Typical Signs of Intercostal Nerve Pain and How to Manage It

Intercostal nerve pain is not a rare condition and can cause significant worry and confusion for those affected. So, how can you identify the typical signs of intercostal nerve pain?

1. What is Intercostal Nerve Pain?

Intercostal nerve pain is the result of nerve pain in the area corresponding to the intercostal nerves. These nerves radiate throughout a person’s chest and abdomen. Nerve pain occurs when your sensory nerves are irritated or become overly sensitive. The sensory nervous system is responsible for sending information about bodily sensations and changes to the brain.

One of the most common causes of intercostal nerve pain is irritation of tissues and nerves following chest surgery, often lung surgery.

Another common cause of intercostal nerve pain is the reactivation of the herpes virus or shingles. Reactivation of this virus is not an active infection, but it causes a painful rash, often around the chest and abdomen. Shingles can lead to intercostal nerve pain by causing inflammation in the spinal nerve roots.

Other recognized causes of intercostal nerve pain include:

• Severe trauma
• Excessive growth of cells around the intercostal nerves, such as due to cancer or infection
• Other surgical procedures, such as chest tube placement or mastectomy
• Pregnancy (though this is very rare)

2. Typical Signs of Intercostal Nerve Pain

The main symptom that patients with intercostal nerve pain experience is pain in the chest area, typically around the ribs or in the upper chest or back, which may cover the entire chest or radiate from the back to the chest. Sometimes, patients may also feel pain along the length of the ribs. The pain tends to be intermittent and may intensify with activities such as:

• Lifting
• Twisting and turning the torso
• Coughing
• Sneezing
• Laughing
• Taking deep breaths

Other signs of intercostal nerve pain may include:

• Abdominal pain
• Fever
• Itching
• Numbness
• Tingling
• Reduced mobility of the shoulder and back
• A sensation of tightness from the front of the chest to the back

Some people may also experience pain in unaffected areas of the body, such as the shoulder blades and lower pelvis. Symptoms that might indicate a medical emergency include:

• Chest pain radiating to the left arm, jaw, shoulder, or back
• A feeling of chest tightness or constriction
• Coughing up yellow-green mucus
• Rapid heartbeat or a vibrating sensation in the chest
• Respiratory issues such as difficulty breathing or an inability to take a full breath
• Severe abdominal pain
• Intense chest pain with breathing or coughing
• Sudden confusion or dizziness, or changes in consciousness, such as fainting or unresponsiveness

3. What to Do If You Experience Typical Signs of Intercostal Nerve Pain?

Treatment for intercostal nerve pain largely depends on the severity of symptoms and the patient’s other medical conditions. Doctors may use various methods to manage intercostal nerve pain, including:

3.1. Medications

Nerve pain often does not respond well to aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or low-dose narcotics. Over-the-counter options may include capsaicin cream, lidocaine gel, or lidocaine patches.

Doctors might prescribe antidepressants to manage intercostal nerve pain, even if you do not have depression. While the exact mechanism is not fully understood, people often experience moderate pain relief within a few weeks. Antidepressants used for intercostal nerve pain include:

• Nortriptyline
• Amitriptyline
• Doxepin
• Protriptyline
• Imipramine
• Clomipramine
• Desipramine

Another medication option for treating nerve pain includes anticonvulsants, such as:

• Carbamazepine
• Oxcarbazepine
• Gabapentin
• Pregabalin

Opioid pain relievers like tramadol, oxycodone, or morphine may be used for nerve pain. However, opioids carry the risk of addiction and death, so the CDC recommends considering other treatment options. If opioids are used, doctors need to closely monitor and prescribe the lowest possible dose.

3.2. Procedures

Doctors may perform procedures such as intercostal nerve block to inject steroids and pain relievers, helping to reduce inflammation and pain. Other beneficial procedures might include thoracic epidural anesthesia and radiofrequency nerve root ablation.

3.3. Therapy

If you experience significant pain, you should avoid physical activities that might worsen muscle strength. Physical therapy and occupational therapy might be needed to prevent muscle loss. Your treating doctor might also use heat and cold therapy to help alleviate intercostal nerve pain. 

Proper treatment can improve comfort, enhance quality of life, and promote longevity.

References: Webmd.com, Verywellhealth.com, Medicalnewstoday.com