Otitis

Intercostal neuralgia disease and treatment. Intercostal neuralgia: symptoms on the right and left and treatment methods

Intercostal neuralgia is compression or irritation of the intercostal nerves. The causes of the disease may be various diseases: osteochondrosis, trauma spinal column or chest, even a common cold. In addition, a careless sudden movement, an unusual physical activity, being in a draft and any other situation that can cause muscle spasm, which leads to irritation of nerve endings.

Symptoms of intercostal neuralgia

This disease is characterized by:

periodic attacks of pain at the moment of inspiration. The pain can be sharp or dull, burning or aching, but always interferes with normal breathing;
possible muscle spasms, tingling in the chest;
the skin changes its usual color - turns pale or red;
sudden movements (changes in body position, coughing, sneezing) increase painful sensations;
pain can be localized in the heart area, under the shoulder blade, in lumbar region backs.

Do not confuse intercostal neuralgia with pathology of the heart muscle. The symptoms of the diseases are similar, but the treatment is completely different. Lost time due to incorrect diagnosis can be decisive, so consultation with a specialist is mandatory!

In heart disease, pain does not depend on body position or sudden movements and stops quite quickly after taking medications. Unlike this disease, with intercostal neuralgia the pain is prolonged and intensifies with active movement.

Symptoms of the disease can occur in adults and children, and in men the pain is usually localized on the left - in the left hypochondrium, and in women on the right - in the heart area. IN childhood Such problems are observed before puberty, when the child’s skeleton begins to actively grow.

Treatment at home

Medication treatment at home

Drug treatment of intercostal neuralgia, unfortunately, is aimed only at relieving symptoms and general support of the body, that is, the patient is prescribed a course of vitamins, with the main emphasis on B vitamins, painkillers and relaxants to relieve muscle spasms. Anti-inflammatory drugs are sometimes added to this list, but their effectiveness is increasingly being questioned. List of tablets used for pain relief:

Analgin;
Tempalgin;
Ketorolac;
Ortofen et al.

Ointments that are used to treat intercostal neuralgia:

Voltaren;
Ketonal cream;
Apizartron and others.

In addition, when treating at home, the patient is recommended to rest in bed for a period of one to three days with the maximum possible straightening of the spine, i.e. the body should be positioned horizontally on a sufficiently hard surface. To achieve this effect, you can use a kind of shield (any flat, solid object of suitable size) placed under the mattress.

After pain relief, diagnostics are required to determine the real reason diseases. If it is established that intercostal neuralgia is the consequences of one of common diseases(cold, stress, infection, diabetes, etc.), then they begin to treat this particular disease.

If the problem lies in a disease of the spine, then in parallel with drug relief of pain in traditional medicine They use various physiotherapeutic procedures: physical therapy and massage, acupuncture, laser therapy, manual therapy, ultrasound, and similar methods of relieving stress on nerve endings. At serious problems A spinal traction procedure may be prescribed.

Any physiotherapy should be prescribed by a specialist - there is a possibility of worsening the situation by using incorrectly chosen procedures.

How to relieve pain at home

The very first step is to make sure that the pain is not caused by a heart disease. If it is impossible to get to a doctor, call an ambulance.

Heart problems can only be confirmed or ruled out with using ECG. Self-diagnosis in this matter is unacceptable.

If you are sure that the pain is caused by intercostal neuralgia, then you need to warm the affected area - this will slightly reduce the muscle spasm. At home, using a heating pad, mustard plaster, anti-inflammatory ointments, pepper plaster, heated salt or sand will help. A warm bandage (scarf, shawl) is applied over the warming agents or a sweater is put on.

As with drug treatment, it is necessary to at least short time endure bed rest. In combination with warming the affected area, rest will relieve spasm and reduce pain.

Several recipes for folk remedies

Pain relief is only the first stage in the treatment of intercostal neuralgia. To obtain a stable result and guarantee against the return of attacks, a long course of treatment is required. This can be done using folk remedies, but only if the doctor has confirmed the diagnosis.

If the patient is not sure of the origin of the pain, the use of any means can be harmful. In addition, time will be lost to begin proper treatment.

The main problem in application folk remedies– duration of the course. It is necessary to continue the procedures for a long time; stopping halfway will not bring results, and may even worsen the condition.

External use - rubs and compresses:

Glycerin and iodine

Glycerin is mixed with iodine in a 1:1 ratio.
The mixture is poured into a dark glass container (to protect it from exposure to light) and shaken thoroughly - the ingredients should be well mixed.
Use a cotton swab to apply the product to painful area back, carefully avoiding the spine area. You need to lubricate the skin with light movements, without rubbing the mixture, as this can cause a burn. Apply a loose bandage on top or simply wear underwear made from natural fabrics (not synthetics).

Iodine warms up the muscles well and relieves pain, but you need to make sure that the patient does not get caught in a random draft or make sudden movements - this can worsen the situation. It is recommended to perform the procedure before bedtime, so that you can immediately go to bed and cover yourself warmly. The course of application is 12-15 sessions with an interval of one day.

