Intercostal neuralgia on the right: symptoms and treatment

Causes and symptoms of the disease

Doctors call advanced osteochondrosis . Sometimes the disease can be triggered by diseases such as kyphosis, spondylitis, ankylosing spondylitis. In addition, an attack occurs due to a cold, hypothermia, previous infections and injuries, poisoning, stress, and unusual physical activity.

The most obvious symptom of the disease is chest pain. A person experiences attacks that worsen when coughing or taking a deep breath. When pressing, you can detect several pain points. The pain is concentrated between the ribs, often accompanied by burning, numbness, and stabbing sensations, but can also be felt in other areas.

The symptoms are similar to those of a heart attack , but there are some differences. With neuralgia, the pain does not change in intensity, but is felt constantly, the pulse and pressure are normal. In any case, if such pain occurs, it is better to consult a doctor.

In addition to pain , intercostal neuralgia causes the following symptoms: muscle contraction, redness or unnatural paleness of the skin, severe sweating, partial numbness of the skin.

Intercostal neuralgia: symptoms, diagnosis and treatment

Chest pain is always alarming. As a rule, the first thing a person thinks about is the heart. Statistics, widely revealed thanks to the media, also echo such fears: deaths from cardiovascular diseases confidently remain at the top of the sad list.

However, it is not only the heart that can hurt in the chest. Natalya Vladimirovna Umerenkova, a neurologist and leading specialist in the neurology department at the Expert Clinic Kursk, told us about intercostal neuralgia, one of the symptoms of which is chest pain.

— Unexpected chest pain is always alarming. What can hurt your chest?

Such pain is a signal for both the doctor and the patient. Many anatomical structures can hurt in this area. This is the heart in case of ischemic disease (angina pectoris, heart attack), large vessels (in case of dissecting aortic aneurysm). Pain occurs with tracheitis, pneumonia, accumulation of air in the pleural cavity (pneumothorax) and its inflammation, tumors of the lungs and mediastinal organs, pulmonary embolism, mediastinitis, pathology of the esophagus (inflammation, peptic ulcer).

You can read about the symptoms, diagnosis and treatment of pneumonia here

Pain can also be “reflected” into the chest when the pancreas, gall bladder, or stomach pathology are affected (peptic ulcer).

Sometimes pain can be of a psychogenic nature - for example, with an imbalance of the autonomic nervous system (also known as vegetative-vascular dystonia).

Vegetative-vascular dystonia - diagnosis or fiction? Read here

Accompanied by chest pain and diseases of the osteochondral structures of the chest and nerve trunks - including intercostal neuralgia.

— How do you understand that chest pain is threatening and an ambulance should be called immediately?

Here it is important not to miss, in particular, such pathologies as unstable angina, myocardial infarction, pulmonary embolism, and thoracic aortic aneurysm.

For this group of diseases there are common manifestations - “alarm signals” that you should definitely pay attention to. This is most often a fairly severe, acute pain, which differs from the pain noted earlier (if it was noted), and does not go away while taking nitrates. The pain may be accompanied by nausea, vomiting, sweating, and pale or bluish skin. Rapid heartbeat often develops, shortness of breath, suffocation, hemoptysis, drop in blood pressure, pre-syncope or fainting are possible. These signs are a reason to immediately call an ambulance.

— What is intercostal neuralgia?

Intercostal neuralgia is a complex of manifestations that develops when the intercostal nerve or nerves are irritated or compressed. There are doctors who regard it as an independent disease with a clearly defined picture, while others consider it a syndrome that can be caused by a variety of disorders. In any case, intercostal neuralgia is coded in ICD 10 (code G58.0).

— What kind of pain occurs with intercostal neuralgia? By what signs can it be distinguished from other pain?

Intercostal neuralgia is often characterized by a unilateral location of pain (right or left), which is semi-encircling in nature. The patient can describe it quite clearly, i.e. indicate its location, the course of distribution (usually along the intercostal space).

The pain is quite acute, can be constant (with periods of worsening) or paroxysmal. Longer than that with stable angina (with the latter, the pain usually goes away after 3-5 minutes at rest).

Pain with intercostal neuralgia has periods of worsening/improving, is quite clearly associated with physical activity, changes in body position, and can be provoked by coughing, sneezing, or deep breathing. In addition to pain, symptoms such as numbness, burning, pulsation, and involuntary muscle contraction are often encountered in the intercostal space.

The difference between pain in intercostal neuralgia and cardiac pain (in particular angina) also lies in the absence of irradiation to the left arm and lower jaw; no fluctuations in blood pressure; The duration of the pain syndrome also differs (with neuralgia, pain can be bothersome for a long time), there is no effect from taking nitrates, there are no symptoms signaling a serious pathology of the heart and blood vessels. The provoking factors in the occurrence of pain also differ (awkward movement and a deep breath can trigger an attack of pain with intercostal neuralgia); Adopting a pain-relieving position minimizes it in case of intercostal neuralgia, but does not affect the intensity of “heart” pain.

