What's happening and what are the options?
The intercostal nerves emerge from the spinal cord in the thoracic region and innervate the muscles and skin of the chest and abdomen. Their irritation or damage causes pain along the rib. True nerve damage is less common than is commonly thought: more often this name hides pain from the muscles, joints of the ribs and vertebrae. However, the tactics in both cases are similar if serious illnesses are excluded.
- Musculoskeletal chest wall pain
- Nerve irritation due to changes in the spine
- Postherpetic neuralgia after lichen
- Pain after injury or broken ribs
- Pain after chest surgery
Causes and risk factors
Pain can be caused by awkward movement, long stay in an uncomfortable position, hard physical work, and severe coughing. In older people, changes in the thoracic spine and osteoporosis with vertebral fractures are important. One important cause is shingles: pain may appear several days before the rash. Diabetes can cause damage to the thoracic nerves.
- Muscle strain, uncomfortable posture
- Severe cough, injury, bruised ribs
- Osteochondrosis and spondyloarthrosis of the thoracic region
- Shingles
- Diabetes mellitus
- Chest surgery
Symptoms and differences from heart disease
Neuralgia is characterized by pain that is clearly associated with movement, breathing and pressing on a certain point between the ribs, and is often located on the side or back. Heart pain is usually pressing, behind the sternum, appears during exertion or excitement, can radiate to the left arm, jaw, is accompanied by shortness of breath and sweating, does not change when turning the body. However, these signs are not absolute, so if you have chest pain for the first time in your life, as well as in people with risk factors for cardiovascular disease, an ECG is needed.
- Burning or shooting pain along the rib
- Worsening when inhaling, coughing, sneezing
- Pain when pressing between the ribs
- Numbness or increased sensitivity of the skin
- Strengthening when turning and tilting
Diagnostics
The doctor clarifies the nature of the pain, the connection with movement and breathing, examines the skin, palpates the ribs and spine, and checks sensitivity. An ECG helps to rule out acute heart problems; if necessary, tests and consultation with a cardiologist are carried out. A chest X-ray is prescribed for suspected pneumonia, pleurisy, or rib fracture. An MRI of the thoracic spine is needed for persistent pain, neurological impairment, or suspected disc herniation or other spinal changes.
- Neurological examination
- ECG
- X-ray of the chest or spine
- MRI of the thoracic spine according to indications
- Blood tests according to indications
- Ultrasound of the abdominal organs for pain in the lower chest
Treatment
Treatment depends on the cause. For musculoskeletal pain, non-steroidal anti-inflammatory drugs taken orally or in the form of a gel, dry heat, a gentle regimen without complete rest, then therapeutic exercises and massage help. If the pain is severe, your doctor may perform an intercostal nerve block with a local anesthetic. If the pain is neuropathic, burning and prolonged, the neurologist prescribes drugs from the groups of anticonvulsants or antidepressants that act on pain signals. For shingles, it is important to start antiviral treatment as early as possible.
- NSAIDs orally or locally - as prescribed by a doctor
- Dry heat, comfortable sleeping position
- Intercostal nerve block
- Remedies for neuropathic pain
- Antiviral therapy for lichen
- Exercise therapy and massage after pain subsides