Intercostal neuralgia ⚠️: symptoms, causes and treatment

general information

There are 12 pairs of intercostal nerves in the human body. They originate from the roots of the thoracic spinal cord and cover the entire chest, adjacent to the peritoneum, muscles, skin and mammary glands. The individual fibers of each nerve are responsible for tissue sensitivity, motor function and regulation of the functioning of all structures. Accordingly, damage or inflammation in any area can radiate pain to a variety of parts of the body.

The sensations can imitate diseases of internal organs: myocardial infarction, angina pectoris, pancreatitis, gastritis, cholecystitis, etc. In some cases, only a doctor can accurately determine the nature of the pain after a full examination. That is why it is important to seek help promptly if chest pain occurs.

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Forms

There is no special classification of the disease. There are several separate forms depending on the mechanism of occurrence:

radicular: associated with irritation of the spinal cord roots at the point of their exit from the spinal column;
reflex: associated with overstrain of muscle fibers at the site of the nerve passage.

There is also a classification of neuralgia depending on:

causes: primary (associated with damage or inflammation of the nerve itself) and secondary (due to other diseases);
localization: unilateral and bilateral;
course of the disease: acute and chronic.

Causes

The list of main causes of intercostal neuralgia includes:

degenerative-dystrophic diseases of the spine: osteochondrosis, arthrosis, hernias and protrusions of discs, etc.;
uneven or excessive load on the spine and back muscles (due to carrying heavy objects, poor posture, etc.);
spinal column deformities (primarily scoliosis);
diseases of the nervous system, in particular multiple sclerosis;
infectious lesions: tuberculosis, herpes zoster, influenza;
injuries of the spine and chest, surgical interventions in this area;
tumors in the ribs, sternum, spinal column;
taking certain medications;
increased load on the respiratory muscles and abdominal muscles;
increased intra-abdominal pressure, including during pregnancy.

In addition, intercostal neuralgia can occur secondary to other diseases, for example, pleurisy, pathology of the digestive system, kidney disease, thyrotoxicosis, and immunodeficiency states. Adolescents during the period of active skeletal growth may also experience similar symptoms.

Symptoms

The main symptom of intercostal neuralgia is severe pain in the chest along the nerve. As a rule, it occurs suddenly and resembles an electric shock, gradually spreading along the ribs. The nature of the sensations can be different: shooting, pulsating, constant, burning or dull.

Deep breathing, turning the head or body, bending, pressing or simply touching the chest causes a pronounced increase in pain. In addition, characteristic signs of neuralgia are:

persistence of pain at night;
the ability to determine the epicenter of pain;
redness or paleness of the skin in the affected area;
a feeling of tingling, crawling or, conversely, numbness along the affected nerve;
slight muscle twitching in the affected area.

As a rule, during an attack of neuralgia, a person tries to lie or sit motionless in a position in which the pain becomes slightly less.

If the cause of the pain syndrome is herpes zoster, first redness appears on the skin along the affected nerve, then numerous blisters that burst, forming crusts. After recovery, increased pigmentation remains in this area for some time.

Differences from myocardial infarction

Chest pain, especially on the left, can be a consequence not only of intercostal neuralgia, but also of more serious problems. The most dangerous is myocardial infarction. This condition requires emergency medical attention. The characteristic differences in pain are:

occurrence against the background of physical, less often psycho-emotional stress;
spread to the left arm, shoulder, left half of the neck and lower jaw;
no changes when turning the body, bending, pressing on the sore area;
decreased intensity when taking nitroglycerin and its analogues.

A heart attack is often accompanied by cold, sticky sweat, pale skin, dizziness, and fear of death.

It is important to remember that the signs of a cardiovascular accident and intercostal neuralgia are not always so radically different. An accurate diagnosis can only be made by a doctor.

Analgesics

A number of patients do without medications in this group, but if the patient experiences severe pain attacks, then it is necessary to relieve them with painkillers. The most popular analgesics based on analgin are Baralgin, Sedalgin, Spazmalgon. As soon as severe pain subsides, you should stop taking them.

These tablets also have a number of disadvantages and side effects, in particular on the digestive tract. If the patient additionally uses ointments and creams with an anesthetic component, then it is necessary to take into account the total amount of the product that the patient receives.

