What Is Intercostal Neuralgia?

Intercostal neuralgia is neuropathic pain in the intercostal nerves, the nerves arising from the spinal cord, just below the ribs. Intercostal neuralgia often causes thoracic (upper back) pain that radiates into the chest wall and the upper trunk. 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.

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 stabbing, sharp, tender, aching, gnawing, burning, and/or spasm-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 intensity with activity, including lifting, turning and twisting the torso, coughing, sneezing, or laughing. 

Other symptoms of intercostal neuralgia may include: 

• Abdominal pain
• Fever
• Itchiness
• Numbness
• Tingling
• Restricted mobility of shoulders and back
• Pain 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.

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

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.

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

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: This musculoskeletal imaging technique 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

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.