Everything you need to know about intercostal neuralgia: causes, symptoms, treatment. Neuralgia in the heart area: symptoms and treatment

Intercostal neuralgia (another name is thoracic radiculitis) is a disease associated with pinched intercostal nerves.

Its main manifestation is pain syndrome, which, according to the medical scale, ranks third after contractions during childbirth and renal colic. The disease most often affects people aged 25 to 60 years; it is practically not diagnosed in children. The incidence among men and women is almost the same.

Causes of intercostal neuralgia

Doctors identify many factors, each of which can cause radiculitis of the thoracic spine. A person has 12 pairs of intercostal nerves, and pinching of each nerve bundle or fiber can cause severe pain, which can only be relieved by a blockade.
The causes of intercostal neuralgia are:

1. Intercostal osteochondrosis is the most common factor in the occurrence of the disease. The sagging and deformed vertebrae put pressure on the nerve fibers. As a result, inflammation develops and the patient experiences severe pain. The problem is most often chronic, and long-term and complex treatment is required to eliminate it.
2. Sudden movements, for example, when playing sports - nerves are pinched by muscles, usually this is a short-term phenomenon that goes away without medical intervention.
3. Injuries of the thoracic spine - pressure on the nerve fibers is exerted by bone fragments, hematomas or muscles.
4. Serious physical exercise– can lead to microtraumas of the thoracic region, muscle rupture, and the appearance of hematomas.
5. Hypothermia – low temperature indoors can cause muscle spasm, which, in turn, leads to compression of nerve tissue.
6. Infections - herpes, flu or tuberculosis lead to the penetration of pathogenic bacteria and toxins into the intercostal space. A person’s temperature rises, general weakness and pain occur.

Intervertebral hernia can cause intercostal neuralgia

1. Intervertebral herniation - bulging disc elements put pressure on surrounding nerves, causing severe pain. Often the discomfort is so intense and unbearable that only a blockade can relieve it.
2. Benign or malignant neoplasms in the spinal region – tumors exert significant pressure on the surrounding space, often nerve tissues are also subject to compression. This reason can lead to the appearance of intercostal neuralgia not only in adults, but also in children.
3. Alcoholism or toxic poisoning (for example, lead) - waste and toxins entering the body have a negative effect on the nervous tissue, which can lead to the development of radiculitis.
4. Ankylosing spondylitis is systemic disease, which leads to serious deformation of the spine. Due to compression of the intercostal elements, the patient experiences serious discomfort and his movements are limited.
5. Congenital anomalies of the development of the thoracic spine - some newborn children have such anomalies as the absence of one rib on the right or left, duplication of ribs, deformation of the vertebrae, etc. Some deviations lead to compression of nerve fibers.
6. Curvature of the spine - serious forms of scoliosis can lead to the development of intercostal neuralgia and the appearance of constant pain. The curvature process often begins in children school age and without timely treatment can progress rapidly.
7. Lack of vitamins - if the body does not receive enough vitamin D, a serious disease develops - rickets, leading to deformities bone tissue. If there is not enough vitamin B, then the metabolic processes in themselves nerve fibers.
8. Taking medications – long-term use Some medications in large doses can lead to toxic poisoning by their components, which causes attacks of thoracic radiculitis.
9. Frequent stress – the psychosomatics of intercostal neuralgia are associated with it. If a person often worries, worries and worries, he suffers nervous system in general, which negatively affects the intercostal nerves.

The causes of intercostal neuralgia are sometimes hormonal in nature. For example, diabetes mellitus disrupts metabolism in the body as a whole, including in the thoracic spine. Menopause in women leads to osteoporosis and other bone disorders.
To overcome a disease, you need to identify its root cause. If the disease is caused by herpes, you need to use antiviral drugs If it is caused by intercostal osteochondrosis, the spine should be treated. In some cases, only a blockade of powerful painkillers helps relieve pain.

Psychosomatics of intercostal neuralgia

The branch of medicine that establishes the connection between illnesses and mental and emotional state person is called psychosomatics. According to adherents of this trend, no disease arises just like that. You can identify the problems contained in the head and leading to its appearance.

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Intercostal neuralgia can be caused by a general state of anxiety, blockage of positive emotions, frequent stress and anxiety, a desire for self-punishment and self-flagellation. Pain on the right or left side of the heart is associated with constant feeling guilt, lack of self-confidence and strength.

In children and adults, thoracic sciatica is associated with emotions such as anger, fear and sadness. A conflict with superiors or a quarrel with household members can provoke an attack. To eliminate mental blockages, a person often needs the help of a psychologist. A kind of psychological blockade is established to help end the process of self-flagellation.

How does intercostal neuralgia manifest?

The main symptom that distinguishes intercostal neuralgia is severe pain that spreads throughout the middle spine. Often the discomfort is one-sided and concentrated on the right or left, affecting the mammary gland and radiating to the upper extremities. Unpleasant sensations are aching, dull or burning in nature ( acute phase), worsen with movement, sneezing, coughing. Sometimes only a novocaine blockade helps to remove it.


During an attack of radiculitis in adults and children, the temperature may rise. There may be numbness in the limbs, crawling “goosebumps”, muscle twitching on the right or left, depending on the location of the problem.
On the affected area there is increased sensitivity to palpation and cold, redness may appear. Skin temperature is lower than in other places.

Which doctor should I contact?

Pain in the area of ​​the heart and to the right of it is often confused with problems of cardio-vascular system, so they are referred to a cardiologist. This is not the specialist who can help you with neuralgia.
If you have a fever, chest pain, increased sweating, or numbness in your limbs, consult a neurologist. Treatment of radiculitis is his specialty. He will conduct a diagnosis and select the correct treatment.
If the cause of intercostal neuralgia pain is influenza or herpes, you will be referred to specialized specialists who will prescribe you antiviral therapy.

Diagnosis of intercostal neuralgia

After an oral conversation with the patient and his oral questioning, the doctor prescribes studies that help confirm the preliminary diagnosis. The following tests can be used for this purpose:

• general blood test - shows an increased number of leukocytes;

General blood analysis

• bacteriological blood test - such a study is necessary if the cause of the disease is herpes;
• X-ray of the middle spine;
• CT and MRI - thanks to these methods you can see abnormalities that a regular x-ray does not show;
• myelography – special research, thanks to which it is possible to determine changes in the nervous tissue of the middle spine;
• ultrasound examination and others.

Only based on the test results can we make a diagnosis accurate diagnosis- intercostal neuralgia. Having received it, the doctor prescribes treatment for the disease. If its cause is herpes, they are prescribed antivirals If there are spinal disorders, a whole range of measures is necessary. In some cases, drug blockade is required to relieve pain.