During any procedures, the spine area should not be affected. Only a competent specialist can work with the spine.

Birch bud tincture

You can collect the buds yourself (if it’s spring outside) or purchase them at the pharmacy.

pour a handful of buds with vodka (0.5 l);
leave for ten days in a cool, dark place.

Rub the affected area with birch bud tincture better in the evening. The product can be used during the day if the patient does not intend to leave the house. Be sure to wrap up the mashed area or dress warmly.

Radish or horseradish juice

Freshly squeezed juice is rubbed into the back in the direction from the spinal column (the spine itself is not affected). This product has a pronounced warming effect, but can cause irritation on the skin. Before use, you should do a test for individual tolerance. If necessary, the hot juice can be replaced with flax or wormwood seeds. The grains are poured with boiling water or steamed in a bag over steam and applied to the affected area.

Olive or sea buckthorn oil, ground with flax or wormwood seeds, will soften the skin and add effectiveness to the procedure.

Lilac buds and internal pork fat

An effective ointment can be prepared at home. Dried lilac buds are ground with internal fat at the rate of 1 part kidneys to 4 parts lard. The composition is rubbed into the sore spot as needed.

Camphor, mustard, egg white

Another version of the ointment is prepared from camphor (50 ml), dry mustard (50 g) and about 100 ml of raw egg white(one egg may not be enough). Mix camphor oil with mustard powder and add lightly beaten egg white. Mix everything thoroughly. Be sure to store the ointment in the refrigerator; warm the composition slightly in your palms before applying.

Bodyaga tincture

This freshwater sponge is infused with vodka, alcohol, and moonshine for several weeks in a dark place. Rub the prepared tincture on the affected area overnight. The alcohol infusion can be prepared in advance; it withstands long-term storage.

Burdock leaves

An ordinary weed sometimes works just as well medicines. The only catch is that the leaves must be freshly cut. Alternatively, you can prepare a few leaves in advance and store them in the refrigerator, but the more time passes from the moment of collection, the less benefit will remain in the burdock. The method of application is simple - wash the leaf and apply inside to the affected area, wrap warmly and leave overnight.

Geranium leaves

Leaves of a houseplant (3 - 4 pieces) are applied to the sore spot and secured with a bandage made of natural fabric. Keep the compress for two hours, during which time you need to replace the geranium leaves with fresh ones several times. This remedy relieves pain well and can be used during every attack.

Valerian tincture

The product is used as a compress. A napkin made of natural fabric (linen, cotton) is moistened with tincture and placed on the painful area, covered with a film on top and wrapped warmly. In this case, just warm clothes are not enough; you need a bandage that is not too tight so that the compress remains in the desired position. At the same time, the bandage should not interfere with movements or put too much pressure on the chest, interfering with normal breathing. You can keep this compress for several hours; you should not leave it overnight - the alcohol contained in the tincture can cause a burn. Valerian relieves pain, relaxes and calms.

Potatoes and onions

Another version of the compress is made from grated raw potatoes and onions. The recommended proportion is 1:1, but it is advisable to check individual tolerance on a small area of skin. If painful sensations occur, change the proportions of the compress towards increasing the potato mass.

The resulting mixture is applied to the sore spot and the cake is held until completely dry. The compress can be secured with a bandage or simply lie down without moving until the mixture dries.

Sedatives

Decoction of mint leaves with honey

This remedy is taken orally as a sedative. The decoction is prepared from fresh or dried peppermint leaves; regular mint is not suitable for salads. It'll take a handful fresh leaves or 1 tbsp. l. dry. Pour a glass of boiling water over the herb, cover and leave for about half an hour. Then you need to strain the infusion, you can add a couple of teaspoons of honey. Take half a glass twice a day.

Infusion of lemon balm and orange peels

This is also a sedative. Dry and chop the orange peel (you can chop it finely before drying), mix with dry lemon balm leaves in a 1:1 ratio. Pour one tablespoon of the mixture into a glass of boiling water, cover and leave for 10 minutes, strain and add 1 tsp. alcohol infusion valerian. If desired, you can add a little honey to the mixture. Take the product twice a day, a glass, for a month.

Taking a sedative in the morning can reduce the reaction rate, which is especially dangerous for drivers, so it is recommended to reduce the dose or not drive.

Therapeutic baths

A decoction of young aspen bark is used for a medicinal bath.

Young thin branches of aspen or poplar (0.5 kg) are poured with water and boiled for half an hour.
Then they insist for the same time.
The resulting decoction is added to bath water (water temperature approximately 40 degrees).

clean water

healing effect

Elderly people and those who suffer from certain diseases (for example, heart problems) should consult a doctor before using baths - these procedures put a lot of stress on the body, and instead of the expected benefits, they can cause harm.

It’s sad, but often the cause of intercostal neuralgia is age. Time cannot be stopped or rewinded, so take care of yourself and take care of your spine. Follow well-known rules– a little movement, a little self-control and food restrictions, a positive attitude – and live happily ever after.

