Pain in the thoracic spine (osteochondrosis, intercostal neuralgia)

Approximately 5% of patients who visit doctors at the clinic complain of chest pain. Their causes are different - sometimes they go away quite quickly on their own, and sometimes they are caused by serious diseases. “Neuralgia of the chest” - many people often use this term, but various pathologies can be hidden behind it.

Our expert in this field:

Lashch Natalia Yurievna

Neurologist of the highest category, candidate of medical sciences, associate professor. Laureate of the Moscow City Prize in the field of medicine.

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What is intercostal neuralgia?

Neuralgia of the intercostal nerves is pain of a different nature that occurs due to various etiological factors. It is more often observed in adult men and women over 30-35 years of age. Symptoms of neuralgia may appear suddenly on one or both sides of the chest, along one or more intercostal nerves. The disease has an ICD code - M.79.2.

To understand what intercostal neuralgia is, you should understand the anatomical features of the thoracic nerves. There are 12 pairs in total. Each intercostal nerve contains motor, sensory and sympathetic fibers. It originates from the anterior roots of the spinal cord of the thoracic spine, passes along the lower edge of each rib, reaching the sternum. The parietal pleura covers the nerve fibers on top.

Thoracic nerves transmit impulses to the skin, the musculo-ligamentous apparatus of the chest and the anterior wall of the abdomen, partly the pleura and peritoneum, and the mammary glands. Sensitive fibers of neighboring nerve trunks actively interact with each other, creating cross innervation.

How to distinguish intercostal neuralgia from heart disease?

If neuralgia has acute symptoms in the thoracic region on the left side, differential diagnosis with heart disease must be carried out. You should not look for the cause of the pain syndrome on your own. Thoracalgia on the left side should always be a reason to consult a doctor.

Heart pain and symptoms of intercostal neuralgia on the left have distinctive features:

Symptoms of intercostal neuralgia on the left and right should also be differentiated from other diseases (pleurisy, pneumonia, thoracic aortic aneurysm, pericarditis, acute pancreatitis and others). If there is severe pain in the chest, only a doctor can determine exactly what it is - neuralgia or another pathology.

Causes of intercostal neuralgia and risk factors

Intercostal neuralgia can develop for a variety of reasons. Among them are:

• injuries to the thoracic nerves, chest and spine;
• surgical interventions, long-term immobilization of a person in a certain position;
• poisoning with chemicals, prolonged use of medications;
• congenital developmental anomalies, hereditary diseases;
• infectious processes (shingles, tuberculosis, brucellosis and others);
• some neurological diseases, such as radiculitis and multiple sclerosis;
• diseases of the spine (osteochondrosis, deforming spondylosis, herniated intervertebral discs);
• compression of nerve branches in the bone-connective sheaths, for example, in the presence of scar changes, benign or malignant neoplasms;
• immunodeficiency (HIV infection, cancer, etc.);
• allergic reactions;
• diabetes;
• various metabolic disorders in nervous tissue and its hypoxia;
• lack of B vitamins in the body;
• alcohol abuse;
• osteoporosis;
• pathology of nearby anatomical structures (aorta, lungs, pleura);
• various systemic diseases (atherosclerosis, rheumatism, anemia, thyrotoxicosis, etc.).

More often, chest neuralgia appears due to several causes. Therefore, it is typical for older patients with vascular, degenerative and metabolic disorders. Sometimes symptoms of neuralgia appear after excessive physical activity, sudden movements or prolonged stay in one position. They can also occur after hypothermia or severe stress.

More often, intercostal neuralgia is observed on the left or right; less often, there is a bilateral lesion. In most cases, the pathogenesis is based on muscle spasm, leading to compression of nerve fibers. Pain occurs in response to nerve damage.

In children, signs of intercostal neuralgia are rare. When they appear, parents should definitely show the child to the doctor, as this may be a signal of the presence of a serious pathology. The doctor will determine the possible causes and explain how to cure intercostal neuralgia in this case.

Features of the course and causes of the disease in women

Pain associated with intercostal neuralgia in women extends mainly to the area of ​​the heart and mammary glands. The pain intensifies with every sudden movement.