How to get rid of intercostal neuralgia

To eliminate the disease, a set of measures is used. Let's accept this medications(in particular NSAIDs), local remedies(ointments, gels), vitamins. Patients with neuralgia are recommended to undergo electrophoresis, laser therapy, darsonval, massage, etc.
In severe cases, a blockade based on novocaine, lidocaine and other painkillers is necessary. The blockade allows you to relieve pain, without which it is impossible for the patient to lead a normal life.
To heal, you need to do special sets of exercises. One of the most popular was invented by the recognized doctor Bubnovsky. If the cause of the illness is constant unrest, the patient needs to be provided with peace and proper daily routine.

Consequences of intercostal neuralgia

The only thing that is dangerous about intercostal neuralgia is pain shock, which occurs due to very bright discomfort. How long it lasts depends on whether competent first aid was provided. The patient becomes restless, walks from one point to another, and constantly changes positions. Moans and screams are possible. There is a decrease blood pressure, fainting is possible if such an exacerbation does not go away for a long time.
If your loved ones experience neuralgia attacks, it is important to know what to do in advance. You can immediately administer a dose of painkiller to the patient, place him on the bed, and ensure sufficient oxygen access.
Radiculitis of the middle spine is a problem that is often diagnosed in adults, less often in children. You can select different reasons its appearance: herpes, frequent stress, lack of vitamins, spinal diseases, etc. Pain permeates certain points on the patient's chest, and he cannot move or even breathe. In some cases, a novocaine blockade is required to improve the condition, in others it is possible to get by with more gentle treatment.

Damage to the intercostal nerves, accompanied by acute pain. It is characterized by paroxysmal shooting or burning pain in one or more intercostal spaces, extending from the spinal column to the sternum. Diagnosis is based on complaints and an objective examination of the patient, to exclude/identify pathology of the spine and internal organs Additional examination is carried out using radiography, CT, and endoscopy of the gastrointestinal tract. The main directions of therapy are etiotropic, anti-inflammatory, neuroprotective and physiotherapeutic treatment.

General information

Intercostal neuralgia is a pain syndrome associated with damage to the intercostal nerves of any etiology (due to pinching, irritation, infection, intoxication, hypothermia, etc.). Intercostal neuralgia can occur in people of different ages, including in children. Most often it is observed in adults. The most common is intercostal neuralgia, caused by osteochondrosis of the spine with radicular syndrome or intervertebral hernia of the thoracic region, and also caused by herpes zoster. In some cases, intercostal neuralgia acts as a “signaler” of serious diseases of the structures that form the chest, or organs located inside it (for example, pleurisy, tumors of the spinal cord, chest and mediastinum). In addition, left-sided intercostal neuralgia can mimic cardiac pathology. Due to the diversity of etiologies of intercostal neuralgia, patient management is not limited to clinical neurology, but often requires the participation of related specialists- vertebrologists, cardiologists, oncologists, pulmonologists.

Anatomy of intercostal nerves

Intercostal nerves are mixed, containing motor, sensory (sensitive) and sympathetic fibers. They originate from the anterior branches of the spinal roots of the thoracic segments spinal cord. There are a total of 12 pairs of intercostal nerves. Each nerve passes in the intercostal space below the edge of its corresponding rib. The nerves of the last pair (Th12) pass under the 12th ribs and are called subcostal. In the area from the exit from the spinal canal to the costal angles, the intercostal nerves are covered by the parietal pleura.

The intercostal nerves innervate the muscles and skin of the chest, the anterior wall of the abdomen, the mammary gland, the costophrenic part of the pleura, and the peritoneum lining the anterolateral surface of the abdominal cavity. The sensory branches of adjacent intercostal nerves branch and connect with each other, providing cross-innervation, in which an area of ​​skin is innervated by one main intercostal nerve and partially by the superior and inferior lying nerve.

Causes of intercostal neuralgia

Damage to the intercostal nerves may be inflammatory in nature and be associated with previous hypothermia or an infectious disease. The most common neuralgia of infectious etiology is intercostal neuralgia due to herpetic infection, the so-called. herpes zoster. In some cases, damage to the nerves is associated with their injury due to bruises and fractures of the ribs, other injuries to the chest, and spinal injuries. Neuralgia can occur due to compression of the nerves by the intercostal muscles or back muscles with the development of muscular-tonic syndromes associated with excessive physical activity, work with uncomfortable position, reflex impulses in the presence of pleurisy, chronic vertebrogenic pain syndrome.

Various diseases of the spine (thoracic spondylosis, osteochondrosis, intervertebral hernia) often cause irritation or compression of the intercostal nerves at the point of their exit from the spinal canal. In addition, the pathology of the intercostal nerves is associated with dysfunction of the costovertebral joints due to arthrosis or post-traumatic changes in the latter. Factors predisposing to the development of neuralgia of the intercostal nerves are deformations of the chest and curvature of the spine.

In some cases, intercostal neuralgia occurs as a result of compression of the nerves by a growing benign tumor of the pleura, a neoplasm of the chest wall (chondroma, osteoma, rhabdomyoma, lipoma, chondrosarcoma), aneurysm of the descending thoracic aorta. Like other nerve trunks, intercostal nerves can be affected when exposed to the body toxic substances, hypovitaminosis with deficiency of vitamin B.

Symptoms of intercostal neuralgia

The main symptom is a sudden one-sided piercing acute pain in the chest (thoracalgia), running along the intercostal space and encircling the patient’s torso. Patients often describe it as a “lumbago” or “passing electric current.” Moreover, they clearly indicate the spread of pain along the intercostal space from the spine to the sternum. At the beginning of the disease, thoracalgia may be less intense in the form of tingling, then the pain usually intensifies and becomes unbearable. Depending on the location of the affected nerve, pain can radiate to the scapula, heart, or epigastric region. The pain syndrome is often accompanied by other symptoms (hyperemia or pallor of the skin, local hyperhidrosis) caused by damage to the sympathetic fibers that make up the intercostal nerve.

Characterized by repeated painful paroxysms, lasting from a few seconds to 2-3 minutes. During an attack, the patient freezes and holds his breath while inhaling, since any movements, including respiratory excursion of the chest, cause increased pain. For fear of provoking a new painful paroxysm, during the interictal period patients try to avoid sharp turns of the body, deep sighs, laughter, coughing, etc. During the period between painful paroxysms along the intercostal space, paresthesia may be noted - subjective sensory sensations in the form of tickling, crawling.

With a herpetic infection, intercostal neuralgia is accompanied by skin rashes that appear on the 2-4th day of thoracalgia. The rash is localized on the skin of the intercostal space. It represents small pink spots, which are then transformed into vesicles that dry out to form crusts. Itching is typical, occurring even before the first elements of the rash appear. After the disease resolves, temporary hyperpigmentation remains at the site of the rash.

Diagnosis of intercostal neuralgia

A neurologist can determine the presence of neuralgia of the intercostal nerves based on characteristic complaints and examination data. The patient's antalgic posture is noteworthy: in an effort to reduce pressure on the affected intercostal nerve, he tilts his torso to the healthy side. Palpation in the affected intercostal space provokes the appearance of a typical painful paroxysm; trigger points are identified at the lower edge of the corresponding rib. If several intercostal nerves are affected, during a neurological examination an area of ​​decreased or loss of sensitivity in the corresponding area of ​​the skin of the body can be determined.