Diagnostics

Intercostal neuralgia, regardless of the severity of the pain syndrome and its location, requires a full diagnosis. The following examinations will help distinguish it from other pathologies:

questioning and medical history: identifying the nature of the sensations, the conditions of their occurrence, the duration of the attack, concomitant diseases;
examination and palpation: the doctor evaluates the appearance of the skin, checks the reaction to movements, pressing, turning, bending, assesses the severity of reflexes;
laboratory diagnostics: general and biochemical blood tests, general urine tests: allows to identify signs of damage to the heart muscle (tests for troponins, CPK), inflammation, renal pathology, gastrointestinal diseases, etc.; the exact set of tests depends on the location of the source of pain;
ECG, ultrasound of the heart: allow you to identify or exclude cardiovascular pathology;
X-ray, CT or MRI of the thoracic spine: helps to identify osteochondrosis, osteoporosis, tumors, hernias and protrusions of intervertebral discs, etc.;
Chest x-ray: allows you to assess the condition of the lung tissue and identify signs of tumors;
Ultrasound of the kidneys, abdominal organs (excludes relevant pathology);
FGDS to exclude pathologies of the esophagus, stomach, duodenum;
myelography, contrast discography, electrospondylography to assess the condition of the spine, intervertebral discs, spinal cord and its roots.

If necessary, consultations with narrow specialists and additional examinations are prescribed.

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Treatment

Intercostal neuralgia requires complex and often long-term treatment, including medication, physiotherapy, massage, etc.

Drug therapy

In the acute phase of the disease, therapy is aimed at relieving pain and improving the patient's condition. Depending on the specific clinical situation, the following are prescribed:

non-steroidal anti-inflammatory drugs (NSAIDs): products based on diclofenac, nimesulide, ibuprofen, meloxicam and their derivatives; used in tablet, injection and local (creams, ointments, patches) form;
analgesics: analgin and products based on it; like NSAIDs, they relieve pain;
muscle relaxants to eliminate muscle spasms: mydocalm, etc.;
group vitamins: milgamma, neuromultivitis, etc.; necessary to restore normal functioning of nerve fibers;
sedatives to reduce the psycho-emotional component of pain and improve sleep.

If necessary, the following may additionally be prescribed:

anticonvulsants: inhibit the passage of pain impulses;
antidepressants to relieve tension;
antihistamines and diuretics: relieve tissue swelling, especially relevant for pinched nerve roots;
antiviral drugs for herpes zoster;
glucocorticosteroids for persistent pain and severe inflammation that cannot be relieved by milder means.

Physiotherapy and exercise therapy

Physiotherapeutic procedures are prescribed after the acute pain subsides. Help speed up recovery:

UHF;
reflexology;
magnetic therapy;
electrophoresis;
laser treatment;
paraffin applications;
mud therapy.

These procedures help improve blood circulation and metabolism in the affected area and accelerate the regeneration of nerve tissue.

Physical therapy exercises are prescribed after complete recovery. The main goal of gymnastics is to unload the back muscles. The complex is developed individually. The first classes should be carried out under the supervision of a specialist; in the future, home exercises are allowed.

Other treatments

Since very often the cause of intercostal neuralgia is pathology of the spine and spinal cord, the following are often used as additional methods of influence:

acupuncture;
manual therapy;
therapeutic massage, including the use of warming agents;
Shiatsu massage (acupressure);
osteopathy;
underwater traction and other techniques.

Like all medical procedures, these techniques are used only in a clinical setting and are carried out by specialists with medical education and the appropriate certificate.

Osteochondrosis of the chest. Intercostal neuralgia

Osteochondrosis is a degenerative-dystrophic disease of the cartilage tissue of the human body, affecting the most mobile joints. Most often, the cervical and lumbar spine suffer from the disease. treatment of osteochondrosis of the thoracic region is noted by statistics much less frequently, but due to the anatomical specificity of the structure of this segment, in most cases the disease is diagnosed quite late and requires more time and effort to cure the patient.

Features of the structure of the thoracic spine

The thoracic segment of the spine contains 12 vertebrae connected to the ribs and sternum, forming a rather rigid structure designed to protect the internal organs (lungs, heart, liver, digestive system, etc.). Functionally, the chest is inactive, especially when compared with the cervical spine, and does not experience such significant mechanical stress as the lower back. Therefore, the symptoms of osteochondrosis in this area in the early stages of the disease do not cause much discomfort, and therefore practically do not alarm patients with their severity.

Pathology is usually discovered unexpectedly for the patient, during an x-ray or when serious pain has become a signal of the development of complications such as: protrusion or herniation of intervertebral discs, spinal canal stenosis, displacement of vertebral bodies, etc. Provocateurs of damage to the thoracic spine can be youthful postural disorders, such as scoliosis or Scheuermann-Mau kyphosis.

Symptoms of osteochondrosis of the thoracic region

Symptomatic manifestations of the disease can be different and are directly related to the location of the lesion. First of all, these are pain sensations of a chronic, aching nature, especially after prolonged physical exertion, and acute pain with sudden movements (turning, bending, lifting weights, sometimes even when sneezing or coughing). Stiffness and spasms of muscles, limited movements become the body's response to pain.