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— Can there be an increased body temperature with intercostal neuralgia?

No. If such a manifestation occurs, you need to look for another cause of pain in the chest.

— Why does intercostal neuralgia occur?

The mechanisms leading to intercostal neuralgia may be irritation or compression of the intercostal nerve. This may be due to osteochondrosis of the spine, curvature of the spinal axis, spondylosis, damage to the transverse costal joints; after injury to the ribs and chest, excessive muscle tension (in particular intercostal muscles); with excessive mobility of parts of the ribs on the lateral and anterior surface of the chest; Infringement of the 7th-12th nerves in the connective tissue sheaths of the rectus abdominis muscle is less common.

Does osteochondrosis exist? Find out here

Sometimes the cause of intercostal neuralgia can be the herpes zoster virus. In this case, it is coded in a different section of ICD-10, but the manifestations will be generally the same.

In some cases, intercostal neuralgia can occur after suffering from influenza and a number of infectious diseases.

Additional risk factors for the occurrence of intercostal neuralgia may include diabetes mellitus, alcoholism, and impaired absorption of B vitamins.

“Triggering” moments can be a combination of factors: hypothermia, sudden and/or awkward movement, interventions on the thoracic spine (not entirely correct manual therapy, surgery, etc.).

— Can intercostal neuralgia go away on its own or does it need to be treated?

Sometimes it can go away on its own. However, in the absence of treatment, it is likely that the duration of the disease and the treatment time will increase (with therapy, the period of temporary disability is usually 7-14 days), and the process may become chronic, when the pain can last for weeks, and in the case of the herpetic nature of the disease - for months and years.

The question is also that during self-diagnosis, i.e. when the patient decided that he had intercostal neuralgia and did not go to the doctor to prescribe treatment, you can “miss” some other, often serious, diagnosis that resembles neuralgia in its manifestations. At the same time, the consequences without treatment may not be so harmless, and, in addition, time will be lost.

— What is the risk of intercostal neuralgia if it is not treated? How dangerous is this diagnosis?

If left untreated, recovery time may increase or the pain may become chronic.

— Which doctor should you contact for symptoms of neuralgia?

Since intercostal neuralgia can be confused with much more serious, life-threatening diseases, you should first immediately consult a physician or general practitioner. And only after excluding these pathologies, see a neurologist.

You can make an appointment with a therapist here

Please note: consultations are not available in all cities

Occasionally, when there is a need for therapeutic blockades, the help of a neurosurgeon or traumatologist may be needed.

— How is intercostal neuralgia diagnosed?

An ECG and chest x-ray are required, and body temperature is measured.

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According to indications - radiography or MRI with myelography of the thoracic spine. Sometimes tests are prescribed to confirm/exclude an acute inflammatory process.

— What should you never do if you have intercostal neuralgia? For example, is it possible to warm the area of ​​pain with a heating pad? Exercise? Go to the bathhouse?

None of the above.

— What is the prognosis for this disease? Is intercostal neuralgia successfully treated?

With correct diagnosis and timely treatment, the prognosis is favorable. This pathology is highly treatable.

— What needs to be done to prevent the development of intercostal neuralgia?

For prevention, it is necessary to avoid hypothermia, sudden and awkward movements (especially if they are unfamiliar, insufficient training or “warming up” before training; within the framework of the work performed); optimize body position in the workplace; engage in physical therapy; undergo regular medical examinations; do not hesitate to consult a doctor if any health symptoms appear.

For reference:

Umerenkova Natalya Vladimirovna

In 2004 she graduated from Kursk State Medical University.

In 2004-2005, she completed an internship in neurology at the above-mentioned university.

Since 2015, he has been working at Clinic Expert Kursk LLC, and is a leading specialist in the neurology department. Receives at the address: st. Karl Liebknechta, 7

Preventive measures and treatment of neuralgia

Prevention is very simple - avoid hypothermia and colds. It is possible to use acupuncture and manual therapy. Acupuncture is carried out in several courses with a break of 2 months. Manual therapy affects the cervical and thoracic spine, relieving tension and pain. In case of exacerbation, the following is necessary: ​​bed rest, taking sedatives, painkillers, therapeutic massage.

Symptoms of intercostal neuralgia and its treatment belong to the field of activity of a neurologist. SM-Clinic treats many diseases of the nervous system, of which osteochondrosis is only a small part.

Since often the symptoms of neurological diseases are actually signs of other diseases, the specialist will examine the entire body. If symptoms of intercostal neuralgia are detected, it is better to begin treatment immediately.

How to treat intercostal neuralgia

The disease may go away on its own or may require treatment, which includes:

• Painkillers for intercostal neuralgia include local injections of anesthetic or corticosteroids around the affected nerves.
• Non-steroidal anti-inflammatory drugs - ibuprofen, naproxen and indomethacin.

