Ribs / Chest Wall
Intercostal Neuralgia
늑간 신경통
Dermatomal chest wall pain from intercostal nerve injury or irritation
- How common
- Common in chest pain clinic
- Typical age
- Middle-aged and older
What is it?
Intercostal nerve injury from compression, infection, trauma, or surgery causes dermatomal pain.
Commonly affected: Any T1–T12 level (zoster is unilateral single dermatome)
How it develops
- Nerve Injury TriggerZoster, surgery, trauma, disc etc.
- Neuritis/DemyelinationFiber hypersensitization
- Central SensitizationDorsal horn hyperexcitability
- Allodynia/BurningNon-painful stimuli become severe pain
Symptoms
- Band-like radicular painDermatomal radiation from back to front
- Burning/stabbing painNeuropathic pain character
- AllodyniaLight touch/clothing triggers pain
- ParesthesiaTingling, hyper- or hypoesthesia
- Worse with breathing/motionWorsens with deep breath or motion
How it is examined
- Dermatomal distributionPain follows a single intercostal dermatome
- Tinel's signTapping along nerve reproduces pain
- Sensory testingAbnormal light touch/pinprick response
- History of zosterInquire about prior vesicles/rash
Imaging
Plain X-ray usually normal; diagnosis is clinical, imaging excludes alternatives.
- Normal findings
- No rib/thoracic abnormality
- MRI if structural cause suspected
Imaging usually normal; MRI excludes zoster sequelae, disc compression, tumor.
- Usually normal
- Rule out disc, tumor, metastasis
- Evaluate thoracic foraminal stenosis
Non-surgical care
- Neuropathic agentsGabapentin, pregabalin, amitriptyline
- Topical therapyLidocaine patch, capsaicin cream
- PT / TENSTENS, postural therapy
- Zoster vaccine/antiviralsAcute antivirals; vaccination for prevention
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Refractory pain despite conservative care
Procedures that may be discussed
- Intercostal nerve block / RF ablation
- Neurectomy or nerve stimulator
Outlook
Variable by cause; postherpetic neuralgia can become chronic.