When the upper vertebrae of the thoracic region are affected, the pain is localized in the shoulder girdle, and tingling occurs between the shoulder blades or in the sternum. Damage to the middle areas usually manifests itself as pain in the heart area (which has nothing to do with diseases of the cardiovascular system) and intercostal space or girdle pain just below the heart (resembling hepatic colic). The appearance of osteochondrosis in the lower part of the chest affects the functioning of internal organs and can radiate pain to the abdominal cavity or lower abdomen.

Spasms of muscle structures and circulatory disorders in the affected area provoke a lack of supply of cartilage tissue with water and nutrients. Gradually, the intervertebral discs dry out, lose mobility and elasticity, and over time, their walls (fibrous rings) crack and the gelatinous substance (nucleus) filling them protrudes outward, forming an intervertebral hernia, the treatment of which requires a more serious approach, and in some cases, surgical intervention .

Depending on the location of the formation of herniated discs, they can cause compression of nerve endings and the manifestation of neurological symptoms, such as decreased sensitivity in the upper girdle of the extremities, slowing down of reflex reactions, radiating pain from the shoulder to the hand, etc. Protrusion of the herniated formation into the spinal canal causes compression of the spinal brain and leads to partial or complete immobility (paresis, paralysis) of the upper half of the body and/or disruption of the functioning of internal organs.

Compression of blood veins or arteries often provokes headaches, surges in blood pressure, interruptions in the blood supply to the brain and other vascular pathologies. Quite often, osteochondrosis is accompanied by treatment for intercostal neuralgia or thoracalgia (these are severe pain caused by compression or irritation of the intercostal nerves).

intercostal neuralgia (thoracalgia)

Thoracalgia is one of the most powerful pain syndromes of an acute, piercing, aching, burning, paroxysmal or periodic nature, with difficulty and limitation of respiratory capabilities. It may be accompanied by increased sweating, pulsation or spasms of muscle tissue, decreased sensitivity, paleness or, conversely, redness of the skin. When palpating the spine in the thoracic area along the intercostal spaces, the patient feels a dull pain.

Tissue numbness is observed directly at the site of compression or nerve damage. The feeling of pain with neuralgia can be felt not only in the heart area, but can be felt under the collarbone, in the lower back, under the shoulder blades. In this case, a neurologist or chiropractor must clearly differentiate clinical symptoms to exclude heart pathologies or peptic ulcers.

The main signs for diagnosing thoracalgia:

The pain syndrome does not go away for a long time (does not weaken either day or night). With angina, the pain subsides 15-20 minutes after taking nitroglycerin.
The pain syndrome intensifies with changes in the position of the body, sudden movements, deep inhalations and exhalations, coughing, sneezing, and slight squeezing of the chest or pressing on it. Heart attacks do not give such a reaction to movements of the body in space, but may be accompanied by arrhythmia or surges in blood pressure.
Pain caused by stomach colic is quickly relieved with antispasmodic drugs, but for neuralgia, such drugs will have no effect.
The reasons for this condition of the patient are pinching of the nerve roots of the intercostal system at the point of their exit from the spinal column by intervertebral discs damaged or flattened by osteochondrosis, herniated formations, overgrown osteophytes (bone formations on the vertebrae), tumors or injuries of the chest.
Thoracalgia, as a rule, affects older people, when all the reasons for the progression of the disease intensify against the background of age-related changes (slowdown of metabolic processes, inactivity, accelerated leaching of calcium and other trace elements from the body, changes in the cardiovascular system, etc.). In children and adolescents, intercostal neuralgia is practically not observed.

Treatment of the disease

It should be noted that with both thoracic osteochondrosis and intercostal neuralgia, it is necessary to treat osteochondrosis, since neuralgia is only a pain symptom caused by degenerative-dystrophic changes in cartilaginous tissues. As practice has shown, traditional conservative treatment of the spine still remains quite effective.

During the acute period of the disease, the patient is prescribed complete rest, a maximum reduction in physical activity in combination with medications. Medicines used for neuralgia:

analgesics - orally, intramuscularly, locally (in the form of novocaine or lidocaine blockades);
non-steroidal anti-inflammatory substances - to relieve inflammation and swelling of soft tissues;
muscle relaxants - to eliminate muscle spasms and release nerve roots;
complexes of microelements and B vitamins - for general strengthening of the body and calming the patient’s nervous system.

When the pain syndrome subsides, you can begin the main therapy. It will consist of physiotherapeutic procedures, special dosed physical activity, exercise therapy, massages, attending manual therapy sessions, and diet.