Medicines that are used to treat shingles:

• Antidepressants, which can reduce nerve pain.
• Antihistamines that reduce itching.
• Anti-inflammatory - acyclovir and famciclovir. Reduce the severity and duration of symptoms.
• Corticosteroids, which may reduce the risk of developing postherpetic neuralgia.

Alternative methods are also used to treat intercostal neuralgia. They are carried out both in combination with traditional medicine and independently. Basic procedures:

• Acupuncture
• Massage
• Yoga

Prevention

To avoid pathology or prevent new attacks, you need to follow these recommendations:

• Lead a moderately active lifestyle and avoid excessive exercise.
• Avoid hypothermia.
• Control your posture.
• If you sit at work almost all day, then get up and do exercises every 2 hours.
• If you engage in strength sports or perform heavy physical work, then wear a special corset.
• Treat spinal diseases in the early stages.
• Systematically undergo a course of treatment for chronic pathologies, for example, diabetes, atherosclerosis.
• Drink alcohol in minimal doses.
• Avoid stress.
• Treat colds promptly.
• Eat right.
• Take vitamin and mineral complexes as prescribed by your doctor.

By following these rules, you will significantly improve your health and be able to avoid thoracalgia.

Causes of intercostal neuralgia on the right

Since intercostal neuralgia is a syndrome of a number of pathologies of the spine and nervous system, its causes are degenerative, inflammatory or tumor in nature, and are always associated with a specific disease.

Basic information

Intercostal neuralgia is a pathology characterized by irritation or compression of the nerve fibers between the ribs. The disease manifests itself with sudden burning pain. To understand why it occurs, you need to delve a little deeper into the anatomy.

The intercostal nerves are a continuation of the anterior branches of the nerve bundles of the thoracic spinal cord. There are 12 pairs of nerves that pass under their corresponding ribs on the right and left. The fibers of the last pair reach the abdominal wall.

Reference. When the upper pairs of nerves are damaged, pain occurs, which is considered a consequence of heart or lung disease. When the lower branches are affected, the pathology can be confused with diseases of the gastrointestinal tract.

Intercostal nerves consist of motor, sensory and sympathetic fibers. Symptoms for damage to different nerve fibers differ.

Under the influence of negative factors (spinal diseases, infections, injuries), nerve bundles are damaged. Then the receptors that transmit the impulse to the brain are irritated. The central nervous system reacts to a disturbance in the nerve with pain. In addition, an inflammatory process occurs in the area of ​​the damaged fiber.

Most often, thoracalgia is diagnosed in patients over 35 years of age. In children and adolescents, the disease can manifest itself during a period of rapid skeletal growth.

Consequences

Patients are concerned about the dangers of thoracalgia. The pathology itself is not fatal, but due to constant pain, which is accompanied by nervous tension, the risk of angina pectoris, hypertensive crisis (a sharp increase in pressure), and sometimes heart attack increases.

If left untreated, thoracalgia can cause heart disease

The consequences affect the patient’s daily life, insomnia occurs, work ability and quality of life decrease due to severe pain. In the absence of timely treatment, the disease becomes chronic.

Diagnostic measures

Medical specialists will help determine damage to the intercostal nerve. Diagnosis begins with collecting anamnesis, the doctor asks about existing symptoms, previous injuries, diseases, etc.

Next, a manual examination and neurological tests are carried out to help identify the cause of the pain. The doctor determines the location of the pain and assesses muscle tone. And neurological disorders that manifest as impaired sensitivity in the hands or feet are also of great diagnostic importance.

If necessary, the doctor prescribes clinical blood tests, urine tests, and a herpes test to rule out herpes infection.

The following hardware methods will help diagnose thoracalgia:

• X-rays are used to examine bones; diagnostics are carried out in different projections (direct, lateral, oblique).
• CT scan helps to identify pathological changes in bones. It is not suitable for assessing soft tissues as the images are slightly blurry. This problem can be corrected by combining CT with myelography.
• Myelography is used to study nerve bundles and the spinal cord. During the procedure, a contract solution is injected into the space of the spinal cord.
• Discography is a diagnostic method during which a contrast agent is injected into the nucleus pulposus of the intervertebral disc.
• MRI is an informative technique that allows you to examine nerve tissue, muscles, and ligaments. During the procedure, pathological changes in intervertebral discs, hernia, etc. can be detected.
• Electrospondylography is a modern diagnostic method that allows you to assess the functional state of the spine, determine its pathologies at the initial stages, and monitor their course.

Reference. An ECG is performed to rule out heart disease. To identify pathologies of the digestive tract, an analysis is performed for pancreatic enzymes, gastroscopy, etc. To identify or exclude atypical lung diseases, an X-ray of the chest space is performed, and, if necessary, a CT scan.