Intercostal neuralgia - causes, symptoms and therapy

Nerve pain between the ribs

In most cases, the intercostal neuralgia is the result of nerve irritation of an intercostal nerve in the area of ​​the exit of the nerve from the spinal canal (root irritation). However, the pain may well be reminiscent of an acute myocardial infarction or a lung disease.

When it comes to the detection of diseases in the spine, lungs or pleura, intercostal neuralgia is an important clue in differential and exclusion diagnosis. Even diseases of the heart or digestive tract can often be reliably detected in the presence of these symptoms. Nonetheless, the exact cause of neuralgia between the ribs has not yet been fully elucidated. Basically, however, a nerve disorder in the spine can be used for explanation.

contents

• Nerve pain between the ribs
• definition
• Caution: root compression syndrome
• Intercostal neuralgia due to root irritation syndrome
• Infection-related nerve pain between the ribs
• Cause organ diseases
• Symptoms of intercostal neuralgia
• Diagnosis of nerve pain in the rib area
• Therapy for intercostal neuralgia
• neural therapy
• physical therapy
• drugs
• Acupuncture for nerve pain
• Naturopathy in intercostal neuralgia
• Heat and cold therapy

definition

Intercostal neuralgia (or intercostal neuralgia) generally occurs on the eponymous midribbed nerves (intercostal nerve). 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 intermediate rib nerves arise 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.

Intercostal neuralgia is nerve pain in the ribs and back area. (Image: yodiyim / fotolia.com)

The exit point of each intercostal nerve is the bony spinal canal of the spine or its openings. Neuralgia on these sensitive nerve interfaces between the spinal and intermediate ribs is particularly painful and not entirely harmless.

As the name suggests, intercostal neuralgia is one of the nerve pains known as neuralgia. It is therefore not an independent disease, but rather describes a symptom complex or a pain syndrome, which may occur in connection with various diseases.

Since the human has a total of 12 thoracic vertebrae, between each of which runs a Zwischenrippennerv, intercostal neuralgia can occur at 11 different points of the thoracic spine. The actual source of this nerve pain is therefore often very difficult to determine in the diagnosis. However, the location of the respective underlying disease significantly determines the source of the pain, which makes suspicion of a disease during the diagnosis the decisive clue for finding the point of pain.

Corresponding diseases can be located next to the spine itself in all parts of the body and organs, which are located in the chest and thus in close proximity to the thoracic spine and the ribs. Which includes:

• heart
• lung
• pleura
• bile
• liver

Regardless of the many origins within the thoracic spine, neuralgia of the intercostal nerves is basically manifested by a nerve pain that spreads around the actual source of pain in a ring-shaped to a belt-shaped manner. The pulling pain radiate thus circularly in the chest wall and back, whereby they are significantly strengthened by nerve stimuli such as coughing, sneezing or pressing. Depending on the severity of the underlying health complaint, the nerve pain may last longer or disappear after a short time.

Caution: root compression syndrome

Very often, the symptoms are triggered by nerve compression. They arise when nerve roots experience increased pressure due to constriction (compression) and as a result emit pain stimuli. In the spine area, the so-called root compression syndrome is the most common form of such nerve constrictions. In the case of intercostal neuralgia, this syndrome logically affects the nerve roots of the intermediate ribbed nerves.

Painful movement restrictions, as well as an intensification of pain in coughing and sneezing, are common for a root compression syndrome. If the compression is very severe or even causes bruising at the nerve endings, the syndrome can also lead to emotional disturbances and paralysis, which can extend to the buttocks and leg area. Even dysfunctions, for example in the form of urinary and fecal incontinence, are possible in the context of the syndrome.

Danger: The root compression syndrome is a serious emergency, which is why appropriate nerve problems in combination with the mentioned pain immediately need medical care!

In intercostal neuralgia, root compression concerns the nerve roots of the intermediate ribbed nerves. Compressions can be caused by numerous diseases of the spine. For example, vertebral blockage caused by a herniated disc often causes bottlenecks in the area of ​​the spinal canal, which can be felt by severe nerve pain. Painful movement restrictions, as well as an intensification of the pain in coughing and sneezing are common for the herniated disc.

A herniated disc can cause massive nerve pain. (Image: marga / fotolia.com)

When it comes to dislocations of the parts of the thoracic spine, vertebral and rib fractures also pose the risk of root compression. Mention should also be made of malformations and growth disorders of the thoracic vertebrae, as they are given for example by scoliosis and osteochondrosis.