Severe pain in the ribs prompts a person to go to the doctor to find out how to treat intercostal neuralgia and what medications to suppress the symptoms of the disease.

Intercostal neuralgia does not belong to the category of dangerous diseases. But it develops against the background of serious pathologies and develops into serious complications. Neuralgia is caused by intervertebral protrusions and hernias, tuberculosis, diabetes mellitus, multiple sclerosis, tumors.

The symptoms of neuralgia are such that they can easily be confused with signs renal colic, cholecystitis, angina pectoris. Put correct diagnosis and only a doctor can prescribe treatment based on diagnostic studies.

Use of medicines – main way treatment of intercostal neuralgia. To treat the disease and the cause that caused it, the following is prescribed:

pills;
injections for intramuscular and intravenous administration;
ointments, gels or creams.

The form of medication for intercostal neuralgia is chosen by the doctor. Medicines are prescribed taking into account the severity of the disease, the patient’s well-being and contraindications.

Tablets are considered an ineffective treatment for intercostal neuralgia. In addition, they irritate the mucous membranes gastrointestinal tract, cause adverse reactions. Erosive gastritis and stomach ulcer - possible harm from uncontrolled use of tablets.

Pain relievers

The primary goal of drug therapy is to relieve pain – the main symptom of the disease. Pills and injections help get rid of prolonged debilitating pain. For pain relief the following is usually prescribed:

Spazgan;
Analgin;
Baralgin;
I took it.

To relieve unbearable pain that occurs with swelling of nerve fibers and root compression syndrome, the following is used:

Ketoprofen;
Ibuprofen;
Celebrex;

Analgesics are used to relieve pain and prevent new attacks:

Panadol;
Tylenone;
Pentalgin.

These drugs are available in tablets, injection solutions, in the form of ointments and gels. They are taken in tablets. To quickly relieve pain, injections are given and IVs are placed.

The course of treatment with anesthetics is short, it does not exceed 4-5 days. They disrupt the normal functioning of the gastrointestinal tract.

Local painkillers

Local anesthetics relieve swelling and pain of a neuralgic nature. They are prescribed for temporary relief of acute pain. Reduce pain and eliminate muscle tension ointments, gels, solutions for injections.

The drugs are applied or injected directly into the lesion. They are used to make blockades. Pain is suppressed with injections of Lidocaine, Novocaine or Xylocaine. Application local anesthetics limited in time. They are highly toxic agents that can cause great harm to the body. Unbearable pain removed with one-time blockades.

Anti-inflammatory medications

Inflammatory processes occurring in nerve fibers lead to swelling and pain. The swollen tissue puts pressure on the nerves. Pinched nerve roots are accompanied by pain. Relieving inflammation, eliminating pain.

Inflammatory processes are suppressed with non-steroidal anti-inflammatory drugs:

Ortofen;
Nimesulide;
Ketoprofen;
Voltaren;
Movalis.

The products effectively relieve inflammation. If you use them correctly, according to the scheme given by the doctor, you can get a long lasting stable remission. To eliminate inflammation, take a tablet 2 times a day, give an injection, or use rectal suppositories.

The body's susceptibility to drugs is almost the same. But they are best absorbed through the mucous membranes. Long-term treatment anti-inflammatory drugs cause exacerbation of certain ailments (for example, gastritis or ulcers). They should not be used without a doctor's prescription.

Muscle relaxants

Drug treatment for intercostal neuralgia includes muscle relaxants - drugs with a calming effect. They eliminate pain, relax muscles, and improve the patient’s well-being. Which of them can be used for treatment:

Tizanidine;
Tolperisone.

The taken muscle relaxant eliminates congestion in muscle tissue and swelling. For treatment, use a drug prescribed by a doctor.

Vitamin therapy

To suppress inflammatory processes, replenish vitamins and minerals, and strengthen the immune system, it is necessary to take special complexes. Medicines with B vitamins are involved in blocking acute inflammatory processes that erupt in nerve tissues. Vitamin complexes relieve muscle spasms, neutralize negative impact medications used.

Sedatives

Painful sensations worsen the well-being of patients, plunge them into a state of prolonged stress, create a feeling of discomfort, and reduce the quality of life. Taking sedatives for intercostal neuralgia helps relieve nervous tension, relax skeletal muscles, normalize the condition of a sick person.

For this purpose, medication with a sedative extract can be included in drug therapy. medicinal plant. Suitable for treatment:

Chamomile;
Mint;
Motherwort.

Herbs with a sedative effect are used separately or preparations are made from them. It is worth drinking infusions and decoctions from them. Pharmaceutical preparations have an effective effect: syrups, tinctures.

They drink a sedative at night. It promotes good sleep, good rest, relieves nervous and muscle tension. Essential oils: lavender and peppermint have an excellent relaxing effect.

Medicines with bee and snake venom

Eliminate intercostal neuralgia with medicines based on snake oil and bee venom. The effectiveness of ointments and gels with these poisons is quite high. They warm up the skin, accelerate blood circulation, remove metabolic products, and saturate tissues with bioactive substances. The drugs regenerate damaged nerve tissue.