Clinical differentiation of pain syndrome is important. Thus, when pain is localized in the cardiac region, it is necessary to differentiate them from pain syndrome with cardiovascular diseases, primarily from angina pectoris. Unlike the latter, intercostal neuralgia is not relieved by taking nitroglycerin, but is provoked by movements in the chest and palpation of the intercostal spaces. For angina pectoris pain attack It is of a compressive nature, provoked by physical activity and is not associated with turning the body, sneezing, etc. In order to clearly exclude coronary heart disease, the patient is given an ECG; if necessary, a consultation with a cardiologist is indicated.

When the lower intercostal nerves are damaged, the pain syndrome can mimic diseases of the stomach (gastritis, gastric ulcer) and pancreas (acute pancreatitis). Stomach pathology is characterized by a longer and less intense pain paroxysm, usually associated with food intake. With pancreatitis, girdle pain is also observed, but they are usually bilateral in nature and associated with food. In order to exclude pathology of the gastrointestinal tract, additional examinations may be prescribed: determination of pancreatic enzymes in the blood, gastroscopy, etc. If intercostal neuralgia occurs as a symptom of thoracic radiculitis, then painful paroxysms occur against the background of constant dull pain in the back, which decreases when the spine is unloaded in a horizontal position. To analyze the condition of the spine, a chest X-ray is performed, if a intervertebral hernia- MRI of the spine.

Intercostal neuralgia can be observed in some lung diseases (atypical pneumonia, pleurisy, lung cancer). To exclude/detect such a pathology, a chest x-ray is performed, and if indicated, a computed tomography is performed.

Treatment of intercostal neuralgia

Complex therapy is carried out aimed at eliminating the causative pathology, relieving thoracalgia, and restoring the affected nerve. One of the main components is anti-inflammatory therapy (piroxicam, ibuprofen, diclofenac, nimesulide). In case of severe pain syndrome, drugs are administered intramuscularly, therapy is supplemented by therapeutic intercostal blockades with the introduction local anesthetics and glucocorticosteroids. An auxiliary means in relieving pain is the prescription of sedatives, which reduce pain by increasing the threshold of excitability of the nervous system.

Etiotropic therapy depends on the genesis of neuralgia. Thus, for herpes zoster, antiviral agents (famciclovir, acyclovir, etc.), antihistamine pharmaceuticals and local use of antiherpetic ointments are indicated. In the presence of muscular-tonic syndrome, muscle relaxants (tizanidine, tolperisone hydrochloride) are recommended. If there is compression of the intercostal nerve at the exit of the spinal canal due to osteochondrosis and displacement of the vertebrae, gentle manual therapy or spinal traction can be performed to relieve the compression. If nerve compression is caused by a tumor, surgical treatment is considered.

In parallel with etiotropic and anti-inflammatory therapy, neurotropic treatment is carried out. To improve the functioning of the affected nerve, it is prescribed intramuscular injection B vitamins and ascorbic acid. Drug therapy successfully complemented by physiotherapeutic procedures: ultraphonophoresis, magnetotherapy, UHF, reflexology. For herpes zoster, local UV irradiation on the area of ​​the rash is effective.

Forecast and prevention of intercostal neuralgia

In general, with adequate treatment, intercostal neuralgia has a favorable prognosis. Most patients experience complete recovery. In the case of herpetic etiology of neuralgia, relapses are possible. If intercostal neuralgia is persistent and cannot be treated, you should carefully reconsider its etiology and examine the patient for the presence of a hernia intervertebral disc or tumor process.

Prevention measures include timely treatment diseases of the spine, prevention of its curvature, adequate therapy chest injuries. The best protection against herpes infection is high level immunity, which is achieved in a healthy way life, hardening, moderate physical activity, active recreation Outdoors.

Thoracalgia (ICD 10 code - M54.6.) is a disease of peripheral nerves, accompanied by severe pain.

Thoracalgia disorder, like chest pain, is sometimes associated with the manifestation of other disorders: heart attack, angina, etc.

Most often, the disease indicates problems with the spine.

Causes of the disease

Causes of pain:

• scoliosis and kyphoscoliosis;
• damage to the thoracic spine, some disorders of the nervous system;
• hernia or protrusion of the vertebral discs of the sternum of the spinal column;
• spinal overload;
• muscle spasm;
• stress, decreased immunity, herpes, etc.

When exposed to such processes and disorders, the nerve is compressed by nearby tissues.

The affected nerve does not perform its normal functions, which may cause pain in the affected part.

Chest pain in at a young age often associated with Scheuermann-May disorder, which causes increased kyphosis and deformation of the vertebrae. The cause of pain in the lower part of the sternum in older people may be osteoporosis with the presence of a compressive fracture of the vertebrae.

Girdle pain in the sternum can appear due to herpes zoster, nerve damage due to diabetes, and vasculitis.

The risk of developing thoracalgia is increased by low physical activity, bad habits, heavy lifting, long monotonous work, etc.

Types and clinical variants of thoracalgia

Types of violation:

• vertebrogenic and vertebral thoracalgia;
• during pregnancy;
• psychogenic;
• chronic;
• musculoskeletal;
• pain is localized on the left and right.

Vertebrogenic thoracalgia

4 stand out clinical options violations:

Nature of pain syndrome

With osteochondrosis, pain occurs in this way. On initial stage There are disturbances in the structure of the vertebral disc, the core tissues lose moisture and the disc, accordingly, loses its elasticity.

At the next stage, disc protrusion is observed.

The part of the disc protruding into the canal cavity presses on the posterior longitudinal vertebral ligament, innervated by the spinal nerves. Irritation of the nerves of this ligament causes back pain, which is called thoracalgia.

Subsequently, the integrity of the disc capsule is compromised and the destroyed core enters the spinal canal– an intervertebral hernia appears.

Basically, hernial protrusion is observed in the lateral parts of the disc, where the nerve roots pass. At this stage, irritation of these nerves is added, which also causes pain.

Pain syndrome, vertebrogenic bilateral lumboischialgia, is provoked by problems in the lumbosacral region. What should you know in this case?

Symptoms and syndromes characteristic of the pathology

The main manifestations include:

1. Constant, piercing, paroxysmal pain, concentrated in the right or left half of the sternum. It spreads in the spaces between the ribs and intensifies with inhalation, coughing, and body movements.
2. Pain accompanied by numbness, burning along the nerve or its branches. That is why the disorder sometimes manifests itself as pain in the back, under the shoulder blade, in the lower back.
3. Chest pain caused by excessive muscle tension. Often these are the back extensors, shoulder muscles and scapula. Muscle pain tends to increase when the affected muscle is stretched.
4. The manifestation of the chronic form is expressed in a weak but constant effect of symptoms and the development of the disease. The chronic condition is tolerable for the patient. Pain may appear for 3 months, after which it subside for an indefinite period. After some time they will return, but with greater force and consequences. To protect yourself from the chronic form of the disorder, you need to seek help and begin treatment immediately.

