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Nerve pain between the ribs
In most cases, intercostal saline neuralgia is the result of nerve irritation of an intercostal nerve in the area where the nerve exits the spinal canal (root irritation). However, the pain may well be reminiscent of an acute heart attack or lung disease.
When it comes to the discovery of diseases in the area of the spine, lungs or pleura, intercostal neuralgia is an important indicator in the differential and exclusion diagnosis. Diseases of the heart or digestive tract can often be reliably tracked down if this symptom is present. Nevertheless, the exact development of a neuralgia between the ribs has not yet been fully clarified. Basically, however, a nerve disorder in the area of the spine can be used as an explanation.
Intercostal neuralgias (or intercostal neuralgias) basically occur on the eponymous intercostal nerves (nerve intercostalis). Located in the back of the chest (thorax), these nerves run at the level of the thoracic spine between the thoracic vertebrae and pairs of ribs located there. The nerve endings of the intercostal nerves originate from the spinal nerves (spinal nerve), which connect the spinal cord (medulla spinalis) as an essential component of the central nervous system with the peripheral nervous system.
The bony spinal canal of the spine and its openings serve as the exit point of each intercostal nerve. Neuralgias at these sensitive nerve interfaces between the spinal and intercostal nerves are particularly painful and not entirely harmless.
As the name suggests, intercostal neuralgia is one of the nerve pain known as neuralgia. It is therefore not an independent clinical picture, but rather describes a complex of symptoms or a pain syndrome that can occur in connection with various diseases.
Since humans have a total of 12 thoracic vertebrae, between each of which there is an intercostal nerve, intercostal neuralgia can occur at 11 different points in the thoracic spine. The actual source of this nerve pain is therefore often very difficult to determine in diagnosis. However, the location of the respective underlying disease determines the source of pain considerably, which makes suspected illness during diagnosis the decisive indicator for finding the source of pain.
Corresponding diseases can be located in addition to the spine itself in all parts of the body and organs that are located in the chest and thus in the immediate vicinity of the thoracic spine and the ribs. Which includes:
Regardless of the diverse points of origin within the thoracic spine, a neuralgia of the intercostal nerves is generally noticeable through a nerve pain that extends in a ring to belt shape around the actual source of pain. The drawing pains radiate in a circle in the chest wall and back, whereby they are intensified by nerve stimuli such as coughing, sneezing or pressing. Depending on the severity of the underlying health complaint, the nerve pain can last longer or disappear after a short time.
Caution: root compression syndrome
The symptoms are very often triggered by nerve compression. They arise when nerve roots experience increased pressure due to narrowing (compression) and consequently emit pain stimuli. In the spinal area, the so-called root compression syndrome is the most common form of such nerve shortages. In the case of intercostal neuralgia, this syndrome logically affects the nerve roots of the intercostal nerves.
Painful restrictions on movement, as well as an intensification of pain when coughing and sneezing, are common for root compression syndrome. If the compression is very strong or even bruises at the nerve endings, the syndrome can also cause emotional disorders and paralysis, which can extend to the buttocks and legs. Even functional disorders, for example in the form of urinary and faecal incontinence, are possible within the framework of the syndrome.
Danger: Root compression syndrome is a serious emergency, which is why corresponding nerve complaints in combination with the aforementioned pain must be treated immediately by a doctor!
In intercostal neuralgia, root compression affects the nerve roots of the intercostal nerves. Compression can occur here due to numerous diseases of the spine. For example, vertebral blockages caused by a herniated disc often cause bottlenecks in the area of the spinal canal, which can be felt by severe nerve pain. Painful restrictions on movement, as well as an intensification of pain when coughing and sneezing, are common for herniated discs.
If there are dislocations of parts of the thoracic spine, fractures of the vertebrae and ribs also pose the risk of causing root compression. Malformations and growth disorders of the thoracic vertebrae, such as those caused by scoliosis and osteochondrosis, should also be mentioned.
While scoliosis is a side deviation of the spine that is dangerous for the nerve course of the spine, osteochondrosis hides a disturbance in the conversion of cartilage to bone mass, which can either be congenital or caused by vertebral fractures. If this causes spinal instability, a narrowing of the spinal nerves cannot be ruled out.
Other spinal disorders that can trigger a root compression syndrome on the intercostal nerves and thus intercostal neuralgia are vertebral tumors and degenerative changes in the spine (osteopathies). The latter include signs of wear and tear on the vertebral joints caused by spondyloarthritis and osteoporosis.