The disease develops for the following reasons:

• Osteochondrosis of the thoracic spine.
• Reduction in the volume of intervertebral cartilage.
• Hypothermia. Cold leads to pinched nerve endings. Systematic exposure to low temperatures provokes the disease to become chronic.
• Alcohol abuse, drug use. Bad habits provoke irritation of the peripheral nervous system, and this can cause the development of intercostal neuralgia.
• Tumors and hernias of the spine.
• Spinal injuries. Injuries in the chest and neck area are especially dangerous. When injured, the nerve root is irritated, which during the healing process changes shape and location, moves into the healing scar, and is compressed by bone calluses.
• Excessive physical activity, heavy lifting. Overexertion of the female body leads to micro-tears of the intercostal muscles. During the healing process, the nerve roots change or move, subsequently causing pain.
• Infectious diseases: herpes, pleurisy, pneumonia.
• Hormonal imbalances.
• Diabetes.

Important! A common cause of intercostal neuralgia in women is wearing a tight, uncomfortable bra. Compressing the chest area with underwear causes permanent injury to the nerve endings.

Most often, thin women suffer from this problem, since their body is not protected by a fat layer.

Forms of the disease

Chest neuralgia can be primary (an independent pathology) and secondary (a symptom of another disease). There are also radicular and reflex forms of the disease. In the first case, symptoms of intercostal neuralgia on the left and right arise due to irritation of the spinal roots. The second type of pathology occurs due to a negative effect on peripheral receptors.

In addition, clinicians distinguish the following types of thoracic neuralgia:

• musculoskeletal;
• vertebrogenic;
• spicy;
• chronic;
• right-sided;
• left-handed;
• psychogenic;
• during pregnancy.

Intercostal neuralgia of a certain type has its own characteristic symptoms and treatment features.

Symptoms of neuralgia on the right and left

Any neuralgia, including intercostal neuralgia, is primarily pain. Painful sensations can be of a different nature (aching, dull, sharp, piercing, burning) and have different intensity. Sometimes the pain is so severe that it forces a person to take a forced position and sharply limit physical activity. Intercostal neuralgia, which has pronounced symptoms, is described by patients as a lumbago or electric current discharge running from the spine to the sternum.

Thoracalgia often begins gradually, with a tingling sensation in the intercostal spaces, then acquires pronounced intensity. Less often it occurs suddenly. The pain can radiate to the scapula, epigastric area, heart, arm and lower back. Sometimes it takes on an encircling character. It intensifies with changes in body position, movements, coughing and deep breathing.

As a rule, painful attacks are constantly repeated, lasting from a few seconds to 2-3 minutes. Therefore, treatment of acute intercostal neuralgia on the right and left, first of all, always begins with the elimination of pain.

In addition to thoracalgia, a person may be bothered by characteristic local signs caused by the influence of sympathetic, sensory and motor nerve fibers. Intercostal neuralgia, depending on the damage to a particular nerve, will have characteristic symptoms on the right, left or both sides of the chest:

• impaired sensitivity, crawling sensation, numbness, tingling;
• muscle twitching;
• increased sweating;
• change in skin color.

If chest neuralgia appears against the background of a herpes infection, it may be accompanied by skin rashes. The latter appear 2-4 days after the onset of thoracalgia. Elements of the rash are located on the skin of the intercostal space in the form of small pink spots, which then turn into vesicles and then into crusts. Subsequently, traces of pigmentation may remain on the skin.

Self-massage

You can reduce pain by rubbing and stroking the intercostal spaces with your fingertips. This must be done in a sitting position. You can also knead your back muscles with both hands or clasp your hands and rub them from the lower back to the shoulder blades. In addition, massage of the reflexogenic zone located on both sides of the thoracic region between the first lumbar and seventh cervical vertebrae can help you. The most effective way is to massage the points between the fourth and fifth thoracic vertebrae for two minutes using Golden Star balm. If you don’t have a balm on hand, just massage with clean fingers and then apply a pepper patch to the indicated points.

Diagnosis of intercostal neuralgia

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Acute intercostal neuralgia is a reason to contact a competent, qualified neurologist. Since symptoms in adults with damage to the thoracic nerves can be disguised as other diseases, the patient must undergo a comprehensive examination to exclude possible pathology. The doctor must conduct a survey and examination.

The person’s posture is noteworthy when he leans towards the healthy side, so as not to provoke a painful attack. Palpation of the chest reveals pain. Trigger points are identified at the lower edge of the rib, where the affected nerve passes. If neuralgia affects several nerve branches, which often happens, this leads to a decrease or complete loss of sensitivity in the corresponding area of ​​the body.

First of all, the doctor must distinguish the symptoms of intercostal neuralgia on the left from cardiovascular pathology. For this purpose, the patient undergoes an ECG. If indicated, a cardiologist is consulted. In order to correctly diagnose and treat intercostal neuralgia, the doctor also excludes diseases of the respiratory system, digestive tract, musculoskeletal system, infectious processes and other diseases. He may prescribe a number of additional tests (laboratory tests, x-ray of the lungs, ultrasound of the abdominal organs, MRI of the spine, etc.).

