapy. For acute pain syndrome, the use of procedures such as cryotherapy or chivamat is effective. Physiotherapy can reduce pain and inflammation of the spinal structures. After the acute period has stopped, physiotherapy is carried out in courses (ultrasound, electrical stimulation, cold laser, etc.).
• Corseting. The use of a corset is possible in case of acute pain syndrome to reduce the load on the nerve roots, facet joints, and lumbar muscles. But the duration of wearing a corset should be short, since prolonged fixation can lead to muscle atrophy.
• Epidural steroid injections or facet joint injections are used to reduce inflammation and control pain in severe radicular syndrome.
• Manual therapy. Manipulations can improve the mobility of the motor segments of the lumbar spine and relieve excess muscle tension. Using mobilization techniques also helps modulate pain.
• Acupuncture. This method is widely used in the treatment of radicular syndrome in the lumbosacral spine and helps both reduce symptoms in the acute period and is included in the rehabilitation complex.
• Exercise therapy. Exercise includes stretching and strengthening exercises. The exercise program allows you to restore joint mobility, increase range of motion and strengthen your back and abdominal muscles. A good muscle corset allows you to support, stabilize and reduce tension on the spinal joints, discs and reduce the compression effect on the spine. The volume and intensity of exercise should be increased gradually to avoid relapse of symptoms.

• In order to achieve stable remission and restore full functionality of the spine and motor activity, it is necessary for the patient, after completing the course of treatment, to continue independent exercises aimed at stabilizing the spine. The exercise program must be individual.