INTERCOSTAL NEURALGIA

Pain--has an Element of Blank--

It cannot recollect

When it began--or if there were

A time when it was not--

It has no Future--but itself--

It's Infinite Contain

It's Past--enlightened to perceive

New Periods--of Pain. 

Emily Dickinson 

The unforgettable pain 

The first type of intercostal neuralgia is caused by herpes zoster, the same virus that leads to chickenpox in children and shingles (a painful skin rash with blisters) in adults.  

In short, intercostal neuralgia means a burning, stabbing pain that engulfs the bottom of the rib cage on one or both sides. "Walking to work this morning,” a patient tells, “I suddenly felt an awful spasm in the left upper quadrant that soon became exceedingly painful. I was sure I was having a heart attack… Three years later, I’m still suffering from this pain, and I still do not know its cause. It is especially bad when I’m sitting or going to bed. It hurts to cough and take deep breaths; I can hardly sneeze or laugh." When a rash of small watery blisters accompanies the pain, it points to infectious intercostal neuralgia. More often, however, this condition is due to the compression of nerve roots or intercostal nerves.  

Two causes, two treatments 

The former condition is caused by the same herpes zoster virus responsible for chickenpox in children and shingles (a painful skin rash with blisters) in adults. This virus can damage nerve tissue and hide in the spinal cord nerve roots. 

The pain caused by intercostal neuralgia ranks third on the list of the severest pains, along with acute kidney pain. The attacks may involve muscle convulsions, sweating, tingling in the thorax; the patient’s skin may take on a reddish or pale hue.  

Various kinds of stress that weaken the immune system may activate the virus and trigger inflammation of intercostal nerves.  Since this disease is infectious, your doctor is likely to prescribe antiviral drugs. Regrettably, even after the contagion is eliminated, postherpetic neuropathy (intermittent chronic pain along the impaired intercostal nerves) may well follow.  This disorder calls for a serious, complex treatment including anti-inflammatory medication and strong painkillers such as Lidocaine patches or injections. It is also quite resilient and offers a real challenge to both the sufferer’s patience and the physician’s skill.  

The second type of intercostal neuralgia is due to the irritation or pinching of an intercostal nerve or its roots that come out of the spine. 

The second type of intercostal neuralgia results from the irritation or pinching of an intercostal nerve or its roots that come out of the spine. These highly vulnerable roots pass through a narrow gap between the vertebrae, just behind those intervertebral disks that, if you recall, are prone to herniating. This may happen after physical exertion (like weight lifting) or because of a lack of regular exercise, when core muscles become too weak to protect intervertebral disks even from a minor load. Herniated disks “pinch” the nerve roots in this narrow gap (like a finger caught in a door), causing severe pain, muscle spasms, and inflammation (reddening and swelling). In this case, as you may imagine, antiviral drugs are pretty useless.

You need medicines that reduce spasms, inflammation, pain, and swelling.  A bandage or a belt around your mid-body should alleviate the pain and improve blood supply by providing some relaxation to the muscles that are working hard to immobilize the problem area.  

Anything else in stock? 

Surprising as it may sound, another quick remedy against pain is ice – and not heat, as commonly thought. As you know, exposure to heat means a more vigorous blood supply, a higher body temperature, reddening, and swelling. But pain is already accompanied by all of these. Would you extinguish a fire with gasoline? No, it is water that stops fire. In a similar way, it is cold that stops inflammation. Don’t play a martyr, though: prolonged exposure to cold may intensify pain and spasms. Apply an ice pack for a minute or two, move it slowly around as if chasing the receding pain. This will also reduce swelling and facilitate your blood flow, therefore soothing inflammation and promoting a fast recovery of the injured nerve root.  

Inflammation yields well to certain time-tested pharmaceuticals. Please note that the famous Tylenol or Aspirin are good painkillers but have little anti-inflammatory effect. On the other hand, Ibuprofen (also marketed as Motrin, Advil, and under other trademark names) helps against pain as well as inflammation. Just make sure you use the right dosage of 10 mg per 2.2 pounds of body weight. If you weigh in at 175 pounds, take 800 mg (FOUR 200 mg pills) a day. A lesser dose would benefit you no more than a glass of holy water.  

The ultimate remedy 

Comprehensive treatment of intercostal neuralgia includes professional manual therapy combined with anti-inflammatory and pain-killing remedies. 

Well, the best way to deal with a finger caught in a door is to open that vicious door. In a similar way, a pinched nerve root needs to be released. This can be done by means of professional manual therapy combined with anti-inflammatory and pain-killing drugs. Your first visit to the doctor would typically last about 30 minutes and include manual diagnostics (the precise identification of the injured area and the associated muscles), neuromuscular massage, and manual therapy (targeted pressure on blocked muscles and joints to reduce spasms and swelling, restore normal circulation, and launch the self-healing processes).

Additional diagnostic tools such as MRI, X-ray, or lab tests may be used as appropriate. The doctor would also prescribe the right medication to reduce inflammation and eliminate pain. In serious cases, if need be, you may receive injections into trigger points and joints.  

As a rule, a combination of manual therapy and medication can take care of even the most complicated and advanced cases of intercostal neuralgia.