Thoracic neuralgia is an indication for electroneurography. This method allows you to determine the condition of nerve fibers by assessing their structure and functionality.

Chest neuralgia can be a manifestation of benign and malignant tumors. It is often the first symptom of a herniated disc and degenerative changes in the spine. Therefore, early identification of its causes is considered an important task for the neurologist and the patient.

How to treat intercostal neuralgia?

Treatment of any neuralgia, including intercostal neuralgia, is aimed at eliminating the clinical manifestations and causes of the disease. Therapy includes a whole range of activities. If a patient is diagnosed with neuralgia, you can find out how to treat it from the specialists of our clinic. The doctor will select the optimal therapeutic course, taking into account the characteristics of the disease and the individual characteristics of the person.

As a rule, intercostal neuralgia requires long-term treatment and further measures to prevent painful attacks. The doctor prescribes specific methods of therapy, determines the duration of each course, and gives his recommendations on lifestyle and regimen. The treatment plan may include:

• painkillers;
• etiotropic therapy aimed at combating the underlying disease;
• anti-inflammatory drugs;
• neurotropic drugs;
• physiotherapy;
• osteopathy;
• massage;
• Exercise therapy.

The doctor always chooses how to treat neuralgia, based on the clinical picture, the stage of the process, the results of diagnostic examinations and the individual characteristics of the patient.

Treatment

Intercostal neuralgia requires complex and often long-term treatment, including medication, physiotherapy, massage, etc.

Drug therapy

In the acute phase of the disease, therapy is aimed at relieving pain and improving the patient's condition. Depending on the specific clinical situation, the following are prescribed:

• non-steroidal anti-inflammatory drugs (NSAIDs): products based on diclofenac, nimesulide, ibuprofen, meloxicam and their derivatives; used in tablet, injection and local (creams, ointments, patches) form;
• analgesics: analgin and products based on it; like NSAIDs, they relieve pain;
• muscle relaxants to eliminate muscle spasms: mydocalm, etc.;
• group vitamins: milgamma, neuromultivitis, etc.; necessary to restore normal functioning of nerve fibers;
• sedatives to reduce the psycho-emotional component of pain and improve sleep.

If necessary, the following may additionally be prescribed:

• anticonvulsants: inhibit the passage of pain impulses;
• antidepressants to relieve tension;
• antihistamines and diuretics: relieve tissue swelling, especially relevant for pinched nerve roots;
• antiviral drugs for herpes zoster;
• glucocorticosteroids for persistent pain and severe inflammation that cannot be relieved by milder means.

Physiotherapy and exercise therapy

Physiotherapeutic procedures are prescribed after the acute pain subsides. Help speed up recovery:

• UHF;
• reflexology;
• magnetic therapy;
• electrophoresis;
• laser treatment;
• paraffin applications;
• mud therapy.

These procedures help improve blood circulation and metabolism in the affected area and accelerate the regeneration of nerve tissue.

Physical therapy exercises are prescribed after complete recovery. The main goal of gymnastics is to unload the back muscles. The complex is developed individually. The first classes should be carried out under the supervision of a specialist; in the future, home exercises are allowed.

Other treatments

Since very often the cause of intercostal neuralgia is pathology of the spine and spinal cord, the following are often used as additional methods of influence:

• acupuncture;
• manual therapy;
• therapeutic massage, including the use of warming agents;
• Shiatsu massage (acupressure);
• osteopathy;
• underwater traction and other techniques.

Like all medical procedures, these techniques are used only in a clinical setting and are carried out by specialists with medical education and the appropriate certificate.

Is osteopathy effective for intercostal neuralgia?

The causes of neuralgia in the rib area can be different. However, in many cases, a pinched nerve is caused by the consequences of various injuries a person has received in the past. The capabilities of fine diagnostics using hands make it possible to identify and eliminate these disorders, which leads to the elimination of compression of the nerve and the restoration of its normal blood supply. As a result, inflammation and its integral companion – pain – go away. Osteopathy shows high effectiveness in the treatment of both unilateral and bilateral intercostal neuralgia.

Possible complications and consequences

Any neuralgia, in particular intercostal neuralgia, that does not respond to treatment, may be a sign of a serious illness. Most of the complications that arise with thoracalgia are precisely a manifestation of the underlying pathology, which worsens against the background of constant pain.