Thoracalgia syndromes:

1. Radicular or pain syndrome.
2. Visceral syndrome. Lesions of the thoracic spine are always combined with disruption of the innervation of the chest organs, which can cause problems in the functioning of these organs.
3. Radicular syndrome with vegetative states. Often this is instability of pressure, anxiety, a feeling of lack of air, a feeling of a lump in the throat when swallowing.

Sometimes pain of this nature is confused with heart problems. Pain in heart disease is constant, and the attack is relieved by taking nitroglycerin.

If the pain does not disappear when taking the drug, then this is a manifestation of osteochondrosis.

Intercostal neuralgia, unlike thoracalgia, is characterized by superficial pain along the spaces between the ribs.

Diagnostic techniques

If there is pain in the sternum, it is necessary to exclude other origins of pain associated with the need for medical assistance. medical care. If there is any suspicion of acute illness, then the patient must be urgently admitted to the hospital.

Methods of research used to make a diagnosis:

• X-ray;
• scintigraphy;
• densitometry;
• ENMG;
• laboratory research.

Healing procedures

If symptoms indicate that the patient has thoracalgia, it is better to begin treatment immediately.

Different treatments are used for different variants of the syndrome:

1. In case of scapular-costal lesions, the costotransverse joints are affected, the mobility of the ribs and the muscles that lift the scapula are restored.
2. For anterior chest syndrome, post-isometric exercises for the pectoral muscles and massage are performed.
3. In case of violations of the lower cervical region restore the functioning of its motor elements and muscles.
4. For disorders of the upper chest, attention is paid to restoring the functioning of the thoracic disc segments through post-isometric relaxation techniques. Usually, healing effect achieved after 2-4 sessions.

Treatment of deviations with medications is ineffective without physiotherapy, massage and therapeutic exercises.

A neurologist prescribes the following medications:

• anti-inflammatory: diclofenac, Celebrex;
• for muscle tone disorders - sirdalud, mydocalm;
• neuroprotectors: B vitamins.

Physiotherapy:

• cryotherapy;
• hivamat;
• laser treatment;
• electrophoresis.

All these measures improve tissue microcirculation, their restoration, and reduce inflammation.

Massage is carried out only after physiotherapy. During the massage, the doctor acts on the scapular muscles and paravertebral area of ​​the thoracic part.

When acute pain The massage must be stopped for a while.

Moderate physical activity is the main method of treatment chest pain. Exercise therapy makes it possible to restore the biomechanics of movements, which makes it possible to stop the development of pathological processes.

Traditional medicine

Traditional methods of treatment:

• warming with mustard plasters, heating pad, salt, sand;
• rubbing with alcohol tinctures;
• herbal teas with chamomile, lemon balm.

Folk remedies temporarily neutralize pain, but do not cure the disease completely.

Gentle manual therapy performed to mobilize motion segments, remove muscle blocks, eliminate subluxation of facet joints, reducing pain, and restoring range of motion in the spine.

Acupuncture allows you to restore the conductivity of nerve fibers and relieve pain.

Preventive measures

For prevention, it is necessary to take care of the spine, carefully handle weights, observe the temperature regime, rest on comfortable furniture, a mattress, and nutritious food.

It is very important to play sports, which will allow you to keep your muscles toned and “develop” your spine; if you have injuries or other disorders of the spine, consult a doctor.

Please note that infections and other diseases can also cause pain.

Combination treatment allows you to achieve a positive result in a fairly short time, slow down the development of the disorder for a long time.

Thoracalgia is a complex problem, both for diagnosis and treatment, which requires the efforts of a large number of competent specialists.

It is known that osteochondrosis and blood pressure are interconnected, which is why when a person goes to the doctor with complaints of elevated blood pressure, the spinal column is examined. If we consider the spine as a whole, then each department has innervation and responsibility for the work of a group of organs. The cervical spine is responsible for the activity of the brain and parts of the organs located in the chest.

Osteochondrosis is considered to be the most common disease affecting the spine. If we consider the structure of the cervical spine, it is most susceptible to inflammation and degenerative processes. This is due to the fragility of the section and its mobility. If there are violations in the integrity of other departments, deviations in the functioning of organs also occur, but it is the cervical region that can affect the pressure numbers.

Reasons for the development of osteochondrosis

Osteochondrosis of the cervical spine develops for a number of reasons, among which the main place is occupied by a person’s lifestyle. Since the vertebrae of the cervical spine are mobile and not protected by a powerful corset of muscles, they “wear out” during life, that is, their surface wears off, salt deposition occurs, and osteophytes appear.

The human spine, when its structures are damaged, tends to replace them with calcifications, that is, a process of salt deposition occurs, which is osteochondrosis. Also, with osteochondrosis, the structure of the spine weakens, which is why the following phenomena are characteristic:

• tissue proliferation leads to compression of blood vessels and nerves;
• weakening of the structure causes disc displacement;
• Malnutrition and stress provoke protrusion (protrusion) and hernias.

All these conditions can affect the vessels leading to the brain, causing pressure to increase, which reveals many accompanying symptoms. The question arises: what causes osteochondrosis?

Osteochondrosis of the cervical spine occurs for the following reasons:

If osteochondrosis of the cervical spine has developed, then a pathological effect occurs on nearby tissues, vessels, and nerve endings. Since it enters the brain a large number of blood to nourish it and saturate it with oxygen, then large vessels pass near the cervical spine, and when pressure is applied to them, an increase in pressure is recorded.

Pathogenesis of high blood pressure

If salt deposition occurs, the development of protrusions, osteophytes, or the formation of a hernia in the neck and chest, then this threatens with two dangerous consequences. The threat of pinched nerves – intercostal neuralgia and compression of the vertebral artery – increases. If intercostal neuralgia is characterized by symptoms of pain and limited mobility, then the effect on the vertebral artery and other vessels leading to the brain causes the following symptoms:

Often, compression of blood vessels is accompanied by pinching of nerve endings, which is why intercostal neuralgia occurs.

Considering the process anatomically, such a condition can be observed. It is already known that there is vertebral artery, which is responsible for blood supply and nutrition of the cerebellum, occipital lobe of the cortex medulla oblongata, trunk, inner ear and spinal cord. That is, if the spine of the neck is damaged, the function of breathing, swallowing, heart rate and pressure may be impaired. With intercostal neuralgia of the thoracic region, signs of pain in the chest, shoulder blades, and shoulder girdle are added and the functioning of the heart and respiratory organs is disrupted.

A compressed artery also threatens brain hypoxia, causing blood pressure numbers to either increase or decrease. In most cases, the combination of intercostal neuralgia and osteochondrosis of the neck is marked by an increase in pressure, which is accompanied by headache, nausea and decreased performance.