The product with poison is used externally, it is rubbed into the lesions with soft massaging movements, bypassing the heart area. For treatment use:

Apisatron. Ointment with bee venom suppresses pain and inflammation, restores blood flow.
Viprosal. Ointment with viper venom eliminates pain and improves blood circulation. Camphor and fir, which the drug contains, have an analgesic effect.

These ointments are used as prescribed by a doctor. They are not always used for treatment of:

lactation;
pregnancy;
allergies;
heart diseases.

Antiviral agents

Problem: how to treat intercostal neuralgia of a viral nature is easily solved. Antiviral medications are used to suppress it. Effectively fight pathology:

Amiksin;
Remantadine.

Ointments and gels

Remedies for neuralgia in the form of ointments and gels quickly relieve pain. They instantly penetrate through the skin pores into the deep tissues, to the lesion, reduce the severity of pain and eliminate swelling.

External agents stimulate blood circulation, distract from pain, and remove nervous tension. Thanks to them, blood supply to the sore spot improves, nutrition of damaged tissues, and pain goes away.

To treat intercostal neuralgia use:

Fastum-gel. The product relieves pain, stimulates blood flow, and eliminates swelling.
Capsicam. The ointment, due to its effective warming effect, accelerates the supply of blood to tissues. It restores tissue trophism and helps replenish nutrients.
Finalgon. The ointment warms up. Thanks to her blood vessels are expanding. Blood flow increases. Oxygen and nutrients enter the tissues.
Indomethacin, Ortofen, Naklofen, Ibuprofen. Ointments fight inflammation, swelling and pain.
Menovazin. The ointment has a pronounced analgesic effect.
Chondroxyl. The chondroprotector restores mobility to the spine.

Preference is given to ointments. Their rate of penetration into tissue is higher than that of gels. On early stages and at severe pain use ointments that can relieve muscle spasms and relax muscles.

Patients suffering from sharp pain, try not to prescribe ointments with a burning effect. By increasing stimulation at the site of the lesion, it is possible to provoke the development of an ischemic crisis or heart attack due to excessive outflow of blood from the coronary vessels.

Antispasmodics

With neuralgia, the muscle tissue surrounding the damaged nerve fibers spasms, their tone is excessively high. Without eliminating muscle spasms, you cannot get rid of pain. Increased tone relieved with antispasmodics:

Besalol;
Halidor;
No-spy;
Papazol.

To eliminate spasms, they take pills and give injections.

Intercostal neuralgia requires comprehensive therapeutic treatment. Thanks to it, pain is quickly relieved, the patient’s well-being is improved, and the inflammatory processes that cause the disease are blocked. Prescription of treatment by the doctor - prerequisite. The prescribed medications will give the maximum therapeutic effect and will not allow complications to develop.

Damage to the intercostal nerves, accompanied by acute pain syndrome. Characterized by paroxysmal shooting or burning pain in one or more intercostal spaces, running from the spinal column to the sternum. Diagnosis is based on complaints and an objective examination of the patient, to exclude/identify pathology of the spine and internal organs Additional examination is carried out using radiography, CT, and endoscopy of the gastrointestinal tract. The main directions of therapy are etiotropic, anti-inflammatory, neuroprotective and physiotherapeutic treatment.

General information

Intercostal neuralgia is a pain syndrome associated with damage to the intercostal nerves of any etiology (due to pinching, irritation, infection, intoxication, hypothermia, etc.). Intercostal neuralgia can occur in people of different ages, including in children. Most often it is observed in adults. The most common is intercostal neuralgia, caused by osteochondrosis of the spine with radicular syndrome or intervertebral hernia of the thoracic region, and also caused by herpes zoster. In some cases, intercostal neuralgia acts as a “signaling signal” serious illnesses structures that form the chest or organs located within it (for example, pleurisy, tumors of the spinal cord, chest and mediastinum). In addition, left-sided intercostal neuralgia can mimic cardiac pathology. Due to the diversity of etiologies of intercostal neuralgia, patient management is not limited to clinical neurology, but often requires the participation of related specialists - vertebrologists, cardiologists, oncologists, pulmonologists.

Anatomy of intercostal nerves

Intercostal nerves are mixed, containing motor, sensory (sensitive) and sympathetic fibers. They originate from the anterior branches of the spinal roots of the thoracic segments spinal cord. There are a total of 12 pairs of intercostal nerves. Each nerve passes in the intercostal space below the edge of its corresponding rib. The nerves of the last pair (Th12) pass under the 12th ribs and are called subcostal. In the area from the exit from spinal canal up to the costal angles, the intercostal nerves are covered by the parietal pleura.

Intercostal nerves innervate the muscles and skin of the chest, anterior abdominal wall, mammary gland, costophrenic part of the pleura, peritoneum lining the anterolateral surface abdominal cavity. The sensory branches of adjacent intercostal nerves branch and connect with each other, providing cross-innervation, in which an area of skin is innervated by one main intercostal nerve and partially by the superior and inferior lying nerve.

