Intercostal neuralgia causes severe pain in the chest and back. It is not uncommon for the cause of the nerve pain to be an infection with herpes zoster (shingles). Treatment is usually with medication and depends on the underlying disease.
What is intercostal neuralgia?
Sufferers of intercostal neuralgia suffer from nerve pain that originates between the ribs or along the chest wall. The chest cavity is surrounded by the chest wall, which is made of bone and tissue. The intercostal nerves run along the chest wall and are responsible for the neuralgia. Where exactly the pain is localized varies from case to case. Likewise, the intensity of pain varies with each patient. Typically, the pain is long-lasting and pulling. Patients report that the pain increases when they cough or sneeze. Deep breaths are also usually accompanied by increased pain intensity. Thus, intercostal neuralgia can be distinguished from cardiac pain because there is no increase in pain with deep breathing.
Causes
Intercostal neuralgia is not an independent disease, but a symptom of the underlying disease. There are various causes for which intercostal neuralgia occurs. All possible causes are associated with mechanical damage to the nerves between the ribs. For example, intercostal neuralgia can be caused by rib fractures, where parts of the bone press on a nerve. Furthermore, severe wear and tear of the vertebral bodies of the spine can pinch nerves, causing neuralgia. Intercostal neuralgia is particularly common in association with herpes zoster, also known as shingles. This viral disease causes inflammation of the nerves, which can also affect the intercostal nerves. This viral disease leads to inflammation of the nerves, which can also affect the intercostal nerves. Furthermore, intercostal neuralgia can be caused by tuberculosis or tumors in the lungs. In some cases, postthoracotomy syndrome occurs after a surgical procedure in which the patient’s chest has been opened, in which affected individuals suffer from neuralgia of the intercostal nerves.
Symptoms, complaints, and signs
Intercostal neuralgia is primarily manifested by severe pain in the chest and back. The syndrome is typically characterized by a rapid spread of pain, with complaints usually occurring in a belt or ring shape. They are limited to one or two parts of the body, such as the area between the ribs and the chest wall or the right upper abdomen. The pain itself is felt by the affected person as pulling. It can last for several days, weeks or even months and increase in intensity as it progresses. The discomfort increases with sneezing, coughing and heavy laughing. Some patients experience recurrent attacks of severe pain, associated with sweating, dizziness, and panic attacks. Intercostal neuralgia can also cause sensations such as tingling or numbness. Malpositions, which can be recognized by an unusual posture, are also characteristic. In the long term, the incorrect postures in turn cause pain reactions and dysfunctions of the holding apparatus. In advanced stages, intercostal neuralgia leads to restricted breathing and eventually to persistent respiratory distress. If the paralysis is not treated, there is a risk of permanent nerve damage. The chronic pain and restricted movement promote the development of depression and other mental illnesses.
Diagnosis and progression
Infogram on pain regions, progression and development of pain, and intensity levels in pain perception. Click image to enlarge. In intercostal neuralgia, prompt diagnosis is important to prevent the pain from becoming chronic. Generally, neuralgia is not said to have occurred until about three days of nerve pain have passed. If the symptoms do not go away on their own by then, a doctor must definitely be consulted. The attending physician first takes a detailed medical history. In particular, he asks about the type of pain and its localization. This is followed by a palpation examination to determine exactly where the pain is localized.If the patient reacts sensitively to pain at certain points where intercostal nerves run, intercostal neuralgia can be diagnosed. However, this is merely the identification of one of the symptoms of the underlying disease. As the diagnosis progresses, the underlying disease must be elicited. Thus, in some cases, the physician orders a myelography, i.e., a contrast medium X-ray of the spinal canal. Chest x-rays or ultrasound examinations may also be used for diagnosis. How intercostal neuralgia progresses depends on the underlying disease. In most cases, however, the course can be considered positive.
Complications
In intercostal neuralgia, most patients usually suffer from severe pain in the back and chest. This pain has a very negative impact on the patient’s quality of life. Furthermore, pain at rest can also lead to sleep problems. It is not uncommon for breathing difficulties to occur in addition to the pain. The affected person may also lose consciousness. Furthermore, the breathing difficulties can lead to a fear of death. It is not uncommon for paralysis or other sensory disturbances to occur in the affected regions. Furthermore, the patients suffer from insensations and are thus considerably restricted in their everyday life. The permanent pain often leads to depression or other psychological upsets. As a rule, the disease does not progress positively without treatment. The pain can be limited with the help of painkillers. Furthermore, tensions have to be released, whereby no further complications occur. However, the symptoms cannot be completely limited in every case. Life expectancy is usually not reduced by intercostal neuralgia. If necessary, the affected person is then dependent on various therapies.
When should one go to the doctor?