By the way: Vertebral surgery also poses a certain risk of causing root compression due to surgical complications.
Intercostal neuralgia due to root irritation syndrome
The root irritation syndrome (radiculopathy), also known as root syndrome, is often confused with the root compression syndrome. However, this does not lead to a narrowing of the nerves, but to nerve irritation, which is generally a little more mild than compression. However, this nervous disorder is not to be trifled with, because root syndrome can also cause serious damage to the intercostal nerves.
The causes of radiculopathy are largely the same as for root compression. In addition, nerve inflammations come into question. These are caused, among other things, by inflammatory rheumatic joint diseases such as spondylitis or a bone infection such as bone marrow inflammation (osteomyelitis).
Radiculopathy is also relatively similar to the root compression syndrome in its symptoms, which further complicates a differential diagnosis in intercostal neuralgia. An important indication of root irritation syndrome is the absence of nerve paralysis. In addition, inflammation-related neuralgia of the costal arch is often favored by infections, so that the inflammation and symptoms are not uncommonly widespread. The danger here is that in addition to individual roots, intercostal nerves, other nerve endings and even the muscles can be affected by the disease.
Important: If the respiratory muscles or nerve roots of the diaphragm are affected, this could result in life-threatening respiratory failure. Even motor disorders as well as mood swings and cognitive impairments are not excluded in the case of root irritation syndrome as the cause of intercostal neuralgia.
Infection-related nerve pain between the ribs
Root irritation syndrome is often triggered by herpes viruses that have been carried over. The causative agents of herpes zoster, also known as shingles, are thought to be one of the main infectious agents for intercostal neuralgia. Infectious diseases of the lungs, which are associated with neuralgia, also suggest involvement in some diseases.
In addition to shingles, infection-related diseases such as pneumonia, pleurisy and puberty are also discussed. Even gastrointestinal infections such as gastritis cannot yet be ruled out as possible causes of the neuralgia.
Cause organ diseases
As already mentioned, medicine has so far been tracking the exact causes of the pain in the aching intercostal nerves. However, it is considered very likely that adjacent organs influence the development of nerve pain in the presence of the underlying disease. Apart from infections, cardiac diseases as well as diseases of the liver and bile are particularly worth mentioning.
In India, doctors also discovered a neuralgia between the ribs that developed in the course of chronic pancreatitis in the patient. Vascular swelling in the area of the spine, for example due to high blood pressure or arteriosclerosis (hardening of the arteries), can theoretically also be responsible for painful intercostal nerves.
Symptoms of intercostal neuralgia
Cardinal symptom of neuralgia between the ribs is always pulling chest pain and back pain, which spread in a ring around the source of pain. Movement stimuli such as displacements of the upper body, strong laughter, pressing as well as coughing and sneezing reflexes intensify the pain symptoms, which depending on the cause can last for a short or long term.
Occasionally, seizure-like peaks occur without previous stimuli, which instead occur with
- and panic attacks
accompanied. The other symptoms, on the other hand, are heavily dependent on the underlying disease and the extent of the nerve disorder. The following accompanying symptoms are conceivable for intercostal neuralgia:
- Feeling disorders
- Restricted movement
- Breathing problems and shortness of breath
- Pain-related posture of the upper body
- Muscle tension
- Muscle dysfunction
- motor disorders
- Dysfunction of organs
- cognitive disorders
Diagnosis of nerve pain in the rib area
In order for the diagnosis to be effective in the event of suspected intercostal neuralgia and for a subsequent disease determination to be successful, the patient's medical history requires the most detailed information possible on existing complaints and possible previous illnesses. It is not sufficient to describe the location of the pain in the chest area. In addition, situations in which the pain intensifies and information about existing accompanying symptoms must also be mentioned. Anyone who has suffered from a spinal, infectious or organ disease before the nerve pain occurred should also raise this issue during the patient survey.
After the patient consultation, an initial palpation of the affected spine region usually takes place. In this way, the source of pain can be pinpointed more accurately and how sensitive the patient is to pain. This is followed by a more intensive detailed physical examination for differential diagnosis.
Imaging examination methods such as myelography are in the foreground. The term describes a special X-ray method to display the spinal canal, in which a contrast medium is injected into the canal. Computed tomography (CT) or magnetic resonance imaging (MRI) can then be used to visualize any compression and inflammation of the nerves. Dislocations and degenerative changes in the spine can also be determined using imaging diagnostic methods. In this regard, an EKG also allows the assessment of cardiovascular health.
