Intercostal Neuralgia – What You Should Know

Intercostal neuralgia is pain that comes from irritation or injury to the intercostal nerves — the nerves that run along the spaces between your ribs. This type of pain can be uncomfortable and confusing, especially because it may feel like chest, back, or abdominal pain. But it is not the same as heart or lung pain.

What Causes Intercostal Neuralgia?

Intercostal neuralgia occurs when an intercostal nerve becomes irritated, inflamed, compressed, or injured. There are several possible triggers:

• Injury or trauma to the chest wall or ribs (e.g., hit, fall, fracture)
• Surgery involving the chest such as thoracotomy or mastectomy (post-operative nerve irritation)
• Viral infection, most commonly shingles (postherpetic neuralgia)
• Nerve entrapment where surrounding muscles or scar tissue press on the nerve
• Idiopathic causes — meaning pain with no clear origin

Signs & Symptoms

The hallmark symptom is pain along the rib cage that often:

• Feels sharp, burning, stabbing, aching, or shooting
• Comes in a band-like pattern around your ribs or chest wall
• May be constant or come and go
• Gets worse with deep breathing, coughing, sneezing, or movement

Other symptoms can include:

• Tingling, numbness, or sensitivity in the skin over the affected area
• Pain that increases with touch, tight clothing, or temperature changes

See Also: Intercostal Muscles Anatomy

How Is It Diagnosed?

Diagnosis begins with a careful clinical history and physical exam, focusing on exactly where and how the pain occurs. Your doctor may:

• Press gently between the ribs to see where it hurts most
• Ask about recent injuries, surgeries, or infections
• Order imaging tests like X-rays, CT or MRI to rule out fractures, tumors, or other causes

Treatment Options

There’s no one-size-fits-all cure, but many people find relief with a combination of approaches:

1. Medications

These aim to reduce nerve pain rather than typical muscle soreness:

• Neuropathic pain medicines such as gabapentin or pregabalin
• Tricyclic antidepressants (used at doses for nerve pain)
• Topical treatments like lidocaine patches or capsaicin cream for localized pain
• Over-the-counter pain relievers for mild discomfort

Note: Opioid painkillers are rarely recommended due to risks and limited long-term benefit.

2. Physical Therapy

Gentle stretching, breathing exercises, and posture correction can help reduce pressure on the nerves and improve mobility.

3. Nerve-Focused Procedures

If pain is significant or persistent, your doctor may recommend:

• Intercostal nerve blocks — injections of local anesthetic and steroid around the nerve for relief
• Radiofrequency ablation or peripheral nerve stimulation in select cases for chronic nerve pain

These procedures are performed by pain specialists and can provide long-lasting relief.

When to See a Doctor

Seek medical evaluation if:

✔ Your pain is severe or getting worse
✔ Pain limits your daily activities
✔ Pain doesn’t improve with rest or simple treatments
✔ You have fever, unexplained weight loss, or other concerning symptoms

Prevention & Patient Tips

• If you are over age 60, talk to your doctor about shingles vaccination — it can reduce the risk of post-herpetic neuralgia.
• Avoid chest injuries when possible
• Maintain good posture and core strength to reduce muscle strain

Bottom Line

Intercostal neuralgia is nerve pain along the ribs that can be intense and persistent, but it’s treatable. With the right combination of medications, therapy, and pain-management techniques, most people can achieve substantial relief and return to normal activities.

References & More

1. What to Know About Intercostal Neuralgia – Webmed
2. Fazekas D, Doroshenko M, Horn DB. Intercostal Neuralgia. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: Pubmed
3. Williams EH, Williams CG, Rosson GD, Heitmiller RF, Dellon AL. Neurectomy for treatment of intercostal neuralgia. Ann Thorac Surg. 2008 May;85(5):1766-70. [PubMed]