Since intercostal neuralgia can be a symptom of various diseases, a rapid clarification of the underlying disease is necessary. Depending on what other symptoms occur in those affected, they should see either their family doctor or a specialist after just a few days. An early diagnosis is also important, as the pain can otherwise become chronic in some cases. Doctors speak of intercostal neuralgia when the symptoms persist for more than three days without significant improvement. If the symptoms do not improve on their own after this period, those affected should consult a doctor. However, if patients experience symptoms such as fear of death, severe nerve pain or shortness of breath at an earlier stage, or if the symptoms worsen continuously, it is advisable to seek medical treatment immediately. In rare cases, neuralgia may have serious causes that may require prompt surgical intervention. If left untreated, intercostal neuralgia can last for several months, depending on the presenting condition. Prompt treatment and diagnosis can reduce the duration of symptoms to a few days, depending on the cause.
Treatment and therapy
Treatment of intercostal neuralgia depends on the underlying condition. Basically, there are a number of treatment options that the physician can decide on together with the patient in the individual case. For severe pain, analgesics are administered first. This is not a causal therapy, but brings relief to the affected person in acute cases. Non-steroidal anti-inflammatory drugs are particularly suitable for pain treatment in intercostal neuralgia. This type of analgesic works particularly well in neuralgia because it spreads its effect to the periphery of the body. Muscle relaxants are also often used to relieve any tension in the muscles. Sometimes those affected suffer from extreme pain for which conventional painkillers have no effect. In these cases, the treating physician administers strong painkillers that act on the central nervous system. Morphine, an opioid, is administered particularly frequently. There is also the option of local anesthesia, which guarantees freedom from pain for a limited period of time. For many physicians, local anesthesia is preferable to the administration of opioids, since strong painkillers stress the body and cannot be administered without side effects. In addition to pain therapy, causative therapy is also administered. In the case of shingles, antivirals are administered.If an intercostal nerve is pinched, physiotherapy can help in many cases. This involves working out exercises that can relieve the painful area. In some cases, the exact cause of intercostal neuralgia is unknown and treatment is limited to pain management.
Outlook and prognosis
The prognosis of intercostal neuralgia is tied to the underlying disease present. Because the complaints develop because of an existing health irregularity, intercostal neuralgia is not a disease in its own right. The complaints disappear immediately with the recovery of the causative disorder. A blanket outlook on the further course of development cannot be given. There is an individual assessment and evaluation for a possible healing success. In severe cases, secondary diseases occur. These can be of a physical or psychological nature. If it is possible to treat the existing nerve damage quickly and without further complications, the prospect of a complete recovery is favorable. In mild rib fractures, regeneration is documented in most patients after completion of the healing process of the bone damage. Simple fractures usually heal and cause few long-term symptoms. However, if the disease progresses unfavorably, chronic complaints are possible. If the patient suffers a tumor, a life-threatening situation can occur. If the tumor can be removed completely, relief from the symptoms is conceivable. Nevertheless, without treatment or in an advanced stage, the cancer can develop into a fatal course. In the case of viral diseases, the prognosis is favorable as soon as the pathogens die off as a result of drug therapy. Recurrence of symptoms over the lifespan cannot be ruled out.
Prevention
Intercostal neuralgia is not a disease in its own right, but merely a symptom. For this reason, there are few prophylactic measures that can be taken. If intercostal pain occurs, a physician should be consulted quickly to diagnose the underlying condition as early as possible.
Follow-up care
In most cases, direct follow-up measures for intercostal neuralgia are severely limited or not available at all to affected individuals. First and foremost, the disease must be detected by a physician at an early stage so that early treatment can be initiated. An independent cure cannot occur, so that those affected by intercostal neuralgia are always dependent on medical treatment by a physician. The treatment itself is carried out with the help of various physiotherapy measures. Those affected can also repeat many of the exercises themselves in their own homes, which speeds up the treatment. When taking painkillers or other medications, patients should always follow their doctor’s instructions. It is also important to ensure that the medication is taken regularly and in the correct dosage. Since intercostal neuralgia has a negative effect on the muscles of the affected person, no more physical or stressful activities should be performed in order not to put unnecessary strain on them. In this context, help and support from the patient’s own family can also have a positive effect on the further course of the disease. As a rule, intercostal neuralgia does not reduce the life expectancy of the affected person.
What you can do yourself
In addition to drug treatment, physiotherapeutic measures are also useful for intercostal neuralgia, which are supported by the affected person at home through exercises and other measures. Breathing and stretching exercises help with chest pain and improve overall well-being. In some cases, alternative methods such as massage or pain point pressing are also useful. If sleep complaints or psychological problems occur in the course of the disease, therapeutic counseling is indicated. However, the affected person should not only turn to physicians and psychologists, but also inform friends and relatives about his disease. In the therapy of intercostal neuralgia, the support of the personal environment is an important factor. If the paralysis and sensory disturbances increase, the sufferer must take measures to compensate for the movement restrictions.This can be the use of a walking aid, but also a handicapped accessible facility or even accommodation in a nursing home. The course of the disease is always decisive. The development of the individual symptoms should be recorded in a complaints diary. In this way, an individual therapy can be worked out together with the medical team, which usually enables the affected person to continue living relatively symptom-free.