Diagnostics

Since pressure in osteochondrosis is associated not only with damage to the blood vessels of the brain, but also with compression of them in the neck or chest, treatment of high blood pressure antihypertensive drugs will not give the full healing effect. Before prescribing therapy for hypertensive syndrome, you need to examine the spine. This will not only identify abnormalities in the condition of the blood vessels, but will also eliminate damage to the nerves, that is, intercostal neuralgia.

During the examination, the doctor conducts an examination to identify curvatures and displacement of the discs. It is necessary to diagnose the neck and chest in order not to miss any deviations. X-ray diagnostics are prescribed, and the spine must be examined in different projections.
A study using CT or MRI may be necessary. With intercostal neuralgia, there is pain from the heart, so doctors often prescribe an ultrasound and an electrocardiogram.

Treatment of osteochondrosis

Based on the diagnosis, a treatment algorithm is selected. Operations for osteochondrosis are rarely performed; neglected protrusions and hernias are equated to their indications. Since compression of blood vessels mainly occurs due to the deposition of salts in the neck, in order to reduce blood pressure numbers, you need to get rid of osteophytes, displacements and calcifications. For intercostal neuralgia, treatment with manual therapy is important, and for osteochondrosis of the neck, a similar method is indicated with caution.

It is allowed to perform a massage, with the help of which the muscles are strengthened, the discs are put in place and the deposition of salts is reduced. When blood pressure rises, it threatens brain damage, so high numbers need to be lowered. Treatment with drugs from the group of antihypertensive drugs and muscle relaxants is effective. NSAIDs are prescribed for severe back pain, but headache caused by pressure are not removed.

Among muscle relaxants, Mydocalm (Tolperisone) and beta blockers for blood pressure are effective. Since increased blood pressure affects brain function and a person’s general well-being, it is recommended to take Cavinton. Its use normalizes blood circulation functions and affects the metabolic process in the brain. For stress and nervousness, prescribed sedatives– Novo-passit, valerian extract, motherwort, Persen.

Treatment with medications alone will not be entirely sufficient, so doctors recommend gymnastics. Exercises are selected aimed at developing the muscles of the neck and chest. Neck turns to the sides, up and down, and bends to the side are recommended. Exercises must be done carefully, since blood vessels and nerves pass near the vertebrae and discs.

For severe pain, reflexology and blockades using glucocorticosteroids and local anesthetics are prescribed. Wearing a Shants collar is necessary during surgical interventions or in case of neck injuries.

If the pressure, on the contrary, is low, then drugs from the group of adaptogens are prescribed - ginseng tincture, chicory root and others. Shown healthy sleep and being outdoors.

2016-10-04

Intercostal neuralgia

Neuralgia is a derivative of two words (neur - nerve and algus - pain). Thus, in literal translation from Greek, this term means pain along the nerve fiber. Accordingly, intercostal neuralgia is pain along the intercostal nerve. Anatomically, the intercostal nerves originate from the roots spinal nerves thoracic region. Physiologically, the intercostal nerves are mixed. This means that they contain sensory and motor nerve fibers. The intercostal nerves pass along the intercostal spaces (along the lower edges of the ribs) and innervate the intercostal muscles. In addition, sensory and motor branches go from these nerves to the diaphragm, pleura, peritoneum, and muscles of the anterior abdominal wall. Thus, thanks to these nerves, the respiratory excursion of the chest occurs and intra-abdominal pressure is maintained.

Causes

By its nature, intercostal neuralgia is secondary in most cases. This means that, without being independent disease, it develops as a complication of other diseases and pathological processes. Most often, these diseases and pathological processes are associated with damage to the spine, but not only. As a rule, pain along the intercostal nerves is associated with osteochondrosis. At the same time, degeneration of the intervertebral discs itself is not directly related to intercostal neuralgia. But a typical complication of osteochondrosis, disc herniation, is the most common cause of intercostal pain.

Any type of pain can cause such pain. pathological process in the spine, to one degree or another accompanied by pinching, inflammation and swelling of the nerve roots of the thoracic region. In addition to disc hernias, structural changes in the vertebrae can lead to intercostal neuralgia:

• Spondylolisthesis - displacement of the vertebrae relative to each other
• Spondylolysis - destruction of the vertebral arches
• Spondylosis is the growth of pathological bone formations (osteophytes)
• Spondyloarthritis
• Curvatures of the spinal column - scoliosis, pathological lordosis and kyphosis.

Some of these conditions may be congenital, and some develop from diseases such as tuberculosis, syphilis, ankylosing spondylitis, tumors and spinal injuries.

It is noteworthy that intercostal neuralgia is not always caused by negative processes in the spine. The fact is that various diseases and metabolic disorders to one degree or another affect all organs and tissues - the skin, smooth and skeletal muscles, mucous membranes of internal organs, blood vessels and nerves suffer. Moreover, nervous tissue, as the most highly organized, is the most vulnerable.

For example, digestive disorders are accompanied by decreased absorption nutrients from the intestines into the blood. Nutrient deficiency leads to trophic disorders of all nerve fibers, including intercostal ones. In addition, quite often, with pathology of the intestines, liver, or stomach, the diaphragm is reflexively irritated, and through it the intercostal nerves.

Malnutrition of nervous tissue often occurs at the microcirculatory level, when the transport of oxygen and nutrients is hampered by weak myocardial contractility, due to atherosclerotic vascular damage during hypertension, diabetes mellitus. Trophic disorders in the intercostal muscles, manifested by neuralgia, can be caused by other endocrine disorders– diseases thyroid gland, adrenal glands, degenerative-inflammatory processes in the ovaries. In this regard, there are frequent cases of intercostal neuralgia in women in menopause. Thus, any disease or pathological process that leads to structural changes in the spine or metabolic disorders can lead to intercostal neuralgia.

It goes without saying that the leading symptom of intercostal neuralgia is pain. The pain can be constant, aching, or, conversely, sharp, paroxysmal. Often it radiates to the heart area, sternum, and under the shoulder blades. Because of this, there are often cases false diagnosis angina pectoris and myocardial infarction. In contrast to these conditions, intercostal neuralgia intensifies at the height of inspiration, after a change in body position, and with axial load (pressure) on the chest.

In turn, pain between the ribs is accompanied by psycho-emotional stress and can lead to increased blood pressure, angina pectoris and breakdowns heart rate. Intensification of the pain syndrome occurs when exposed to provoking factors - physical activity, hypothermia, stress, dietary errors, prolonged stay in the same body position.

Since the pain intensifies with breathing, the patient begins to spare the chest and does not deep breaths. Over time, this leads to decreased ventilation and stagnation in the lungs. The emerging cough increases pain in the intercostal spaces, thereby closing a vicious circle.

A typical symptom of intercostal neuralgia is pathological tension of the back muscles in the area of ​​the spinal segment corresponding to the intercostal nerve.

In the projection of the innervated nerve, redness of the skin and paresthesia (unpleasant sensations in the form of burning, numbness, coldness) are often noted. All this leads to a deterioration in the quality of life - due to constant pain and anxiety, sleep is disturbed, often the patient is not able to perform his usual work or do what he loves.

Read more about the symptoms of intercostal neuralgia here

Types of treatment

Treatment of intercostal neuralgia is aimed at:

• Anesthesia
• Relaxation of pathologically tense muscles
• Relieving inflammation and normalizing metabolic processes in nervous tissue
• Elimination of etiological factors of intercostal neuralgia.

In this regard, it is shown:

• Drug treatment
• Massage
• Physiotherapeutic procedures
• Acupuncture
• Manual therapy.

Medicines

Drug treatment of intercostal neuralgia is mainly aimed at relieving pain and inflammation. For this purpose, non-steroidal anti-inflammatory drugs (NSAIDs) are used. It's quite numerous medicinal group, including Indomethacin, Diclofenac, Ibuprofen and their derivatives in tablets, injections and ointments. At the same time, the most popular products are for external use, gels and ointments - Diklak gel, Emulgel, Indomethacin ointment, and other medications with anti-inflammatory and local irritating effects.

Paravertebral blockades provide an excellent analgesic effect. Novocaine or another local anesthetic (Lidocaine, Trimecaine) is injected into the projection of the spinal roots on the side of the midline of the spine at the paravertebral point. From the soft tissues, the medicine diffuses directly into the nerve fiber tissue, due to which pain relief is achieved. In this case, pain relief occurs quickly, but not for long - after a few hours the pain can manifest itself again. In addition, paravertebral blockades have virtually no effect on the etiological factors of intercostal neuralgia. In addition to local anesthetics, steroids can be injected into paravertebral points. hormonal drugs– Kenalog, Diprospan.

The delivery of oxygen and nutrients can be enhanced through drip administration of Trental and Pentoxifylline, which improve blood microcirculation. Drugs such as Actovegin, Mexidol, Neuromidin and other neuroprotectors improve metabolism not only in the brain, but also in peripheral nerves. Depending on the causes, antibiotics, immunomodulators, digestive enzymes, and vitamins can be used in the treatment of intercostal neuralgia.

Here you will find advice from doctors on methods of treating intercostal neuralgia

Massage and physical treatments

During massage and physiotherapeutic procedures, the muscles of the chest and back are relaxed, pinched nerves are released and inflammation in the nerve fibers is relieved, which in turn leads to pain relief. It should be noted that physiotherapy, like massage, is carried out only in the remission (quiescence) phase of neuralgia. They cannot be performed if pain in the intercostal spaces is caused by tuberculosis, tumor, or if there is concomitant diseases– hypertension, diabetes mellitus, suffered a heart attack myocardium.

Electrical muscle stimulation, electrophoresis and phonophoresis, magnetic therapy, and darsonvalization are indicated as physical procedures. Massage of the back muscles is carried out while lying on your stomach. In this case, not only the back is massaged, but also the muscles of the neck and upper limbs by kneading and stroking. Subsequently, the patient turns over onto his back and massages with similar movements pectoral muscles and intercostal nerves along the anterior axillary line.

Unconventional methods

The effect of the massage is strengthened by manual therapy. When performing this procedure, the chiropractor uses his hands directly on the displaced vertebrae. During this effect, the vertebrae return to their original position, the spaces between the vertebrae widen, and pinched nerves are released. The method is effective, but if the technique is violated, serious complications are possible.

More about methods home treatment neuralgia can be learned from this article

IN last decade became widespread new method treatment – ​​structural osteopathy. Unlike manual therapy, physical therapy and massage, structural osteopathy can be performed even during an exacerbation. This method is safe for the patient, and does not require any drugs or equipment. The essence of the method is that through certain manual manipulations on muscles and ligaments, metabolic processes in the spine and nearby tissues are improved, the functioning of internal organs is improved, and the immune system is strengthened. In this regard, osteopathy is akin to acupuncture, in which, as a result of influencing certain points, blood supply and innervation of the spine and internal organs improves. It is noteworthy that the desired points can be anatomically distant from the spine and located on the hands, feet, and ears.

Prevention

In conclusion, mention should be made of the prevention of intercostal neuralgia. After all, prevention is much more effective than treatment. Moreover, in most cases it takes a long time to treat intercostal neuralgia. After all, the main cause of intercostal pain, osteochondrosis, is an irreversible process. But this does not mean that the patient is doomed to lifelong suffering.

In order for intercostal pain to remind itself as little as possible, you should avoid hypothermia, physical exertion, injuries, and infectious diseases. Under unfavorable working conditions (vibration, shock, long-term “sedentary” work), there must be an optimal regime of work and rest. And if intercostal pain occurs, you should immediately consult a doctor.

More articles about intercostal neuralgia

Intercostal neuralgia is a lesion of the intercostal nerves, accompanied by intense pain. The pathology itself does not pose a threat to life, but the symptoms of intercostal neuralgia may mask serious illnesses, which include, first of all, cardiovascular pathologies, in particular myocardial infarction. In some cases, intercostal neuralgia indicates the presence of other diseases, for example, neoplasms of the spinal cord or chest organs, pleurisy.

Intercostal neuralgia is one of the most common diseases of the human nervous system.

The intercostal nerves contain both sensory and motor fibers, as well as sympathetic fibers. In the human body, there are 12 pairs of nerves in the intercostal region, each of which passes below the edge of the corresponding rib in the intercostal space as part of the neurovascular bundle. Intercostal nerves innervate the skin and muscles of the peritoneum, costal and diaphragmatic parts of the pleura, anterior abdominal wall, mammary gland, and chest. Neuralgia occurs when the roots of the intercostal nerves are compressed at their exit from the spine, usually as a result of muscle spasm.

Intercostal neuralgia occurs equally often in men and women. Susceptibility to the disease increases with age.

Synonyms: neuralgia of the intercostal nerves, thoracic radiculitis.

Causes of intercostal neuralgia and risk factors

The most common causes of neuralgia of the intercostal nerves are:

• osteochondrosis, spondylitis, ankylosing spondylitis and other diseases of the thoracic spine;
• tumors of the thoracic spinal cord;
• sudden unsuccessful movement;
• chest injury;
• forced awkward body position;
• general hypothermia of the body, hypothermia of the chest and back;
• pathology upper section gastrointestinal tract;

In women, intercostal neuralgia can be caused by wearing tight underwear, as well as being underweight. In children and adolescents, intercostal neuralgia can occur during a period of intensive growth of the bone skeleton.

The contributing factors are:

• metabolic disorders (diabetes mellitus);
• age-related changes in blood vessels;
• diseases of the nervous system;
• infectious and inflammatory diseases;
• uncomfortable workplace.

Forms of the disease

There are two main forms of intercostal neuralgia:

• radicular - caused by irritation of the roots of the spinal cord and is accompanied by pain in the thoracic region, can masquerade as cardiac pathology;
• reflex – occurs due to muscle tension in the intercostal spaces.

Intercostal neuralgia occurs equally often in men and women. Susceptibility to the disease increases with age.

Depending on the location, intercostal neuralgia is classified into unilateral and bilateral. The latter often occurs against the background of immunodeficiency, radiation sickness, herpes infection and a number of other diseases.

Symptoms of intercostal neuralgia

The main symptom of intercostal neuralgia is paroxysmal piercing pain, which can be shooting, burning, stabbing, or resemble an electric shock. The pain intensifies when laughing, coughing, deep breathing, turning the body, raising the upper limbs. In addition, pain increases with palpation of the affected area and can become unbearable for the patient. The patient takes a forced body position (antalgic postures) to reduce or stop pain. The pain is long-lasting, often persisting day and night, although its intensity may vary.

The pain can have different localization. Women in the background hormonal changes in the menopausal and/or postmenopausal period, pain is often noted in the area of ​​​​the projection of the heart, pain can radiate to the mammary gland. In men, pain is more often localized at the level of the lower ribs, on the left side of the chest. Depending on the location of the lesion, the pain may radiate to the heart, scapula, and epigastrium. When pain is localized along one or two intercostal nerves, it can acquire a girdling character.

A characteristic sign of intercostal neuralgia is that pain does not decrease at night. In the early stages of the disease, pain in the chest may be less intense, manifesting itself in the form of tingling, but increase with the progression of the pathology. Pain with intercostal neuralgia can be either unilateral or bilateral. During the first few days from the moment of occurrence pathological condition attacks of intercostal neuralgia can lead to sleep disturbances (including insomnia) and worsening general condition patient.

In children, intercostal neuralgia manifests itself as severe pain in the affected area and is accompanied by convulsions, sleep disturbances, increased excitability, and speech disorders.

The clinical picture of the disease may include:

• muscle spasms in the affected area;
• numbness of the affected area;
• increased sweating (hyperhidrosis);
• pallor or redness of the skin;
• feeling of crawling sensations;
• shortness of breath (due to incomplete breathing during attacks of pain); etc.

Signs of intercostal neuralgia, which is caused by herpetic viral infection, are skin rashes and itchy skin, occurring even before the rash appears. Skin rashes are pink spots that transform into vesicles and dry out. The rash is localized on the skin of the intercostal space. Temporary hyperpigmentation of the skin is observed in place of the rash elements during convalescence.

Diagnosis of intercostal neuralgia

The primary diagnosis of intercostal neuralgia is carried out on the basis of complaints and anamnesis, as well as an objective examination of the patient. Often the data obtained is sufficient to diagnose the disease. In complex diagnostic cases, as well as for the purpose of differential diagnosis with other pathologies that have similar manifestations, an additional examination is carried out, which, depending on the indications, includes:

• magnetic resonance and computed tomography (to exclude neoplasms, hernia);
• X-ray examination of the chest and spine in direct, lateral and oblique projections;
• electroneurography (if the consequences of injuries are suspected);
• electrocardiography (to exclude diseases of the cardiovascular system);
• ultrasonography;
• contrasting discography;
• gastroscopy (to exclude pathologies of the gastrointestinal tract);
• general and biochemical blood test;
• serological blood test; etc.

The information content of computed tomography increases when performed together with an X-ray contrast examination of the spinal cord cerebrospinal fluid tracts (myelography).

In some cases, intercostal neuralgia indicates the presence of other diseases, for example, neoplasms of the spinal cord or chest organs, pleurisy.

It is possible to identify pathology at an early stage, as well as monitor the effectiveness of treatment using electrospondylography. The method allows you to assess the condition of the spine and determine the extent of damage.

Required differential diagnosis intercostal neuralgia with other diseases:

• cardiovascular pathologies (angina pectoris, coronary heart disease, myocardial infarction);
• intervertebral hernia;
• thoracic radiculitis;
• lung cancer and other chest tumors;
• diseases of the gastrointestinal tract (gastritis, acute pancreatitis, gastric ulcer);
• renal colic ; and etc.

Treatment of intercostal neuralgia

Patients with intercostal neuralgia are prescribed bed rest for a period of several days to several weeks.

Acute pain syndrome accompanying intercostal neuralgia is relieved by parenteral administration of analgesics. If this is not enough, they resort to novocaine blockade of the intercostal nerves. After the pain intensity decreases, the patient is transferred to parenteral painkillers.

Treatment of intercostal neuralgia is complex. With increased muscle tone Centrally acting muscle relaxants are used. Swelling in the affected area is eliminated with the help of diuretics, as well as venotonics. In order to improve the functions of the nerve involved in the pathological process, parenteral use of ascorbic acid and B vitamins is indicated. Non-steroidal anti-inflammatory drugs are used according to indications (for patients with heartburn, gastritis or peptic ulcers, their prescription is supplemented with drugs from the group of organotropic gastrointestinal drugs), sedatives, antidepressants, vitamin complexes.

In the case of the development of intercostal neuralgia against the background of a herpetic infection, antiviral drugs and antihistamines are prescribed. Treatment is supplemented local application antiherpetic drugs in the form of ointment.

In women, intercostal neuralgia can be caused by wearing tight underwear, as well as being underweight. In children and adolescents, intercostal neuralgia can occur during a period of intensive growth of the bone skeleton.

As a complement to the main treatment of intercostal neuralgia in the area of ​​pain localization, physiotherapy and manual therapy can be used after relief acute symptoms intercostal neuralgia

In case of intercostal neuralgia due to displacement of the vertebrae or osteochondrosis, gentle manual therapy or traction of the spinal column can be performed. For intercostal neuralgia that has developed against the background of spinal pathologies, it is recommended to supplement the main treatment physical therapy, including a set of rehabilitation exercises.

For intercostal neuralgia caused by a tumor, treatment is carried out in the oncology department.

Possible complications and consequences

In the absence of adequate treatment, intercostal neuralgia can have complications:

• circulatory disorders with subsequent development of pathologies of muscles and internal organs;
• chronic pain syndrome;
• exacerbation of chronic diseases of the digestive system;
• increased blood pressure, hypertensive crisis;
• transient ischemic attack, stroke;
• angina attack accompanied by intense pain; and etc.

Forecast

With timely treatment, the prognosis of the disease is favorable. In case of intercostal neuralgia caused by herpetic infection, relapses are common.

Prevention

Specific prevention of neuralgia of the intercostal nerves has not been developed; general strengthening measures will help prevent the development of pathology. Recommended:

• a healthy lifestyle, including regular moderate physical activity and a rational, balanced diet;
• timely treatment of spinal diseases, chest injuries, pathologies of internal organs;
• measures to help prevent spinal curvature or treat an existing curvature;
• avoiding hypothermia;
• work in comfortable conditions, with prolonged forced body positions, take breaks for a short warm-up.

Video from YouTube on the topic of the article:

Sharp chest pain is often associated with heart disease, but there is no need to panic right away.

Maybe, a painful attack is caused by intercostal neuralgia.

It occurs due to inflammation or pinched nerve endings.

Among neurological diseases, it is considered the most insidious, since the symptoms can be attributed to many pathologies of the chest.

The disease usually occurs after 35 years of age and is practically not observed in children and young men.

Features of the pathology

Intercostal neuralgia is a pain syndrome that is caused by irritation of nerve endings. The mechanism of development of this disease is quite complex and consists of compression of the intercostal nerves.

Each nerve bundle contains autonomic and sensory fibers that react sharply to the slightest damage. In addition, when nerve endings are pinched, displacement occurs intervertebral discs, which leads to acute pain.

It should be noted that intercostal neuralgia is not considered a separate disease. The background for its development is concomitant diseases or negative changes occurring in the body.

Therefore, before treatment, it is necessary to determine the underlying pathology, since pinching of the intercostal nerves is often one of the signs of a serious pathology.

Classification

Intercostal neuralgia is divided into two types:

But regardless of the type of neuralgia, the symptoms of the pathology are acute and require immediate treatment.

What diseases can be confused with

Heart damage often mimics this disease. Therefore, a thorough diagnosis is needed.

In diseases of the cardiac system, typical changes in pulse and pressure are present, but in cases of damage to the intercostal nerves, such indicators are absent.

In addition, pain associated with heart pathology does not affect the appearance of unpleasant sensations when changing body position. And the presence of intercostal neuralgia causes pain in any movement, as well as even deep breathing. The diagnostic criterion is taking nitroglycerin. If this drug does not have an effect, the problem is not in the heart.

Diseases with similar symptoms:

• Myocardial infarction.
• Angina pectoris.
• Shingles.
• Malignant formations.
• Lung pathologies.

Intercostal neuralgia can easily be confused with other diseases, so it is important to carry out a differential diagnosis in time.

How to distinguish intercostal neuralgia from cardiac pathologies?

Knowing the nature, strength and localization of pain, it is easy to determine intercostal neuralgia.

The most important difference is that pain with neuralgia in the chest lasts for a long time and intensifies with movement.

And here for heart disease, pain is relieved in 5 minutes medicines , for example, nitroglycerin.

For diseases of the cardiovascular system, pain does not increase with movement. It is accompanied by irregular pulse rhythms and surges in blood pressure.

In the presence of intercostal neuralgia pulse and blood pressure are always normal. They can only be violated by a person’s psychological state.

Neuralgic pain often radiates to the lumbar region and is similar to an attack of renal colic.

If there is a suspicion that an attack of pain is not associated with neuralgia, you should immediately seek medical help. Timely diagnosis of the disease will facilitate treatment.

Video: "Differential diagnosis: intercostal neuralgia and heart disease"

Symptoms and features of neuralgia

The main symptom of intercostal neuralgia is an attack of piercing pain. It can be piercing, shooting, and often resembles an electric shock. Painful sensations intensify when coughing, turning the body and raising the arms.

The pain increases if you palpate the affected area. It becomes unbearable, and the patient tries to take an antalgic (forced) position to reduce discomfort. The pain in this disease is usually long-lasting and varies in intensity.

Pain syndrome has different localization. In men, pain is more often observed on the left side of the chest, in the area of ​​the lower ribs. May radiate to the scapula and heart. If the pain is localized along the intercostal nerves, then it takes on a girdling character.

In women, pain is also noted in the area of ​​​​the projection of the heart with a return to the mammary gland.

A characteristic symptom is the presence of pain at night.

Variants of neuralgia and associated pain:

• If intercostal neuralgia manifests itself in the thoracic spine, then aching pain is noted behind the sternum (cardialgia). Pain in the area of ​​the shoulder blades is often associated.
• When nerves are compressed in the lower spine, pain occurs in the area of ​​the collarbones and upper thoracic region. Painful sensations They intensify when turning the head, tilting the body, and also radiate to the neck and shoulders.
• Scapular-costal neuralgia. The condition is accompanied by stabbing pain of varying duration. They occur between the shoulder blades, in the nipple area and near the armpit. Pain also appears when breathing deeply.
• Intercostal neuralgia, which developed in chest wall(V anterior section). In this case, there is a prolonged aching pain, which is localized in the sternum or near the armpits.

Types of pain due to neuralgia:

Diagnosis of intercostal neuralgia

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Next fact

Primary diagnosis is carried out based on the patient's history and complaints. Sometimes such data is enough to determine the disease. IN difficult cases additional examination is required, that is, differential diagnosis, to exclude diseases with similar symptoms.

The following methods are used:

CT scan will provide more information if done in combination with myelography.

Since intercostal neuralgia is easily confused with other pathologies, Differential diagnosis must be carried out to exclude the following diseases:

• Vascular pathologies.
• Atypical pneumonia.
• Pleurisy.
• Gastrointestinal diseases.
• Kidney disease.

Despite the high information content of modern diagnostic methods, they still cannot accurately diagnose in this case. Neuralgia is functional impairment With typical symptom which is expressed by pain.

Ultrasound and tomography can only determine:

• Presence of pinched nerve tissue: cyst, neoplasm, inflammatory focus.
• Poor local blood circulation in the area of ​​pain.

This is very important, as it allows you to determine treatment tactics. But in the presence of “classical” neuralgia, which is not serious illness, such expensive methods are often useless.

Electroneuromyography can be distinguished; the method determines the condition of the nerves. This study (ENMG) is used to detect disturbances in the passage of nerve impulses along a nerve.

How is the procedure performed?:

• The nerve is irritated by electric current, that is, neurostimulation occurs.
• If the nerve is motor, then irritation of the necessary muscles appears. Then the muscle response is analyzed (time, amplitude) and an impulse curve is derived from these indicators.
• In neuralgia, when the nerve is sensitive, the reaction to artificial irritation that causes pain is examined.

The procedure is painless, but is sometimes accompanied by burning or tingling.

You need to know that everything instrumental methods, are appointed as additional measure. The main means of diagnosing neuralgia is a careful medical interview and visual examination by an experienced specialist.

Self-diagnosis

If signs of intercostal neuralgia appear for the first time in a person, it is unlikely that he will be able to correctly identify the disease. Moreover, by making an incorrect diagnosis, you can get unwanted complications.

It can be:

• The pain syndrome will become chronic.
• Exacerbation of diseases of the digestive system.
• Ischemic attack, up to stroke.
• Frequent attacks of angina pectoris.
• Hypertensive crisis.

Therefore, it is better not to take risks, but to immediately contact a neurologist.

Conclusion

Intercostal neuralgia- a disease that occurs due to irritation of the intercostal nerves. It is often confused with heart diseases such as angina. Home distinctive feature is that with neuralgia the pain is constant and appears during movement.

Since the pathology is a consequence of other diseases, it is necessary to carry out an accurate diagnosis from a specialist in order to prescribe the correct therapy in the future.

Intercostal neuralgia should not cause much concern, but it does cause a lot of discomfort. You can easily prevent neuralgic pain by simply following general strengthening measures. It is advisable to harden the body, prevent hypothermia and promptly treat spinal diseases.

Rheumatologist, Orthopedist

Engaged in the management of traumatological and orthopedic patients, reading radiographs and interpreting test results, as well as conducting conservative and operational methods treatment.