CONDITION

INTERCOSTAL NEURALGIA

Intercostal neuralgia is a type of nerve pain that affects the intercostal nerves, which originate from the spinal cord beneath the ribs. This condition typically leads to thoracic pain, impacting the chest wall and upper trunk.

The primary symptom of intercostal neuralgia is intense, burning, or sharp pain, which can occur around the ribs, upper chest, or upper back. Additional symptoms may be a squeezing pressure sensation that wraps around the chest from front to back, tingling and numbness around the area of nerve distribution.

CAUSES

Intercostal neuralgia results from irritation, inflammation, or compression of the intercostal nerves located beneath the ribs. Several factors can contribute to this, including:

Chest trauma
Viral infections like shingles (postherpetic neuralgia)
Nerve pressure or entrapment
Injury from surgery that requires opening the chest to access the throat, lungs, heart, or diaphragm (thoracotomy)

TREATMENT

INTERCOSTAL NERVE BLOCKS

The intercostal nerves, located between the ribs in the upper back, can become irritated or inflamed, often due to conditions like shingles, leading to Postherpetic Neuralgia. An intercostal nerve block involves injecting an anesthetic and/or steroid into these nerves to alleviate pain. It is commonly used after chest or abdominal surgery, a mastectomy, or rib fractures.

The first nerve block serves as both a test and a potential treatment. If it provides pain relief, the physician gains insight into the role of the intercostal nerve in the patient's condition. If there is no relief, alternative treatments may be considered, or it may indicate that another issue is causing the pain.

PREPARATION OF THE PROCEDURE:

Avoid solid foods for at least four hours before the procedure.
Clear liquids (water, tea, etc.) are allowed up to two hours prior if sedation is planned.
Follow any medication instructions from the physician.
Bathe or shower before the procedure and wear loose, comfortable clothing.
Arrange for a caregiver to drive home afterward.

DURING THE PROCEDURE:

The physician numbs the area with a local anesthetic.
Using fluoroscopic (x-ray) guidance, the physician carefully places the needle and administers the injection, possibly at multiple sites along the nerve.

AFTER THE PROCEDURE:

Some soreness or bruising may occur; applying ice or taking over-the-counter pain relievers can help.
Rest for a few hours but return to regular activities unless otherwise directed.

OUTCOMES:

Pain relief varies between individuals. Acute and chronic pain may respond differently to treatment.
The treatment can provide relief for weeks or months, and if successful, additional injections may be considered for ongoing relief.

TREATMENT

INTERCOSTAL NERVE ABLATION

Radiofrequency ablation (RFA) can be performed, which provides longer lasting relief. Radiofrequency ablations involve using a special needle which heats up. This needle then burns or stuns the nerves going to the area of pain. The ablation interrupts the pain sensations originating from nerves for typically greater than 6 months.

Learn more about Intercostal Neuralgia and treatment at Coastal Orthopedic Pain & Spine Center, call us at 727-526-8000 to schedule an appointment.