While scoliosis refers to a spinal column disorder that is dangerous to the spinal cord, hernia osteochondrosis harbors a disorder in the transformation of cartilage into bone, either congenital or caused by vertebral fractures. Should spinal instabilities occur, spinal nerve narrowing can not be ruled out.

Other spinal disorders that can cause a root compression syndrome in the intercostal nerves and thus an intercostal neuralgia, are vertebral tumors and degenerative spine changes (osteopathies). The latter include, above all, signs of wear of the vertebral joints due to spondylarthrosis and osteoporosis.

By the way: Spinal operations also carry a certain risk of inducing root compressions through surgical complications.

Intercostal neuralgia due to root irritation syndrome

Root syndrome (radiculopathy), also known as root syndrome, is often confused with root compression syndrome. However, it does not lead to a narrowing of the nerves, but to a nerve irritation, which is usually somewhat lenient process as a compression. Nevertheless, it is not a joke with this nerve disorder, because a root syndrome can also cause serious damage to the intermediate ribbed nerves.

The causes of radiculopathy are largely the same as in root compression. In addition, nerve inflammation 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).

Also in their symptoms Radikulopathie the root compression syndrome is relatively similar, which further complicates a differential diagnosis in intercostal neuralgia. An important indication of root irritation syndrome, however, is the absence of nerve paralysis. In addition, an inflammation-induced neuralgia of the costal arch is often favored by infections, so that inflammation and symptoms often infection-typical widen. The danger here is that in addition to individual roots Zwischenrippennerven also more nerve endings and even the muscles of the disease can be detected.

Important: If the respiratory muscles or nerve roots of the diaphragm are affected, this could result in life-threatening respiratory failure. Also motor disturbances as well as mood swings and cognitive impairments are not excluded with the root irritation syndrome as cause of a Interkostalneuralgie.

The cause of an intercostal neuralgia may be an infection with the varicella-zoster virus. (Image: Tatiana Shepeleva / fotolia.com)

Infection-related nerve pain between the ribs

The root stimulus syndrome is often triggered by delayed herpesviruses. The pathogens of the herpes zoster disease, also known as shingles, are thought to be one of the main infectious agents for intercostal neuralgia. In addition, lung infectious diseases associated with neuralgia suggest involvement in some disease cases.

In addition to shingles, infectious diseases such as pneumonia, pleurisy and tuberculosis are also discussed. Even gastrointestinal infections such as gastritis can not be ruled out as possible causative agents of neuralgia.

Cause organ diseases

As already mentioned, the medicine is still on the track of the exact causes of the painful crustacean nerves. However, it is highly probable that adjacent organs influence the onset of nerve pain in the presence of an underlying disease. Apart from infections, cardiovascular diseases as well as diseases of the liver and bile are to be mentioned here.

In India, doctors also revealed neuralgia between the ribs, which developed as a result of chronic pancreatitis in the patient. Vascular swellings in the area of ​​the spine, such as high blood pressure or arteriosclerosis (arteriosclerosis), may theoretically be responsible for painful intermediate ribs.

Symptoms of intercostal neuralgia

Cardinal symptoms of neuralgia between the ribs are always pulling chest pain and back pain, which spread around the source of pain in a ring. Movement stimuli such as displacements of the upper body, strong laughter, pressing as well as coughing and sneezing reflexes intensify the pain, which can last for a short or long time depending on the cause.

The main symptom of neuralgia between the ribs is drawing pain in the chest and back. (Image: chombosan / fotolia.com)

Occasionally also seizure-like pain peaks occur without previous stimuli, which instead with

• sweating,
• dizziness
• and panic attacks

accompanied. The other complaints, however, are highly dependent on the underlying disease and the extent of the nerve disorder. Conceivable are the following concomitant symptoms in an intercostal neuralgia:

• paresthesia
• numbness
• numbness
• movement restrictions
• Breathing problems and shortness of breath
• painful restraint of the upper body
• muscle tension
• Disorders of muscle function
• motor disturbances
• Dysfunction of the organs
• cognitive disorders
• depressions

Diagnosis of nerve pain in the rib area

In order for the diagnosis to be successful in the case of suspected intercostal neuralgia and subsequent disease detection, the patient's medical history requires the most detailed possible information on existing complaints and possible previous illnesses. For this, it is not sufficient to describe the location of the chest pain. In addition, situations must be mentioned in which the pain is intensified, as well as information on existing concomitant symptoms are given. Anyone who has suffered from spinal column, infection or organ disease before the onset of nerve pain should also raise this issue during the patient survey.

After the patient talk, an initial palpation of the affected spinal region usually takes place. In this way, the source of pain can be localized more accurately and how painful the patient is. This is followed by a more intensive detailed checkup for differential diagnosis.

