Brain & Nervous System More Neurological Diseases What Is Intercostal Neuralgia? By Lana Barhum Lana Barhum Facebook LinkedIn Lana Barhum has been a freelance medical writer for over 14 years. She shares advice on living well with chronic disease. Learn about our editorial process Updated on January 01, 2023 Medically reviewed by Diana Apetauerova, MD Medically reviewed by Diana Apetauerova, MD LinkedIn Diana Apetauerova, MD, is board-certified in neurology with a subspecialty in movement disorders. She is an associate clinical professor of neurology at Tufts University. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment Prevention Intercostal neuralgia is nerve pain in the chest and upper trunk that radiates from the upper back. The pain comes from the intercostal nerves, the nerves arising from the spinal cord, just below the ribs. Intercostal neuralgia is also known as chest wall pain. Here is what you need to know about intercostal neuralgia, including symptoms, potential causes, diagnosis, treatment, and prevention. Verywell / Julie Bang Intercostal Neuralgia Symptoms The main symptom experienced by people with intercostal neuralgia is pain in the rib cage area. People who experience this type of rib pain may describe the pain as: StabbingSharpTenderAchingGnawingBurningSpasm-like Pain may cover the entire chest or radiate from the back towards the chest. Sometimes, a person may feel pain along the length of the ribs. Pain episodes tend to be sporadic and may intensify with activity, including: LiftingTurning and twisting the torsoCoughingSneezingLaughing Other symptoms of intercostal neuralgia may include: Abdominal painFeverItchinessNumbnessTinglingRestricted mobility of shoulders and backPain in the arms, shoulders, or back When to Call Your Healthcare Provider There are times when rib and chest pain may indicate a life-threatening condition. Intercostal neuralgia can cause severe and debilitating pain that makes it hard to breathe. Sometimes, rib cage pain or chest area pain can be a sign of a condition that may require emergency medical treatment. For example, chest pain may indicate a heart attack. Seek immediate medical attention or call 911 if you or someone you're with starts to have chest pain that is severe and of an unknown cause. Other symptoms that may indicate a medical emergency include: Chest or rib pain that spreads into the left arm, jaw, shoulder, or back Chest pressure or tightening in the chest Coughing up yellow-green colored mucus Heart palpitations or a fluttering feeling in the chest Breathing problems, such as shortness of breath or inability to take a full breath Severe abdominal pain Severe chest pain with breathing or coughing Sudden confusion or dizziness, or changes in consciousness, such as passing out or unresponsiveness What Is Inflammation of the Lungs? Causes Intercostal neuralgia is caused by inflammation and irritation in or compression of the intercostal nerves. Causes of intercostal nerve pain include: Chest trauma, such as a broken rib or bruised chest Viral infections, such as shingles Intercostal nerve entrapment Neuritis (inflammation of a nerve or group of nerves) A surgical complication of a procedure that involved opening the chest to access the throat, lungs, heart, or diaphragm A tumor in the chest or abdomen pressing on the intercostal nerves—these tumors can be benign (not cancer) or cancerous A pulled or strained muscle in the chest wall, shoulders, or back Sometimes, intercostal neuralgia has no known cause. If your healthcare provider is unable to determine a case, you may be diagnosed with idiopathic intercostal neuralgia. The term “idiopathic” is used to describe medical conditions that have no identifiable or clear cause. Why Do My Ribs Hurt? Causes of Rib Cage Pain Risk Factors There are a number of risk factors that increase the chance of developing intercostal neuralgia. Risk factors include: Infection with the varicella-zoster virus, the virus known for causing chickenpox and shingles Participation in high speed or contact sports, such as skiing, snowboarding, football, and wrestling Unsafe driving and automobile accidents, which may lead to injury to the intercostal nerves or ribs Having a condition that causes systemic inflammation, such as inflammatory arthritis What Causes Shingles to Activate? Diagnosis The majority of people with intercostal neuralgia first seek medical care because they think they may be having a heart attack or other cardiac problem. The physical exam is an important part of the intercostal neuralgia diagnosis. This involves inspecting the area where the intercostal nerves are located. Pain produced from simple light pressure can help to assess the extent of pain. To rule out other potential causes of chest wall pain, rib pain, or back pain, additional testing will be done. This will help your healthcare provider to determine if the intercostal nerves are the source of pain or to diagnose other causes of chest pain, such as lung or cardiovascular disease. Other tests to help evaluate causes of pain related to the intercostal nerves include: Chest X-ray: Can look for sources of chest, rib, and back pain and find problems in the airways, bones, heart, or lungs Nerve conduction velocity testing: Assesses nerve damage and dysfunction