Intercostal neuralgia occurs when a person experiences neuropathic pain in their ribs, chest, or abdomen. It may feel like a sharp, stabbing, aching, or burning pain. Various conditions may cause intercostal neuralgia.

Neuropathic pain can occur when the somatosensory nerves become damaged or inflamed. It can have several different causes, though the treatment options are similar regardless of the cause.

Keep reading to learn more about the symptoms and possible causes of intercostal neuralgia, as well as some treatment and prevention options.

Person holds their side in pain from intercostal neuralgia.Share on Pinterest
Image credit: serezniy/Getty Images

Intercostal neuralgia is a condition in which an individual experiences neuropathic pain in the area corresponding to the intercostal nerves. These nerves radiate throughout a person’s rib cage and abdomen.

Neuropathic pain occurs when an individual experiences pain because their somatosensory nerves have been irritated or become overly sensitive. The somatosensory nervous system is responsible for sending information about bodily sensations and changes to the brain.

Intercostal neuralgia is an umbrella term. It refers to any neuropathic pain in the intercostal nerves. As one article explains, the cause can be several different conditions.

One of the more common causes of intercostal neuralgia is tissue and nerve irritation after a thoracotomy. Thoracotomies are surgical interventions in which a surgeon opens a person’s chest, often to operate on the lungs.

Another common cause of intercostal neuralgia is the reactivation of a herpes infection or shingles. This viral reactivation is not an active infection, but it causes a painful rash, often around a person’s chest and stomach.

Shingles can cause intercostal neuralgia by leading to inflammation in the spinal nerve roots.

Some other documented causes of intercostal neuralgia include:

  • traumatic injury
  • excess cell growth around the intercostal nerves, such as due to cancer or infection
  • other surgical procedures, such as chest tube replacements or mastectomies
  • pregnancy (though this is rare)

Despite the many different causes of intercostal neuralgia, this condition can present with many of the same symptoms. These include:

  • a sharp, stabbing, burning, or aching pain in the ribs, chest, or abdomen
  • tingling and numbness in the ribs, chest, or abdomen
  • reduced motor function around the affected area (in severe cases)

These symptoms can be constant or intermittent. This is often associated with the severity of the condition and its underlying cause. The symptoms may also last for a prolonged period of time, even after the initial cause has subsided.

Pregnant people can sometimes develop intercostal neuralgia. This is because pregnancy involves profound bodily changes, which can affect an individual’s spinal cord and nerves.

As one study explains, there are several different ways in which this can occur. For example, one proposed explanation is that the growing uterus may put pressure on the lower intercostal nerves, which might irritate the nerves between a person’s spinal vertebrae.

That said, intercostal neuralgia is not particularly prevalent in pregnancy.

When intercostal neuralgia occurs during pregnancy, it often subsides after delivery. This is because the pressure on the individual’s nerves will be relieved.

Because intercostal neuralgia can develop as a result of so many different conditions, it is important to determine why a person has developed it. This will allow a doctor to recommend specific treatment options that are best suited to the underlying cause.

For example, if a person’s intercostal neuralgia developed due to a thoracotomy, a doctor will typically prescribe some appropriate pain medications. Examples may include:

  • opioids
  • topical medications, such as capsaicin
  • anticonvulsants
  • nonsteroidal anti-inflammatory drugs
  • transcutaneous electrical nerve stimulation
  • tricyclic antidepressants, selective serotonin reuptake inhibitors, or serotonin and norepinephrine reuptake inhibitors

People can also use these pain medications to treat intercostal neuralgia that develops due to shingles, physical nerve irritation, or an unknown cause.

Also, when a person’s intercostal neuralgia is due to shingles, a doctor will often prescribe medications to treat this infection. Common medications for this include:

  • systematic corticosteroids
  • anesthetics
  • the antiviral drug acyclovir

However, as one article notes, intercostal neuralgia can be very difficult to treat, and it can be persistent. Some underlying causes of intercostal neuralgia do not respond well to typical treatment options.

In the above article, the authors present two case studies in which an individual who did not benefit from typical intercostal neuralgia treatments responded well to thermal radiofrequency ablation (RFA).

This technique involves inducing cell death in the affected nerves by using an alternating current to generate heat. The authors of the study suggest that thermal RFA may be an effective treatment option for intercostal neuralgia.

Surgery is rarely necessary for intercostal neuralgia.

Chronic intercostal neuralgia can greatly impact a person’s quality of life.

The condition can be extremely uncomfortable. Chronic pain from intercostal neuralgia can also lead to reduced movement and poor sleep quality. It can also make it difficult for a person to breathe.

Also, intercostal neuralgia has some symptoms in common with other potentially serious health conditions. These include:

For this reason, it is important for anyone with prolonged or acute intercostal neuralgia to see a doctor immediately.

People should also see a doctor if they experience other symptoms of shingles.

Because intercostal neuralgia has so many potential causes, prevention can be difficult.

When the cause of intercostal neuralgia might be thoracotomy, the most effective preventive strategy is to reduce the risk by preventing infection of the wound. This includes using the appropriate anesthetics.

When it comes to intercostal neuralgia due to shingles, the most effective preventive strategy is to minimize the risk of contracting this infection in the first place.

For example, people should receive the shingles vaccine, which research suggests reduces the likelihood of shingles by 51%. The shingles vaccine also reduces the risk of pain from shingles by 66%.

Intercostal neuralgia is a condition wherein a person experiences neuropathic pain in the intercostal nerves, which are the nerves that radiate throughout a person’s rib cage and abdomen.

There are numerous possible causes, such as infections, cancer, inflammatory medical conditions, and physical trauma.

Intercostal neuralgia can be very difficult to treat, as there are so many possible underlying causes. Also, some underlying causes of intercostal neuralgia do not respond well to typical treatment options.

That said, there are numerous treatment options available, as well as some prevention strategies that people may wish to try.