Chest neuralgia itself, with a long-term severe course, can provoke the development of a hypertensive crisis or an attack of angina (less often, myocardial infarction). Severe, constant pain affects a person’s physical and mental state in different ways. Often severe symptoms of intercostal neuralgia on the left or right significantly complicate the patient’s life. He sleeps poorly, is nervous, cannot move normally and do his usual work.

Pain in the intercostal spaces does not allow the patient to perform full breathing movements, which leads to a decrease in oxygen supply to the body and the development of hypoxia. Sometimes neuralgia is accompanied by such debilitating pain that it contributes to emotional exhaustion, and this is a serious complication, since this condition causes depression.

Treatment at the Energy of Health clinic

Doctors at the Energy of Health clinic will always come to the aid of patients with intercostal neuralgia. We offer each client:

• a full examination with consultations with specialists for an accurate diagnosis;
• individual selection of treatment regimen;
• services of a qualified chiropractor;
• own exercise therapy room for the most effective and safe exercises;
• modern methods of physiotherapy;
• massotherapy;
• drug blockades for severe pain syndrome.

Regular observation by a neurologist after the acute period of the disease has subsided will help prevent recurrent attacks.

Neuralgia during pregnancy

If intercostal neuralgia appears in a pregnant woman, how to diagnose it and how to treat it is decided by a neurologist together with a gynecologist. Therapy is selected taking into account possible negative effects on the fetus. Self-medication in this situation is considered unacceptable, as this can have a negative impact on the health of the expectant mother and child.

To prevent chest neuralgia from appearing during pregnancy, it is advisable to follow preventive measures. If a woman has previously had attacks of thoracalgia, then at the stage of preconception preparation she should visit a neurologist and osteopath. The doctor will conduct a diagnosis, and then the neurologist will give a number of recommendations on how to treat intercostal neuralgia. An osteopath will identify possible causes of neuralgia and conduct a treatment session aimed at eliminating them.

Advantages of the clinic

In the neurology department of the Energy of Health clinic, every patient receives the highest level of specialists and modern equipment for diagnosing and treating diseases. We take an integrated approach to therapy and use not only medications, but also physiotherapy, exercise therapy and massage.

Treatment is prescribed only after a thorough examination and is monitored by a specialist until the patients fully recover. Adequate prices, convenient location, private parking - we do everything for the convenience of our clients.

If intercostal neuralgia interferes with living, walking and moving, do not delay treatment. Sign up for the Health Energy clinic and get rid of pain.

Forecast and prevention of intercostal neuralgia

In most patients, intercostal neuralgia can be completely cured. If thoracalgia occurs against the background of a herpetic infection, relapses are possible.

If adequate treatment of neuralgia does not bring the desired result, a more “deep” diagnosis is carried out to search for the possible cause of this condition. First of all, spinal hernias, benign and malignant tumors are excluded.

To prevent neuralgia of the intercostal branches from recurring, and its symptoms in adults to manifest themselves less painfully, doctors recommend the following preventive measures:

• follow the canons of a healthy lifestyle: give the body adequate physical activity, eat right, actively relax in the fresh air, give up bad habits, etc.;
• maintain normal functioning of the immune system;
• monitor posture and spinal health;
• promptly treat chronic diseases and infectious processes;
• if possible, visit the pool and harden yourself;
• undergo preventive examinations on time;
• undergo regular scheduled examinations by an osteopath approximately once every six months.

If a person has previously had thoracic neuralgia, he should not be overcooled, be in a draft, expose the body to excessive physical stress, perform sudden movements or remain in an uncomfortable position for a long time. In addition, it is necessary to eliminate or minimize as much as possible stress and any unfavorable factors that can cause symptoms of intercostal neuralgia on the left, right or both sides.

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Causes

The list of main causes of intercostal neuralgia includes:

• degenerative-dystrophic diseases of the spine: osteochondrosis, arthrosis, hernias and protrusions of discs, etc.;
• uneven or excessive load on the spine and back muscles (due to carrying heavy objects, poor posture, etc.);
• spinal column deformities (primarily scoliosis);
• diseases of the nervous system, in particular multiple sclerosis;
• infectious lesions: tuberculosis, herpes zoster, influenza;
• injuries of the spine and chest, surgical interventions in this area;
• tumors in the ribs, sternum, spinal column;
• taking certain medications;
• increased load on the respiratory muscles and abdominal muscles;
• increased intra-abdominal pressure, including during pregnancy.

In addition, intercostal neuralgia can occur secondary to other diseases, for example, pleurisy, pathology of the digestive system, kidney disease, thyrotoxicosis, and immunodeficiency states. Adolescents during the period of active skeletal growth may also experience similar symptoms.