Causes of intercostal neuralgia

Damage to the intercostal nerves may be inflammatory nature and be associated with previous hypothermia or infectious disease. The most common neuralgia of infectious etiology is intercostal neuralgia due to herpetic infection, the so-called. herpes zoster. In some cases, damage to the nerves is associated with their injury due to bruises and fractures of the ribs, other injuries to the chest, and spinal injuries. Neuralgia can occur due to compression of nerves by intercostal muscles or back muscles with the development of muscular-tonic syndromes associated with excessive physical activity, working in an uncomfortable position, reflex impulses in the presence of pleurisy, chronic vertebrogenic pain syndrome.

Various diseases of the spine (thoracic spondylosis, osteochondrosis, intervertebral hernia) often cause irritation or compression of the intercostal nerves at the point of their exit from the spinal canal. In addition, the pathology of the intercostal nerves is associated with dysfunction of the costovertebral joints due to arthrosis or post-traumatic changes in the latter. Factors predisposing to the development of neuralgia of the intercostal nerves are deformations of the chest and curvature of the spine.

IN in some cases intercostal neuralgia occurs as a result of compression of the nerves by a growing benign pleural tumor, a neoplasm chest wall(chondroma, osteoma, rhabdomyoma, lipoma, chondrosarcoma), aneurysm of the descending thoracic aorta. Like others nerve trunks, intercostal nerves can be affected when the body is exposed to toxic substances, hypovitaminosis with deficiency of B vitamins.

Symptoms of intercostal neuralgia

The main symptom is a sudden one-sided piercing acute pain in the chest (thoracalgia), running along the intercostal space and encircling the patient’s torso. Patients often describe it as “lumbago” or “passing electric current" At the same time, they clearly indicate the spread of pain along the intercostal space from the spine to the sternum. At the beginning of the disease, thoracalgia may be less intense in the form of tingling, then the pain usually intensifies and becomes unbearable. Depending on the location of the affected nerve, pain can radiate to the scapula, heart, and epigastric region. Pain syndrome is often accompanied by other symptoms (hyperemia or pallor of the skin, local hyperhidrosis) caused by the lesion sympathetic fibers, part of the intercostal nerve.

Characterized by repeated painful paroxysms, lasting from a few seconds to 2-3 minutes. During an attack, the patient freezes and holds his breath while inhaling, since any movements, including respiratory excursion of the chest, cause increased pain. For fear of provoking a new pain paroxysm, interictal period patients try to avoid sharp turns of the body, deep sighs, laughter, coughing, etc. During the period between painful paroxysms along the intercostal space, paresthesia may be noted - subjective sensory sensations in the form of tickling, crawling.

At herpetic infection intercostal neuralgia is accompanied skin rashes appearing on the 2-4th day of thoracalgia. The rash is localized on the skin of the intercostal space. It represents small pink spots, which are then transformed into vesicles that dry out to form crusts. Itching is typical, occurring even before the first elements of the rash appear. After the disease resolves, temporary hyperpigmentation remains at the site of the rash.

Diagnosis of intercostal neuralgia

A neurologist can determine the presence of neuralgia of the intercostal nerves based on characteristic complaints and inspection data. The patient's antalgic posture is noteworthy: in an effort to reduce pressure on the affected intercostal nerve, he tilts his torso in healthy side. Palpation in the affected intercostal space provokes the appearance of a typical painful paroxysm; trigger points. If several intercostal nerves are affected, during a neurological examination an area of decreased or loss of sensitivity in the corresponding area of the skin of the body can be determined.

Clinical differentiation of pain syndrome is important. Thus, when pain is localized in the cardiac region, it is necessary to differentiate them from pain syndrome with cardiovascular diseases, primarily from angina pectoris. Unlike the latter, intercostal neuralgia is not relieved by taking nitroglycerin, but is provoked by movements in the chest and palpation of the intercostal spaces. For angina pectoris pain attack It is of a compressive nature, provoked by physical activity and is not associated with turning the body, sneezing, etc. In order to clearly exclude coronary heart disease, the patient is given an ECG; if necessary, a consultation with a cardiologist is indicated.

When the lower intercostal nerves are damaged, the pain syndrome can mimic diseases of the stomach (gastritis, gastric ulcer) and pancreas (acute pancreatitis). Stomach pathology is characterized by a longer and less intense pain paroxysm, usually associated with food intake. With pancreatitis, girdle pain is also observed, but they are usually bilateral in nature and associated with food. In order to exclude pathologies of the gastrointestinal tract organs, they may be prescribed additional examinations: determination of pancreatic enzymes in the blood, gastroscopy, etc. If intercostal neuralgia occurs as a symptom of thoracic radiculitis, then painful paroxysms occur against the background of constant dull pain in the back, decreasing when the spine is unloaded in a horizontal position. To analyze the condition of the spine, a chest x-ray is performed, if a intervertebral hernia- MRI of the spine.

