Intercostal neuralgia meaning
Intercostal neuralgia is a neurological disorder type characterized by intercostal nerve pain [1,3].
Intercostal nerves are the nerves that occur from the spinal cord and are located under the ribs [1,3].
There are bundles of intercostal nerves and each of these nerves will enter the intercostal space that fits best between the parietal pleura and the posterior intercostal membrane. [1,3].
Facts About Intercostal Neuralgia
- The intercostal neuralgia exact prevalence is not easily known, but it is estimated that 3% to 22% of patients with intercostal neuralgia has chest pain; It is also reported that there are approximately 15% of patients in the global population [1].
- The prevalence of postherpetic intercostal neuralgia is 28% and a history of chest surgery is 43%. [1].
- In elderly patients with intercostal neuralgia, a history of shingles and thoracotomy (thoracic surgery) highest [1].
What causes intercostal neuralgia?
The main intercostal neuralgia cause is pressure on the intercostal nerves.
But apart from that, the other most common causes are inflammation and irritation.
Some of the factors that increase the intercostal neuralgia risk or trigger it are:
1. Injury
An injury to the chest can affect the intercostal nerves [1,3].
When the intercostal nerves are damaged or disrupted due to injury, this then triggers the intercostal neuralgia onset [1,3].
2. Medical Procedure
Certain medical procedures can also be an intercostal neuralgia mayor cause, especially in someone with a history of mastectomy and thoracotomy [1].
Mastectomy is a surgical procedure to remove breast tissue completely [4].
Mastectomy is a surgical procedure that is usually used to treat breast cancer or also sometimes as a preventive measure [4].
Meanwhile, thoracotomy is a surgical procedure to open the chest cavity so that it can overcome the problematic organs in the chest [5].
Thoracotomy is usually used to treat esophageal, lung and heart problems [5].
The doctor will make an incision in the chest wall to be able to reach the organs in the chest cavity and treat according to the needs of the patient’s condition [5].
3. Postherpetic Neuralgia
Postherpetic neuralgia is a complication of herpes zoster (also known as shingles) [1,7].
Herpes zoster is also known as shingles, which is a risk condition for people with a history of shingles chicken pox [6].
Herpes zoster is characterized by a red rash and water-filled bumps on the skin; This is generally caused by the same virus that causes chickenpox, namely the Varicella Zoster virus [6].
When someone has chickenpox, even though after that they can recover and recover well, the virus still survives in the body in an inactive state [6].
The virus that causes chickenpox will be in the body for life and can be reactivated when the immune system weakens [6].
People who are prone to chickenpox are also susceptible to shingles or shingles [6].
Herpes zoster is also capable of causing patients to experience postherpetic neuralgia, especially in patients aged 60 years and over [7].
4. Other Factors
Apart from some of the risk factors already mentioned, intercostal neuralgia can also occur due to a number of other factors listed below: [1,3]:
However, intercostal neuralgia does not always have a definite cause and this condition is known as idiopathic intercostal neuralgia. [8].
Intercostal neuralgia symptoms
The main intercostal neuralgia symptom is a sharp, hot and stabbing pain [1,3].
Generally, this kind of pain occurs in the upper chest, upper back, and rib area [1,3].
In addition to this uncomfortable pain, some other accompanying symptoms are: [1,3]:
- Numbness in one or more of these body parts.
- Tingling
- The pressure on the chest from the front to the back is like being squeezed strongly.
- The pain will get worse when the patient does even normal physical activities, such as light stretching to deep breathing.
- The intensity of the pain increases when the patient sneezes, cough or laugh.
- Pain may also arise in the lower hip and shoulder blade.
If caused by postherpetic neuralgia due to Varicella Zoster virus infection, some of these symptoms will also be experienced [1,3]:
- Extremely increased skin sensitivity
- Itchy skin
- Patients are uncomfortable when dressing because clothes rub against the skin
In cases of very severe intercostal neuralgia, some serious symptoms that need to be addressed immediately are:
- Pain with the sensation of being struck by lightning
- Muscle atrophy (reduction or shrinking of muscle tissue resulting in muscle shrinkage; this causes the sufferer to have difficulty moving the body).
- Decreased appetite
- Twitch
- Muscle weakness or paralysis
Intercostal Neuralgia Examination
A physical examination is the first thing the doctor does by pressing the area between the ribs [1,3].
The doctor will also ask the patient to breathe deeply to find out which part of the body feels pain when breathing.
When from both examinations the patient feels severe discomfort and pain, the doctor can immediately conclude the intercostal neuralgia condition.
If the doctor is not too sure about the physical examination alone, the following methods of supporting examination will be carried out: [1,3]:
- Examination of the medical history, namely by asking the patient in detail about his entire medical history and medical history. Often doctors also ask about the patient’s family medical history to make sure the patient’s symptoms are not related to hereditary diseases.
