Intercostal Neuralgia

What is the Definition of Intercostal Neuralgia?

Medical Words

Intercostal neuralgia causes severe pain in the chest and back. It is not uncommon for the cause of the nerve pain to be an infection with herpes zoster (shingles). The treatment is usually drug-based and depends on the underlying disease.

What is intercostal neuralgia?

It is not uncommon for the cause of the nerve pain to be an infection with herpes zoster (shingles). See AbbreviationFinder for abbreviations related to Intercostal Neuralgia.

Those affected by intercostal neuralgia suffer from nerve pain that originates between the ribs or along the chest wall. The chest cavity is surrounded by the chest wall, which is made up of bone and tissue.

The intercostal nerves run along the chest wall and are responsible for neuralgia. Exactly where the pain is located differs from case to case. The intensity of pain is also different for each patient. Typically, the pain is long-lasting and aching.

Those affected report that the pain increases when they cough or sneeze. Even deep breaths are usually associated with increased pain intensity. Thus, intercostal neuralgia can be distinguished from heart pain, since there is no increase in pain with deep inhalation.


Intercostal neuralgia is not an independent disease, but a symptom of the underlying disease. There are various reasons why neuralgia occurs in the intercostal space. All possible causes are accompanied by mechanical damage to the nerves between the ribs.

Intercostal neuralgia can be caused by broken ribs, in which parts of the bone press on a nerve. In addition, excessive wear and tear on the vertebral bodies of the spine can pinch nerves, resulting in neuralgia. Intercostal neuralgia occurs particularly frequently in connection with herpes zoster, also known as shingles. This viral disease leads to inflammation of the nerves, which can also affect the intercostal nerves.

This viral disease causes inflammation of the nerves, which can also affect the intercostal nerves. Intercostal neuralgia can also be caused by tuberculosis or tumors in the lungs. Post-thoracotomy syndrome, in which people experience intercostal neuralgia, sometimes occurs after surgery to open the patient’s chest.

Symptoms, Ailments & Signs

Intercostal neuralgia is primarily manifested by severe pain in the chest and back area. Typical of the syndrome is a rapid spread of pain, with the symptoms usually appearing in the form of a belt or ring. They are limited to one or two parts of the body, such as the area between the ribs and the chest wall or the upper right abdomen.

The pain itself is perceived as pulling by those affected. It can last for several days, weeks or even months and increase in intensity over time. The symptoms increase with sneezing, coughing and heavy laughing. Some patients repeatedly experience severe pain attacks, combined with sweating, dizziness and panic attacks.

Intercostal neuralgia can also cause abnormal sensations such as tingling or numbness. Poor posture, which can be recognized by an unusual posture, is also characteristic. In the long term, the incorrect postures in turn cause pain reactions and functional disorders of the holding apparatus.

In the advanced stage, intercostal neuralgia leads to restricted breathing and eventually persistent shortness of breath. If the paralysis is not treated, there is a risk of permanent nerve damage. Chronic pain and restricted movement promote the development of depression and other mental illnesses.

Diagnosis & History

Infogram on the pain regions, progression and origin of pain as well as the degree of intensity when feeling pain. Click image to enlarge.

In the case of intercostal neuralgia, rapid diagnosis is important to prevent the pain from becoming chronic. In general, neuralgia is only spoken of after about three days of nerve pain.

If the symptoms do not go away on their own by then, you must see a doctor. The doctor treating you first takes a detailed medical history. He asks in particular about the type of pain and its localization. This is followed by a palpation examination to determine exactly where the pain is located. If the patient is sensitive to pain at certain points where intercostal nerves run, intercostal neuralgia can be diagnosed.

However, this is only the determination of one of the symptoms of the underlying disease. In the further course of the diagnosis, the underlying disease must be determined. In some cases, the doctor orders a myelography, i.e. a contrast medium X-ray of the spinal canal. Chest X-rays or ultrasound examinations can also be used for diagnosis. The course of intercostal neuralgia depends on the underlying disease. In most cases, however, the course can be assessed as positive.


With intercostal neuralgia, most patients usually suffer from severe pain in the back and chest. This pain has a very negative effect on the patient’s quality of life. Pain at rest can also lead to trouble sleeping. It is not uncommon for breathing difficulties to occur in addition to the pain.

Those affected may also lose consciousness. The difficulty in breathing can also lead to fear of death. It is not uncommon for paralysis or other sensory disturbances to occur in the affected regions. Furthermore, the patients suffer from abnormal sensations and are therefore significantly restricted in their everyday life. The constant pain often leads to depression or other mental upsets. As a rule, there is no positive course of the disease without treatment.

The pain can be reduced with the help of painkillers. Tensions must also be released without further complications occurring. However, the complaints cannot be completely limited in every case. Life expectancy is usually not reduced by intercostal neuralgia. If necessary, the affected person is then dependent on various therapies.

When should you go to the doctor?