Intercostal neuralgia can be observed in some lung diseases (atypical pneumonia, pleurisy, lung cancer). To exclude/identify similar pathology A chest x-ray is performed, and if indicated, a computed tomography is performed.

Treatment of intercostal neuralgia

Implemented complex therapy, aimed at eliminating the causative pathology, relieving thoracalgia, and restoring the affected nerve. One of the main components is anti-inflammatory therapy (piroxicam, ibuprofen, diclofenac, nimesulide). In case of severe pain, drugs are administered intramuscularly, therapy is supplemented by therapeutic intercostal blockades with the administration of local anesthetics and glucocorticosteroids. An auxiliary means in relieving pain is the appointment sedatives, allowing to reduce pain by increasing the threshold of excitability of the nervous system.

Etiotropic therapy depends on the genesis of neuralgia. So, for herpes zoster, antivirals(famciclovir, acyclovir, etc.), antihistamines and local application antiherpetic ointments. In the presence of muscular-tonic syndrome, muscle relaxants (tizanidine, tolperisone hydrochloride) are recommended. If the intercostal nerve is compressed at the exit of the spinal canal due to osteochondrosis and displacement of the vertebrae, gentle manual therapy or spinal traction can be performed to relieve the compression. If nerve compression is caused by a tumor, surgical treatment is considered.

In parallel with etiotropic and anti-inflammatory therapy, neurotropic treatment is carried out. To improve the functioning of the affected nerve, intramuscular administration of B vitamins and ascorbic acid. Drug therapy successfully complemented by physiotherapeutic procedures: ultraphonophoresis, magnetotherapy, UHF, reflexology. For herpes zoster, local UV irradiation on the area of the rash is effective.

Forecast and prevention of intercostal neuralgia

In general, with adequate treatment, intercostal neuralgia has a favorable prognosis. Most patients have full recovery. In the case of herpetic etiology of neuralgia, relapses are possible. If intercostal neuralgia is persistent and cannot be treated, you should carefully reconsider its etiology and examine the patient for the presence of a hernia intervertebral disc or tumor process.

Prevention measures include timely treatment diseases of the spine, prevention of its curvature, adequate treatment of chest injuries. The best protection from herpetic infection is high level immunity, which is achieved in a healthy way life, hardening, moderate physical activity, active recreation in nature.

Intercostal neuralgia is a pain syndrome that spreads along the nerve fibers and is accompanied by other unpleasant sensations: crawling sensation, burning sensation, numbness, change in temperature sensitivity. The cause of neuralgia can be any of the factors that can cause damage to nerve tissue.

Intercostal neuralgia must be differentiated from other diseases that cause acute pain in the chest area or radiate to this area.

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What is intercostal neuralgia

Intercostal neuralgia is carpal tunnel syndrome, developing as a result of irritation or compression of the intercostal nerves.

This is one of the most common reasons the occurrence of pain in the chest area.

Causes

The causes of the development of pain syndrome localized along the intercostal nerves are the following pathological conditions:

Mechanical trauma to the intercostal nerve trunks by the edges of adjacent vertebrae. This danger arises when the height of the intervertebral cartilaginous discs decreases or when the vertebrae are displaced as a result of a fall or intense physical stress on the spine. This can happen when you suddenly lift an unusual load. Injure nerve fiber capable of osteophytes - salt deposits on the edges of the vertebrae in the area of the intervertebral foramen, where the nerve exits the spine.
Toxic damage to nerve tissue. Any toxic compounds, including those produced by infectious agents, pose a danger. Drug intoxication can also lead to illness.
Osteoporosis caused by metabolic disorders, characteristic of such conditions as menopause, diabetes mellitus, calcium deficiency in the body, disease of the blood system. Osteoporosis can develop with age and in people who do not suffer from these pathologies.
Compression of the nerve root by scar tissue, a growing tumor, or osteophyte. Deformation of the spine, caused by poor posture, can also lead to compression of the nerve root.
Infectious lesion of the intercostal nerve.
Pinching of the intercostal nerve by tense or swollen muscles soft tissues. This picture is typical for exacerbation of osteochondrosis thoracic spine.

Provoking factors

The development of a painful attack can be provoked by the following factors:

jerky movement, especially after a certain period of being in a stationary position;
stretching;
coughing or sneezing;
laughter;
deep breath.

Clinical manifestations

The clinical picture of intercostal neuralgia is quite characteristic and recognizable.

The pain syndrome develops suddenly and has high intensity. In some cases, the pain is so severe that its sudden onset in a patient with low threshold pain sensitivity can cause involuntary urination, darkening of the eyes, loss of consciousness or a panic attack.

The pain wears sharp character, often encircling - spreads from primary focus along the ribs.

Symptoms

The occurrence of pain in this disease is often accompanied by the following symptoms:

nausea, even vomiting;
dizziness;
headache;
darkening of the eyes;
spots before the eyes;
feeling of coldness in the hands and feet;
change in skin color - paleness or hyperemia;
sudden increase in sweating;
the area of the intercostal spaces where the affected nerve is localized is hyperemic, the skin at the site of the lesion is more sensitive to touch and reacts to it with hyperesthesia, hyperhidrosis, and goosebumps.