- Scans such as CT scans, X-rays, or MRI scans will be used by the doctor to check whether the symptoms are due to an injury to the chest.
- Nervous examination, which is to identify problems with the patient’s nervous system.
Intercostal Neuralgia Treatment
There are several methods of treating intercostal neuralgia according to the patient’s condition, namely as follows.
- Antidepressants
The doctor will give you antidepressant drugs that aim to reduce pain related to nerve [1,3].
Some types of antidepressant drugs that are generally prescribed by doctors are:
- Anticonvulsants
In some intercostal neuralgia cases, the doctor may also prescribe anticonvulsants or anticonvulsants, such as [1,3]:
For temporary pain relief, patients can use capsaicin cream or patches that provide heat and relieve pain [1,3].
Lidocaine in the form of a gel can also be used as a pain reliever [1].
- Opioids
For people with intercostal neuralgia who are already classified as severe, doctors will most likely prescribe an opioid-acetaminophen or opioid-aspirin to reduce pain [1].
All types of drugs have their respective side effects and it is important to consult a doctor regarding the duration of use.
- Injection Procedure
The doctor will most likely also give a combination injection of local anesthetic and corticosteroid [1].
The procedure for administering this injection drug is to use X-rays to guide the injection process to the area under the ribs.
The purpose of this medical action is to relieve pain and reduce the risk of inflammation in the patient’s body.
The doctor will also give a thoracic epidural injection because it contains anti-inflammatory; the injection will be made into the patient’s spinal cord area [1].
- Other therapies
According to the needs of the patient’s condition, the doctor may recommend a number of other therapies such as: [1]:
- Relaxation therapy
- Cognitive behavioral therapy
- Physical or occupational therapy
Because severe pain often affects the patient’s psychological condition negatively, psychotherapy is urgently needed [1].
Meanwhile, the patient needs to take physical or occupational therapy to return body movements to normal again [1].
Physical therapy will also help to re-strengthen the muscles that were previously weakened due to intercostal neuralgia and improve their health [1].
What is the prognosis for intercostal neuralgia?
The intercostal neuralgia prognosis varies because it depends on how severe the patient’s symptoms are and how quickly and appropriate treatment the patient gets. [1].
When the high severity is coupled with delayed or inappropriate treatment, the risk of a poor prognosis is higher [1].
Over time, symptoms can worsen and lead to chronic pain in patients if not treated immediately [1].
Complications
Intercostal neuralgia can result in a number of complications, one of the most common being disorders of the respiratory mechanism [1].
In elderly patients, obstructed breathing problems can be bad and even contribute to the risk of death [1].
In addition, chronic pain experienced by sufferers in the long term can affect psychological health conditions [1].
When symptoms receive immediate treatment, various risks of nervous disorders and more severe respiratory problems can be avoided [1].
Intercostal Neuralgia Prevention
Intercostal neuralgia can be prevented by making a number of efforts to improve or improve lifestyle [3].
Some things that can be done to reduce the risk of this disease are: [3]:
- Get the chickenpox vaccine.
- Get a vaccine for herpes or shingles, especially if you are 60 years of age or older.
- Riding a motorcycle or car, complete personal protection.
- Treat immediately medical conditions that begin to appear symptoms in order to control complaints properly.
- Wearing the correct sports equipment, especially if participating in sports that involve a high risk of physical contact and injury.
Whether due to injury or due to other factors, if the intercostal neuralgia symptoms begin to appear, then immediately see a doctor for immediate treatment.
Early detection and treatment of intercostal neuralgia symptoms can minimize the risk of complications in the patient’s body.
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- Dalton Fazekas; Maksym Doroshenko; & Danielle B. Horn. Intercostal Neuralgia. National Center for Biotechnology Information; 2021.
- Image: Henry Vandyke Carter, Public domain, via Wikimedia Commons
- Lana Barhum & Nicholas R. Metrus, MD. What Is Intercostal Neuralgia?. Verywell Health; 2020.
- Andrea Goethals & Jessica Rose. Mastectomy. National Center for Biotechnology Information; 2021.
- Brian Chang; William D. Tucker; & Bracken Burns. Thoracotomy. National Center for Biotechnology Information; 2021.
- Pragya A. Nair & Bhupendra C. Patel. Herpes Zoster. National Center for Biotechnology Information; 2021.
- Charles Gruver & Kevin B. Guthmiller. Postherpetic Neuralgia. National Center for Biotechnology Information; 2021.
- Tirlapur, Seema A.; Priest, Leeb; Daniels, Jane Pb; Khan, Khalid S; & Joseph Aquilina. How do we define the term idiopathic?. Current Opinion in Obstetrics and Gynecology; 2013.
- Video: motivationaldoc
