What to Know About Intercostal Neuralgia

Medically Reviewed by Arefa Cassoobhoy, MD, MPH on July 20, 2023
4 min read

Intercostal neuralgia is nerve pain that affects the area below your ribs and can be caused by several different conditions. People with intercostal neuralgia experience a lot of pain in their ribs, chest, or upper abdominal area.

Pain is the main symptom of intercostal neuralgia and usually occurs in a band that wraps around your chest or abdomen. This pain may be constant or intermittent, and you may also experience numbness and tingling with it. The pain itself, which could last long after whatever caused it subsides, might be:

  • Sharp
  • Aching
  • Radiating
  • Burning
  • Stabbing

Pain caused by intercostal neuralgia may worsen with movements such as jumping, coughing, or sneezing. You might also experience it while breathing in and out, or you could feel it as referred pain in your shoulder blade, back, or groin.

Intercostal neuralgia is caused by injury and inflammation to the intercostal nerves. The intercostal nerves branch off of the spinal cord and run under your ribs. Several different conditions and injuries can damage these nerves. Here are a few.

Post thoracotomy pain syndrome (PTPS). This occurs after a thoracotomy, which is a surgical incision made between your ribs, usually during a procedure to access your lungs or heart. The incision can cause trauma to the intercostal nerve, which may be what causes the pain.  

About 50% of people who have a thoracotomy have PTPS. About 30% of people still have pain four to five years after surgery. In most people, the pain is mild and doesn't interfere with their daily lives.

Postherpetic neuralgia. This is a complication of shingles. You can develop shingles if you've ever had chickenpox. Once you've had chickenpox, the virus stays in your body for the rest of your life. The virus can reactivate and cause shingles if your immune system weakens. This can happen due to aging or if you're taking medicines to suppress your immune system. 

Postherpetic neuralgia is a chronic condition that may last long after your shingles clear up. Between 30% and 60% of people age 60 and older who get shingles will develop postherpetic neuralgia. You should see your health care provider as soon as you suspect you're coming down with shingles. You're less likely to develop postherpetic neuralgia if you start antiviral medicine within 72 hours of developing a shingles rash.  

Trauma. A traumatic injury can cause damage to your intercostal nerves that leads to intercostal neuralgia. 

Medical procedures. You may develop intercostal neuralgia after medical procedures such as a chest tube placement, mastectomy, or other breast surgery.  

Other causes. Other conditions can cause intercostal neuralgia, too, including:

Treatment for intercostal neuralgia will depend on how severe your symptoms are, other medical issues you may have, and your preferences. You may need a combination of treatments for effective pain control, including some of the following options.

Medicines. Nerve pain does not usually respond well to aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or low-dose narcotics. Over-the-counter medicines that may help include capsaicin creams, lidocaine gel, or lidocaine patches.

Your doctor may prescribe antidepressants to treat your pain, even if you don't have depression. Doctors don't know exactly why antidepressants help with nerve pain, but people usually get moderate relief within a few weeks. Antidepressants that may be used to treat intercostal neuralgia include: 

Another type of medicine that may help treat intercostal neuralgia is an anticonvulsant, like:

Opioid pain killers such as tramadol, oxycodone, or morphine may be used to treat nerve pain. Opioids, though, bring a risk of addiction and death. The CDC recommends that doctors consider other treatments for pain that isn't related to cancer. If you do use opioids, your doctor will need to closely monitor you. You should use the lowest possible dose.  

Procedures. Your doctor may perform a procedure such as an intercostal nerve block to inject steroids and pain-relieving medicine. This can help calm the inflammation and relieve pain. Other procedures that may help include a thoracic epidural, and dorsal root ganglion pulsed radiofrequency.

Therapy. If you're in a lot of pain, you should avoid physical activity. This can cause you to lose muscle strength. Physical and occupational therapy may be needed to make sure you don't lose muscle mass. Your therapist may also be able to use heat and cold treatments to help with pain relief.