Diagnostics

Intercostal neuralgia has a characteristic clinical picture and a diagnosis can be assumed based on a history and examination of the patient.

In doubtful cases, additional diagnostic techniques are used to distinguish intercostal neuralgia from other diseases.

Differential

Despite the characteristic clinical picture, an attack of intercostal neuralgia must be differentiated from the following diseases:

Angina and myocardial infarction.
Pleurisy.
Hepatic colic.
Inflammation of the pancreas.
Injury.

Differences between angina pain:

Characteristic	Intercostal neuralgia	Angina pectoris
Provoking factor (if differential diagnosis A thorough history will help)	Unusually intense physical activity, heavy lifting, sudden movement (turning, sneezing, coughing)	Load, sharp drop temperature (for example, going outside in winter). Pain does not depend on the position of the body in space and movements. Deep sigh, cough, palpation do not increase the intensity of the pain syndrome
Localization	In some cases, pain, starting from a certain area, spreads along the intercostal nerve and becomes encircling in nature. Localization of pain is felt in the intercostal spaces	The localization of the source of pain is subjectively felt inside the chest, behind the sternum, often with a shift from the middle to the left, in the region of the heart. The pain syndrome is not characterized by shingles
Cupping	A prolonged attack of pain due to intercostal neuralgia can be relieved by using analgesics or non-steroidal anti-inflammatory drugs (preferably in the form of injections)	The pain syndrome is relieved within a few minutes by taking drugs from the nitrate group (Nitroglycerin, Nitrospray, Isoket, Nitromint)

They also matter additional methods research. In particular, to exclude angina pectoris and acute heart attack myocardium, an electrocardiogram should be recorded.

Normal electrocardiogram

Absence pathological changes on the recording is an argument in favor of intercostal neuralgia.

Differential diagnosis of pleurisy:

X-rays help distinguish intercostal neuralgia from pleurisy and lung damage. Signs of the first disease are clearly visible on an x-ray and leave no doubt among specialists. In the absence of pleurisy in the image, the contours of the border of the chest and the domes of the diaphragm are smooth, the vascular pattern is uniform, and no extraneous shadows are detected.

Normal chest x-ray

Necessity differential diagnosis With hepatic colic occurs when pain is localized on the right. Ultrasound and biochemical research blood.

Pancreatitis is characterized by the presence of signs of an inflammatory reaction during laboratory diagnostics, as well as registration of increased concentrations of pancreatic enzymes in the blood. The pain syndrome in this case is most intense on the left, and may be girdling in nature, but its intensity is not associated with active movements and palpation of the intercostal spaces.

Shingles (herpes zoster) differs from intercostal neuralgia in osteochondrosis of the spine by the presence of vesicular rashes that appear on the surface of the skin of the chest a few days after the onset of the disease and are localized along the intercostal spaces.

Herpes zoster

However, before the rash appears, these pathologies have very similar manifestations.

Treatment

The pain syndrome during the first attack of intercostal neuralgia can be so severe that it will cause a sharp limitation of the patient’s mobility. Therefore, even before arrival medical care, a set of measures is needed to help alleviate the patient’s condition.

The fastest and most lasting results are achieved by complex therapy, combining various treatment methods.

Protective mode and first aid

In the most acute period of intercostal neuralgia, bed rest is necessary for a duration of 1-3 days.

The patient is advised to lie on a hard surface. To do this, you can put a flat board (sheet of plywood) under the mattress. In this condition, the spine acquires a position as close as possible to the physiological one, which helps reduce compression of the nerve root.

At the very beginning of the disease, it is permissible to use sources of dry heat, but it is necessary to avoid excessively hot heating pads and too long exposure to the source of pain.

The patient should move very carefully, without making sudden movements or turns. Lifting heavy objects should be avoided, any activity of the spine and chest should be limited, and sitting should be limited.

Some relief will come from tightly bandaging the chest (with a wide towel or piece of linen) or wearing a support corset.

It is allowed to lubricate the back with a mixture of iodine and glycerin in equal proportions to reduce the intensity of pain. When applying this composition to the chest, it is necessary to avoid the spine and paravertebral areas.