An important role in the treatment of osteochondrosis of the thoracic spine is played by the patient’s attitude, his desire to recover and return to normal life.
It requires a rethinking of some life habits, awareness of giving up bad habits, increased physical activity, good nutrition, morning exercises, constant monitoring by the attending physician and an annual sanatorium-resort vacation. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Complications

Complications of intercostal neuralgia occur quite rarely, however, in severe cases, without appropriate treatment, the patient may encounter the following problems:

severe spasm of the respiratory muscles, limiting inhalation and exhalation;
inability to get out of bed due to significant increase in pain;
excessive pain syndrome that is not relieved by conventional analgesics and NSAIDs;
heart rhythm disturbances due to muscle spasms and nerve pathology;
decreased leg mobility.

In addition, complications can be caused by attempts to be treated outside the clinic. Abscesses and cellulitis after acupuncture, paralysis and decreased sensitivity after manual therapy are not a complete list of problems. That is why you should not treat intercostal neuralgia either independently or with the help of dubious specialists.

Antiviral agents

They are similar to NSAIDs, but act against other pathogens: not bacteria, but exclusively viruses. In practice, they are used extremely rarely in the treatment of joint and neurological diseases. A viral infection of the onset of inflammation can be suspected if intercostal neuralgia occurs in a herpetic nature. Among the external manifestations is herpes zoster.

The most well-known remedy that will help the patient cope with the herpes virus is Acyclovir. Its analogues: Zovirax, Cyclovir, Vivorax. People with weakened immune systems most often suffer from local exacerbations of herpes infection, and therefore it makes sense to check the body for a number of other chronic diseases that lead to a similar weakened state.

Prevention

Prevention of intercostal neuralgia is mainly general measures aimed at strengthening the muscle frame and improving the health of the body. Neurologists recommend:

lead an active lifestyle, play sports at an amateur level;
minimize hypothermia and colds;
watch your posture;
avoid lifting heavy objects;
maintain a high level of immunity;
eat a balanced diet, if necessary, take additional vitamins, especially group B;
treat chronic diseases in a timely manner;
avoid stress, get proper rest and ensure yourself at least 8 hours of sleep every night.

Following these simple rules will significantly reduce the risk of developing intercostal neuralgia.

Technique and implementation features

Regardless of what set of exercises the doctor prescribes, you must adhere to the following rules and recommendations:

Before moving on to the main exercises, warm up your entire body. Do bends and head rotations. A completely standard warm-up, like in physical education classes at school, will do.
Initially, the loads should be minimal. Even if it’s easy for you, do not rush to load yourself more so as not to aggravate the pathology.
The exercises are aimed at strengthening the muscles of the chest, abdomen and back, as well as stretching the spine. This is what affects the disease.
Movements must be smooth, jerks and sharp turns are not allowed.
If exercises provoke severe pain, then you should not endure it, otherwise you risk only complicating the course of the disease.
The back muscles should not be in constant tension.
If an exercise is too difficult for you, remove it from the complex. Over time, you can try to return to it.
You can't skip workouts. Only with regularity will they help overcome intercostal neuralgia and return to a full life.

Treatment at the Energy of Health clinic

Doctors at the Energy of Health clinic will always come to the aid of patients with intercostal neuralgia. We offer each client:

a full examination with consultations with specialists for an accurate diagnosis;
individual selection of treatment regimen;
services of a qualified chiropractor;
own exercise therapy room for the most effective and safe exercises;
modern methods of physiotherapy;
massotherapy;
drug blockades for severe pain syndrome.

Regular observation by a neurologist after the acute period of the disease has subsided will help prevent recurrent attacks.

Advantages of the clinic

In the neurology department of the Energy of Health clinic, every patient receives the highest level of specialists and modern equipment for diagnosing and treating diseases. We take an integrated approach to therapy and use not only medications, but also physiotherapy, exercise therapy and massage.

Treatment is prescribed only after a thorough examination and is monitored by a specialist until the patients fully recover. Adequate prices, convenient location, private parking - we do everything for the convenience of our clients.

If intercostal neuralgia interferes with living, walking and moving, do not delay treatment. Sign up for the Health Energy clinic and get rid of pain.

Let's sum it up

With proper and timely treatment, thoracic intercostal neuralgia is completely curable. Prevention of this disease is to prevent the development of “root cause” diseases, as a result of which neuralgia subsequently occurs. It is also necessary to constantly lead a healthy lifestyle in order to strengthen the immune system and maintain a healthy state of the body.

It is possible to get rid of such a disease, but it is worth starting treatment on time - this will help you forget about the discomfort as early as possible. You should not prescribe treatment methods on your own, so as not to worsen your health condition even more.