Imaging examination methods, such as myelography, are in the foreground. The term describes a special x-ray method for imaging the spinal canal, in which a contrast agent is injected into the canal. Computed tomography (CT) or magnetic resonance imaging (MRI) can be used to visualize any compression and inflammation of the nerves. Also, dislocations and degenerative changes of the spine can be detected in diagnostic imaging procedures. An ECG also allows the assessment of cardiovascular health in this regard.

Diagnosis is supported by imaging techniques such as computed tomography. (Image: Kzenon / fotolia.com)

If physicians suspect that the cause of intercostal neuralgia is not the thoracic spine itself but one of the organs located in the thorax, additional examination methods may be used in addition to the imaging diagnosis. Pulmonary function tests can be used, for example, to assess lung health. Blood tests additionally indicate possible infectious diseases.

Therapy for intercostal neuralgia

Which treatment measures have to be taken depends on the final diagnosis. However, most health complaints can be reliably remedied by appropriate medication and alternative medical measures:

neural therapy

The neural therapy relies on injecting a local anesthetic at certain points in the painful area and can often significantly improve the discomfort within minutes.

physical therapy

Vertebral and nerve blocks, as well as numerous dislocations and herniated discs, can be well treated by appropriate physiotherapeutic measures. Any nerve pain will also be relieved quickly by appropriate therapy steps. Recommended are, for example, manual therapy measures such as healing and pressure massages or manual postural corrections.

In the further course of therapy then a physiotherapeutic exercise training should take place. In addition to a back school, yoga and water aerobics, there are other techniques that can be partially applied already during the diagnosis of rapid therapy. Well-known treatment methods are:

• the Alexander Technique,
• the Feldenkrais method,
• the McKenzie concept
• and the spiral dynamics.

Important: Only allow manual treatment to be carried out by trained specialist personnel! A wrong move can do more harm than good and even worsen existing pain!

drugs

The drugs that are commonly used in intercostal neuralgia include rheumatism (anti-inflammatory drugs), narcotics and analgesics. The latter, in addition to opioids, mainly consist of muscle relaxants designed to prevent painful muscle tensions. In the case of a specific diagnosis, the use of cardiovascular and antimicrobial agents for the treatment of infections is also possible.

Acupuncture for nerve pain

Very popular for the treatment of nerve pain are alternative medical measures such as acupuncture. The targeted stimulation of the body meridians by special acupuncture needles comes from traditional Chinese medicine and has a resolution of nerve, muscle and energy blockades by pressure to the target. This should, among other things, pain relief, such as those caused by nerve irritation and nerve compression, be reliably resolved.

In alternative medicine, nerve pain is often treated with acupuncture. (Image: Africa Studio / fotolia.com)

Naturopathy in intercostal neuralgia

In the field of naturopathy, there are also some herbs that can help to relieve the symptoms. Proven medicinal plants in intercostal neuralgia are:

• bittersweet nightshade
• Knollenhahnenfuß
• Milkweed
• bryony

However, the herbs should not be picked wild and processed privately, because plants such as the nightshade are actually poisonous herbs and therefore only under professional guidance to take. It is best to ask the pharmacist, homeopath or doctor for suitable preparations and to be advised in terms of dosage in detail. It is conceivable, for example, the intake as globules in the potencies D1 to B12 à a maximum of 5 globules per day. As a guideline for herbal drops is commonly a dose of 5 to 20 drops daily.

More harmless is the private use of analgesic and calming nerve herbs like

• eucalyptus,
• St. John's Wort,
• Caraway seed,
• bedstraw,
• lavender,
• laurel,
• rosemary,
• White goosefoot
• and horsetail.

Here, a supportive treatment can easily be done by the private preparation of herbal teas, spas or the application of pain-relieving tinctures and ointments.

Heat and cold therapy

Also worth a try for painful Zwischenrippennerven electrotherapies. It is conceivable in this regard, for example, the so-called spinal cord stimulation, in which using special therapy devices electrical impulses are sent to the spinal cord to relieve pain symptoms.

The effectiveness of this treatment was confirmed in a Belgian study on nerve stimulation in intercostal neuralgia. The researchers tested a modern stimulation process with wireless devices, which proved to be extremely successful.

Conversely, cooling measures can also contribute to pain relief. Coolpacks or cold compresses, which are applied to the affected spine region, are especially recommended. In addition, according to a British study by Cambridge University, cold-water swimming should have a particularly positive effect on intercostal neuralgia during surgery. (Ma)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)