Intercostal neuralgia refers to a pathological condition resulting from compression or irritation of the roots or the entire length of the intercostal nerves or their branches. At the same time there are strong painful attacks in the chest area, which bring suffering to the patient.
Intercostal neuralgia is one of the most painful processes. When it occurs, patients often think of heart pains, since the localization of pain is very similar.
However, unlike heart pains, which are usually caused by circulatory disorders in the vessels of the heart, pain in neuralgia is a process of irritation and hypersensitivity in the intercostal branches of the nerves. Usually intercostal neuralgia affects people in mature and in old age due to age-related degenerative changes in the body, including in the area of the nerve trunks.
The main causes of intercostal neuralgia are degenerative, neoplastic or inflammatory changes in the region of the nervous system, especially peripheral nerve trunks. Contribute to these changes:
- problems of the spine or ribs, their injuries or illnesses,
- diseases of the stomach and intestines ,
- deficiency of vitamins and minerals
- tumors in the thoracic spine,
- excessive tension of the spinal muscles or their inflammation,
- stress and fatigue,
- progressive osteochondrosis ,
- nerve injuries in the thoracic region,
- intoxication with neurotropic poisons, drugs, microbial toxins,
- herpetic nerve damage.
Predispose to the formation of neuralgia:
- weakening of immunity
- heart disease and blood vessels,
- malformations of the spine, its injuries,
- menopause in women, hormonal changes,
- alcohol consumption.
As a result of exposure to one or several causes, the formation of injury, inflammation or compression of the nerve root or its trunk occurs. In this case, the nerve endings receive an excessive amount of impulses, experience hypoxia (oxygen deficiency), which as a result is transformed into pain impulses.
The main manifestation of intercostal neuralgia are pain attacks:
- constant acute pain
- periodic bouts of pain, acute and excruciating, like pain in the heart,
- muscle tension in the back,
- increased pain when coughing or sneezing, turning the body,
- forced posture to relieve pain,
- loss of sensitivity in some areas of the chest.
At the same time neuralgia may be accompanied by:
- severe sweating
- sharp pressure fluctuations
- lower back pain, imitating pain in the kidneys.
The following signs help to distinguish pain along the nerve trunks from heart pain:
- pains in heart diseases are usually non-lasting,
- pains are relieved by taking nitroglycerin,
- pains in the heart give to the arm, shoulder,
- pains do not change with deep breathing,
- there are heart rhythm disturbances.
With neuralgia pain:
- long, do not pass at night,
- pains are aggravated by turning and tilting the body, it hurts a lot when probing the intercostal spaces,
- no relief from nitroglycerin,
- helps warm and receive painkillers.
First of all, the diagnosis of intercostal neuralgia relies on the main complaints of pain in the chest and examination of the patient with a careful feeling of the intercostal spaces. Basically, the diagnosis becomes clear from the examination, but sometimes in difficult cases, methods of instrumental diagnostics are used to identify the cause of neuralgia:
- electroneurography, especially in cases of suspected nerve injury,
- CT or MRI of the spine to exclude volumetric processes in the thoracic region (hernia, spinal tumor and surrounding soft tissues),
- X-ray of the spine and chest organs,
- for pain on the left side – an ECG of the heart and an ultrasound to exclude cardiac pathology.
- general analysis of blood and urine, especially in case of pain radiating to the lower back,
- blood for antibodies to herpes viruses, in case of suspected infection of the nerves.
Intercostal neuralgia is usually treated by neurologists, in some cases the help of neurosurgeons will be needed. First of all, the basis of treatment is the elimination of the underlying disease leading to inflammation or pinching of the nerve.
In the period of acute pain is indicated:
- bed rest for at least a couple of days, and the bed surface should be made flat and firm, placing a shield under the mattress,
- with intercostal neuralgia, warming of the chest area with dry heat – a woolen shawl, a warm compress, a towel – eases pain;
- The use of mustard plasters in the paravertebral zone is permissible (but not on the spine itself),
- massage with anti-inflammatory and warming ointments (finalgon, diclofenac-gel, voltaren, etc.), pepper patch,
- taking sedatives (valerian, motherwort, Persene, Novo-Passit), non-steroidal analgesics – ibuprofen, paracetamol, diclofenac. They can not be abused, over time they can lose effectiveness with frequent use,
- during the exacerbation of physical activity, stress and alcohol intake are prohibited.
With severe pain and ineffectiveness of analgesics resort to novocainic blockades.
In the future, on doctor’s prescription, apply:
- physiotherapy (UFD segment, where there is pain, electrophoresis with novocaine, darsonval),
- laser therapy
- taking higher doses of vitamins of group B.
In the rehabilitation period are shown:
- paraffin and ozokerite applications,
- mud therapy
- baths with radon or hydrogen sulfide.
- Therapeutic exercise, swimming, massages are shown.
In the case of a mass lesion in the spine, compressing the nerve roots and giving pain syndrome, surgical treatment is indicated.
In order to prevent exacerbations of intercostal neuralgia, methods of strengthening the muscles of the back, prevention of hypothermia, normalization of lifestyle, taking vitamins are shown. The prognosis for intercostal neuralgia is favorable.