Intercostal neuralgia is the pain caused by the damage of the intercostal nerves. These are the nerves starting from the thoracic bone marrow that travel along the ribs and end up in the middle of the chest and the abdominal wall. The path of the intercostal nerves defines the distribution of the pain that is caused by the nerve damage, which is typical and follows the intercostal nerve that is suffering along its path around the torso.
There are four main mechanisms causing intercostal neuralgia:
Pressure, block, resection, and inflammation of an intercostal nerve root.
Causes are many and vary:
• Herniated disc in the thoracic spine
• Bone marrow tumors like meningiomas or neurinomas
• Infiltrated tumors in the thoracic wall
• Intercostal nerves injuries after an accident
• Thoracic incisions or cardiac surgery (bypass)
• Inflammations and cases after inflammations, such as the intercostal neuritis and the post-herpetic neuralgia
Patient’s history and a physical exam are enough for the diagnosis of the intercostal neuralgia from the viscera pain that is reflected to the thoracic wall due to the common embryological origin. A typical characteristic of the intercostal neuralgia is the zoster distribution around the torso and it worsens with coughing or sneezing in contradiction with the pain originating from the viscera, such as the heart, the esophagus, the aorta, or the stomach.
For the diagnosis, a thoracic spine MRI scan is always required in order to exclude diseases related to thoracic bone marrow and thoracic nerve roots. However, when there is a history of an injury in the thoracic spine or the possibility of bone damage (e.g., osteoporotic fracture) then a thoracic spine CT scan is required as well.
The etiologic treatment of the intercostal neuralgia depends on the diagnosis while the symptomatic treatment is always pharmaceutical. Medication used for intercostal neuralgia is the same with the one used for other forms of nerve root pain, such as in sciatica. Simple painkillers and nonsteroidal anti-inflammatory medication are the recommended administration while opioids and antiepileptic medication targeting the neuropathic pain are the most effective.
When oral medication is not effective, the local infiltration of the suffering nerve route is used with local anesthetic solution and cortisone. The results of this method are immediate and impressive, especially in intercostal neuritis while the duration of relief from pain depends on the cause of the intercostal neuritis. However, the intercostal block can be repeated, if it’s necessary, with no complications for the patient.