If doctors suspect that the cause of intercostal neuralgia is not in the thoracic spine itself, but in one of the organs located in the chest, other examination methods can be used in addition to the imaging diagnosis. For example, lung function tests can be used to assess lung health. Blood tests also show possible infectious diseases.
Therapy for intercostal neuralgia
Which treatment measures need to be taken depends on the final diagnosis. Most health complaints can be resolved reliably with suitable medication and alternative medical measures:
Neural therapy is based on the injection of a local anesthetic at certain points in the painful area and can often significantly improve the symptoms within minutes.
Vertebral and nerve blockages, as well as numerous dislocations and herniated discs can be treated well with suitable physiotherapy measures. Any nerve pain is also quickly relieved by appropriate therapy steps. Manual therapy measures such as healing and pressure massages or manual position corrections are recommended.
In the further course of therapy, physiotherapy movement training should also take place. In addition to a back school, yoga and aqua aerobics, there are other techniques for this, some of which can be used for rapid therapy during diagnosis. Well-known treatment methods are:
- the Alexander Technique,
- the Feldenkrais method,
- the McKenzie concept
- and spiral dynamics.
Important: Only have manual therapy measures carried out by trained specialist personnel! A wrong handle can do more harm than good and even aggravate existing pain symptoms!
Medications that are used as standard in intercostal neuralgia include rheumatism (anti-rheumatic), narcotics and pain relievers. In addition to opioids, the latter consist primarily of muscle relaxants, which are intended to prevent pain-related muscle tension. With a specific diagnosis, the use of cardiovascular and antibiotic agents for treating infections is also possible.
Acupuncture for nerve pain
Alternative medicine measures such as acupuncture are very popular for the treatment of nerve pain. The targeted stimulation of the body meridians by means of special acupuncture needles comes from traditional Chinese medicine and aims to dissolve nerve, muscle and energy blockages due to pressure. This should, among other things, reliably relieve pain symptoms such as those caused by nerve irritation and nerve compression.
Naturopathy for intercostal neuralgia
In the field of naturopathy there are also some herbs that can help alleviate the symptoms. Proven medicinal plants for intercostal neuralgia are:
- bittersweet nightshade
- Bulb buttercups
- Silk plant
However, the herbs should not be picked wild and processed privately, because plants like the nightshade are actually poisonous herbs and should therefore only be taken under professional guidance. It is best to ask the pharmacist, homeopath or doctor for suitable preparations and to get detailed advice on dosage. It is conceivable, for example, to take the globules in potencies D1 to B12 with a maximum of 5 globules per day. As a guideline for herbal drops, a dose of 5 to 20 drops per day is generally used.
The private use of pain-relieving and soothing nerve medicinal herbs such as
- Johannis herbs,
- Caraway seed,
- White goose foot
- and horsetail.
Here, supportive treatment can be done easily by the private preparation of herbal teas, medicinal baths or the application of pain-relieving tinctures and ointments.
Heat and cold therapy
Electrotherapy is also worth trying for painful intercostal nerves. In this regard, for example, so-called spinal cord stimulation is conceivable, in which electrical impulses are sent to the spinal cord with the help of special therapy devices in order to alleviate pain symptoms.
A Belgian study on nerve stimulation in intercostal neuralgia confirmed that this treatment measure is effective. Here, the researchers tested a modern stimulation method with wireless devices that proved to be extremely successful.
Conversely, cooling measures can also help relieve pain. Coolpacks or cold envelopes placed on the affected spine region are particularly recommended. According to a British study by Cambridge University, cold water swimming is also said to have a particularly positive effect on intercostal neuralgia during an operation. (ma)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Miriam Adam, Barbara Schindewolf-Lensch
- Amboss GmbH: Thoracic pain (accessed: July 29, 2019), amboss.com
- Walter de Gruyter GmbH: Intercostal neuralgia (accessed: July 29, 2019), pschyrembel.de
- Cleveland Clinic: Intercostal Nerve Block (accessed: July 29, 2019), my.clevelandclinic.org
- Mayo Clinic: Postherpetic neuralgia (accessed: July 29, 2019), mayoclinic.org
- Center for Pain Management: Intercostal Neuralgia / Post Thoracotomy Pain (accessed: July 29, 2019), centerforpain.com
- Dureja, G.P .: Intercostal neuralgia: A review, Journal of Neurology & Translational Neuroscience, 2017, semanticscholar.org
ICD codes for this disease: G58ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.