Drug treatment

In the treatment of intercostal neuralgia they are used the following groups medications:

Group	Description
Nonsteroidal anti-inflammatory drugs	In case of acute pain syndrome, it is more advisable to use injectable forms of drugs, since the effect of administration develops faster compared to tablets. If a painful attack is accompanied by vomiting, then taking pills is not advisable. Medicines of this pharmacotherapeutic group cause an analgesic effect and relieve swelling of soft tissues. The dose of the drug is determined individually by the attending physician based on the severity of symptoms. NSAIDs are recommended for a short course, which should be completed immediately after relief of severe pain. In addition to systemic forms of non-steroidal anti-inflammatory drugs are dosage forms- gels, ointments and patches. Their use reduces pain intensity and reduces treatment time systemic forms NSAIDs and anesthetics
Muscle relaxants	Medicines belonging to this group affect muscle tissue, relieve its spasm, which reduces the pathological effect on the nerve root and helps eliminate the manifestations of the disease
Local anesthetic drugs	Blockades with Novocaine or Lidocaine are used in case of acute pain syndrome, which is not eliminated or is not treated effectively with non-steroidal anti-inflammatory drugs
Corticosteroids	For intercostal neuralgia, physiotherapy with ointments containing glucocorticosteroids is effective. Techniques such as electrophoresis and phonophoresis are suitable for this purpose.
Dimexide	This medicinal solution promotes penetration deep into soft tissues medicinal substances, therefore widely used as a component for medicinal and pain-relieving compresses
Sedatives and hypnotics	Their use is permissible in case of insomnia or psychomotor agitation caused by acute pain syndrome, temporarily until pain relief

Intercostal blockade

Massages and manual therapy

In addition to pharmacotherapy, other methods are used for intercostal neuralgia:

Method	Description
	Exposure must be carried out using careful massage movements without putting excessive pressure on the muscles. For massage, it is advisable to use products with a warming effect. They will help relax the muscles and release the compressed intercostal nerve
Acupressure	The effect is carried out using pressure on certain points associated with the diseased area by bioenergetic mechanisms. This technique causes improvement by mobilizing the body's own protective reserves
Acupuncture	By applying pressure to specific points, the acupuncturist stimulates mechanisms that help eliminate muscle imbalances in deep layers back muscles
Manual therapy	This technique should be used after finishing acute period. The essence of the method is to eliminate the displacement of the vertebrae by returning each of them to its place. After returning the spinal column to its original state, the size of the intervertebral foramina is normalized and the pathological effect on the nerve root is eliminated

Physiotherapy

Along with drug treatment physiotherapeutic methods are used:

Prevention

Prevent relapse of intercostal neuralgia or its transformation into chronic form helps strengthen the muscles surrounding the ribs and spine. Active lifestyle, combating physical inactivity, regular exercise special exercises will make the muscles more resilient and accustomed to the load.

Inflammation of the intercostal nerve in any of the twelve ribs (or) is felt as pain in the back and chest. That is why a significant number of patients first of all turn to the doctor, considering this a sign heart attack. If the nerve in the hypochondrium is inflamed, some people consider this a sign of gallbladder disease.

Inflammation of the intercostal nerve - symptoms

The main symptom of intercostal nerve inflammation is pain in the chest area, which can be bilateral, stabbing, sharp or aching.
The pain is centered around the chest area on both sides and may radiate from the back to the front.
Sometimes there is pain when breathing, laughing, or sneezing.
The pain increases with physical activity.

Other symptoms are:

Bilateral pain radiating to the back.
Pain in the ribs, especially on the left side, which may be mistaken for heart pain or angina.
Numbness and/or tingling.
Abdominal pain is also a symptom of intercostal neuralgia.
Loss of appetite.
Pain in the arms and/or shoulders. Direction of pain on the left side shoulder joint and shoulder pain are often mistaken for heart pain or angina.

Some more serious symptoms:

One of the symptoms of intercostal neuralgia with inflammation of the nerve of the chest or rib is pain that radiates to the left hand, shoulder and back.
Constant cough with yellowish-green sputum.
Heart rate increased.
Difficulty breathing.
Acute pain in the abdomen.
Sharp chest pain when breathing or coughing.
Sudden confusion, dizziness, or change in level of consciousness.
Paralysis and muscle atrophy.

Causes of development of intercostal neuralgia

Inflammation of the nerve in the intercostal space can be caused by:

infections,
inflammations,
injuries,
other processes.

One of the most common causes of intercostal neuralgia is surgery chest cavity, which can cause damage to the intercostal nerves.

Some of the reasons are also:

Wound to the chest or rib.
Pinched intercostal nerve.
Degeneration of nerves.
Neuritis.
Pregnancy.
Rib infection.
Surgical procedure in and around the chest cavity.
Tumors around the chest or abdomen.
Injuries to the ribs and intercostal nerves.

Treatment of inflammation of the intercostal nerve

Depending on the cause of the pain, the type of treatment is selected.

In cases where the nerve gets into the suture after surgery, then suture material must be cut out.
Painkillers for neuropathic pain and capsaicin cream are good for relieving pain associated with nerve inflammation.
Sometimes doctors recommend an epidural injection.
In some cases, blocks using local anesthesia or corticosteroids.
NSAIDs can also help relieve pain and reduce inflammation.
Antidepressants for intercostal neuralgia help in calming the pain.
Antihistamines are used to relieve itching.
Antiviral medications reduce the severity and duration of symptoms.
Corticosteroids help in reducing the risk of postherpetic neuralgia.
Other treatments for intercostal neuralgia include cold therapy, acupuncture, yoga, etc.

Inflammation can also occur as a result of pinching. In this case, the treatment is practically no different from