Since intercostal neuralgia can be a symptom of various diseases, rapid clarification of the underlying disease is necessary. Depending on which other symptoms occur in those affected, they should see either their family doctor or a specialist after just a few days. Early diagnosis is also important, as in some cases the pain can otherwise become chronic. Doctors speak of intercostal neuralgia when the symptoms last more than three days without significant improvement. If symptoms do not improve on their own after this period, people should consult a doctor.

However, if the patient develops symptoms such as fear of death, severe nerve pain or shortness of breath at an earlier stage, or if the symptoms continue to worsen, it is advisable to seek medical treatment immediately. In rare cases, neuralgia can have serious causes that may require prompt surgical intervention. If left untreated, intercostal neuralgia can last for several months, depending on the disease present. Rapid treatment and diagnosis can reduce the duration of the symptoms to a few days, depending on the cause.

Treatment & Therapy

The treatment of intercostal neuralgia depends on the underlying condition. Basically, there are a number of treatment options that the doctor can decide on together with the patient in the individual case.

If the pain is severe, painkillers are given first. This is not a causal therapy, but brings relief to those affected in an acute case. Non-steroidal anti -inflammatory drugs are particularly suitable for pain treatment in the case of intercostal neuralgia. This type of painkiller works particularly well for neuralgia, as it spreads its effects to the periphery of the body. Muscle relaxants are often used to relieve muscle tension.

Sometimes those affected suffer from extreme pain that conventional painkillers have no effect on. In these cases, the treating doctor administers strong painkillers that act on the central nervous system. Morphine, an opioid, is particularly common. There is also the option of local anesthesia, which guarantees freedom from pain for a limited period of time. For many doctors, local anesthesia is preferable to opioids because strong painkillers put a strain on the body and cannot be administered without side effects.

In addition to the pain therapy, the causal therapy is carried out. Antivirals are administered for shingles. If an intercostal nerve is pinched, physiotherapy can help in many cases. Exercises are developed to relieve the painful area. In some cases, the exact cause of intercostal neuralgia is unknown and treatment is limited to pain management.

Outlook & Forecast

The prognosis of intercostal neuralgia is linked to the underlying disease. Since the symptoms develop due to an existing health irregularity, intercostal neuralgia should not be understood as an independent disease. The symptoms disappear immediately with the recovery of the causal disorder. A general view of the further course of development cannot be given. An individual assessment and assessment of a possible healing success takes place.

In severe cases, there are complications. These can be physical as well as psychological. If it is possible to treat the existing nerve damage quickly and without further complications, the prospect of a full recovery is good. For minor rib fractures, recovery is documented in most patients after the healing process of the bone damage is complete. Simple fractures usually heal and cause only a few long-term problems. However, if the disease progresses unfavorably, chronic symptoms are also possible.

If the patient suffers from a tumor disease, a life-threatening situation can arise. If the tumor can be completely removed, the symptoms may be alleviated. However, without treatment or at an advanced stage, the cancer can become fatal.

In the case of viral diseases, the prognosis is favorable as soon as the pathogens die off as a result of drug therapy. A recurrence of the complaints over the lifespan cannot be ruled out.


Intercostal neuralgia is not an independent disease, but merely a symptom. For this reason, there are hardly any prophylactic measures that can be taken. In the case of pain in the intercostal space, a doctor should be consulted quickly in order to be able to diagnose the underlying disease as early as possible.


In most cases, direct aftercare measures for intercostal neuralgia are severely limited or are not available at all to those affected. First and foremost, the disease must be recognized by a doctor at an early stage so that early treatment can be initiated. Self-healing cannot occur in this case, so that those affected by intercostal neuralgia are always dependent on medical treatment by a doctor.

The treatment itself is carried out with the help of various measures of physiotherapy and physical therapy. Those affected can repeat many of the exercises themselves at home, which speeds up the treatment. Patients should always follow the doctor’s instructions when taking painkillers or other medications. It is also important to ensure that it is taken regularly and that the correct dosage is used.

Since intercostal neuralgia has a negative effect on the muscles of the affected person, no more physical or stressful activities should be carried out in order not to strain them unnecessarily. The help and support of one’s own family can also have a positive effect on the further course of the disease. As a rule, intercostal neuralgia does not reduce the life expectancy of the person affected.

You can do that yourself

In addition to drug treatment, physiotherapeutic measures are also useful for intercostal neuralgia, which are supported by the affected person at home with exercises and other measures. Breathing and stretching exercises help relieve chest pain and improve overall well-being. In some cases, alternative methods such as massages or pain point pressure are also useful.

If insomnia or psychological problems occur during the course of the disease, therapeutic advice is indicated. However, the person affected should not only contact doctors and psychologists, but also inform friends and relatives about their illness. The support of the personal environment is an important factor in the therapy of intercostal neuralgia.

If the paralysis and sensory disturbances increase, the sufferer must take measures to compensate for the restricted movement. This can be the use of a walker, but also a disabled facility or even accommodation in a nursing home. The course of the disease is always decisive. The development of the individual symptoms should be recorded in a complaint diary. In this way, an individual therapy can be developed together with the medical team, which usually enables the affected person to continue living relatively symptom-free.

Intercostal Neuralgia