Electromyography: Evaluates the muscles and nerve cells that control them Musculoskeletal ultrasound: Involves more in-depth imaging than traditional X-rays or other imaging studies If you have risk factors for heart disease, such as diabetes, high blood pressure, a history of smoking, or a family history of heart disease, your healthcare provider will want to test your heart function. Testing may include: Exercise stress testing: Sometimes called a treadmill test, this test helps your healthcare provider figure out how much the heart can handle with exertion. As the body works harder, it needs more oxygen so it must pump more blood. The stress test can show if the blood supply to the arteries supporting the heart is reduced. Electrocardiogram: An electrocardiogram is a simple, painless test that measures the electrical activity of the heart. Echocardiography: This test uses sound waves to produce live images of the heart to allow your healthcare provider to figure out how your heart and its valves are functioning. Bloodwork: Measures levels of certain cardiac enzymes. If cardiac enzymes are increased, this may indicate a problem with the heart. Treatment Treatment for intercostal neuralgia may depend on the underlying cause, but it is possible for symptoms to resolve without treatment. Treatments for intercostal neuralgia include: Intercostal nerve blocks: Injections of either a local anesthetic or a corticosteroid given around the affected intercostal nerves Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAID pain relievers, such as Advil (ibuprofen), and Aleve (naproxen) can help reduce inflammation and pain. Radiofrequency ablation: This treatment is usually offered to people who experience frequent episodes of intercostal nerve pain. It involves destroying the specific part of the nerve that is causing pain and other symptoms of intercostal neuralgia. Anti-depressants: The drugs have been found to be helpful for reducing and treating nerve pain. Capsaicin cream: Can help with pain relief Neuropathic pain medication: Medications, such as Neurontin (gabapentin), can be used to block the action of nerves causing pain. Your healthcare provider may also recommend complementary therapies, such as acupuncture, massage therapy, and yoga, to help manage your symptoms. These therapies are to be used in conjunction with traditional treatments, and not as lone therapies or as substitutes for medicinal therapies. Prevention Some healthy lifestyle habits may prevent intercostal neuralgia and reduce your risk of developing the condition. Things you can do to reduce your risk are: Driving motor vehicles safely and wearing a seatbelt Getting vaccinated for chickenpox Getting vaccinated for herpes or shingles if you are age 60 and older Wearing protective sports equipment, including helmets and padding Working with your healthcare provider to manage symptoms of an inflammatory disease Summary Intercostal neuralgia is a type of nerve pain that's felt in the chest. It occurs when the intercostal nerves are inflamed, irritated, or compressed. The pain can have a number of possible causes, including chest trauma, shingles, or a pulled or strained muscle. Intercostal neuralgia can sometimes be mistaken for a heart attack. If you're experiencing this kind of pain, your healthcare provider may want to test your heart function before diagnosing you. Treatment for intercostal neuralgia may include pain medications, nerve blocks, anti-depressants, and more. It can often be prevented with safety precautions and getting a shingles vaccine. A Word From Verywell Intercostal neuralgia varies from person to person. Your healthcare provider is in the best position to explain what to expect and how treatment can help. Untreated pain—regardless of the location or source—can lead to complications, including sleep problems, loss of appetite, or mood disorders, such as anxiety and depression. If you find treatments aren’t helping to manage symptoms of intercostal neuralgia, ask your healthcare provider about a referral to a pain management specialist. A specialist can work with you to come up with a pain relief solution that is safe and helps to manage your pain. The Difference Between Bruised, Broken, and Fractured Ribs 8 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. International Pain Foundation. What is intercostal neuralgia? MedlinePlus. When to use the emergency room—adult. Tirlapur SA, Priest L, Daniels JP, et al. How do we define the term idiopathic? Curr Opin Obstet Gynecol. 2013;25(6):468–473. doi:10.1097/GCO.0000000000000025 Thomas S., Lopez F. Intercostal pain syndromes. In: Kahn S., Xu R. (eds) Musculoskeletal Sports and Spine Disorders. Winzenberg T, Jones, G, Callisaya, M. Musculoskeletal chest wall pain. Thorax. 2015;44(8): 540-544 American Heart Association. Exercise stress test. Abd-Elsayed A, Lee S, Jackson M. Radiofrequency ablation for treating resistant intercostal neuralgia. Ochsner J. 2018;18(1):91–93. Huang Y, Mehta N. Intercostal neuralgia and thoracic radiculopathy. In: Desai M, O'Brien J, eds. The Spine Handbook. New York, NY: Oxford University Press; 2018. By Lana Barhum Lana Barhum has been a freelance medical writer since 2009. She shares advice on living well with chronic disease. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit