Nicholas R. Metrus, MD, is a board-certified neurologist and neuro-oncologist. He currently serves at the Glasser Brain Tumor Center in Summit, New Jersey.

Intercostal neuralgia is neuropathic pain in the intercostal nerves, the nerves arising from the spinal cord, just below the ribs. Intercostal neuralgia often causes thoracic (upper back) pain that radiates into the chest wall and the upper trunk. Intercostal neuralgia is also known as chest wall pain.

Here is what you need to know about intercostal neuralgia, including symptoms, potential causes, diagnosis, treatment, and prevention.

The main symptom experienced by people with intercostal neuralgia is pain in the rib cage area. People who experience this type of rib pain may describe the pain as stabbing, sharp, tender, aching, gnawing, burning, and/or spasm-like.

Pain may cover the entire chest or radiate from the back towards the chest. Sometimes, a person may feel pain along the length of the ribs. Pain episodes tend to be sporadic and may intensity with activity, including lifting, turning and twisting the torso, coughing, sneezing, or laughing. 

Other symptoms of intercostal neuralgia may include: 

There are times when rib and chest pain may indicate a life-threatening condition. Intercostal neuralgia can cause severe and debilitating pain that makes it hard to breathe. Sometimes, rib cage pain or chest area pain can be a sign of a condition that may require emergency medical treatment. For example, chest pain may indicate a heart attack.

Seek immediate medical attention or call 911 if you or someone you are with starts to have chest pain that is severe and of an unknown cause.

Other symptoms that may indicate a medical emergency include:  

Intercostal neuralgia is caused by inflammation and irritation in or compression of the intercostal nerves.

Causes of Intercostal nerve pain include:

Sometimes, intercostal neuralgia has no known cause. If your healthcare provider is unable to determine a case, you may be diagnosed with idiopathic intercostal neuralgia. The term “idiopathic” is used to describe medical conditions that have no identifiable or clear cause.

There are a number of risk factors that increase the chance of developing intercostal neuralgia.

The majority of people with intercostal neuralgia first seek medical care because they think they may be having a heart attack or other cardiac problem.

The physical exam is an important part of the intercostal neuralgia diagnosis. This involves inspecting the area where the intercostal nerves are located. Pain produced from simple light pressure can help to assess the extent of pain.

To rule out other potential causes of chest wall pain, rib pain, or back pain, additional testing will be done. This will help your healthcare provider to determine if the intercostal nerves are the source of pain or to diagnose other causes of chest pain, such as lung or cardiovascular disease.

Other tests to help evaluate causes of pain related to the intercostal nerves include:

If you have risk factors for heart disease, such as diabetes, high blood pressure, a history of smoking, or a family history of heart disease, your healthcare provider will want to test your heart function. 

Treatment for intercostal neuralgia may depend on the underlying cause, but it is possible for symptoms to resolve without treatment. 

Treatments for intercostal neuralgia include:

Your healthcare provider may also recommend complementary therapies, such as acupuncture, massage therapy, and yoga, to help manage your symptoms. These therapies are to be used in conjunction with traditional treatments, and not as lone therapies or as substitutes for medicinal therapies.

Some healthy lifestyle habits may prevent intercostal neuralgia and reduce your risk of developing the condition. 

Things you can do to reduce your risk are:

Intercostal neuralgia varies from person to person. Your healthcare provider is in the best position to explain what to expect and how treatment can help. Untreated pain—regardless of the location or source—can lead to complications, including sleep problems, loss of appetite, or mood disorders, such as anxiety and depression.

If you find treatments aren’t helping to manage symptoms of intercostal neuralgia, ask your healthcare provider about a referral to a pain management specialist. A specialist can work with you to come up with a pain relief solution that is safe and helps to manage your pain.

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