Conventional Medical Treatments for Intercostal Neuralgia

What is intercostal neuralgia?

Intercostal neuralgia is a type of neuropathic (nerve) pain. It involves the nerves that arise from the spinal cord and lie beneath the ribs. These nerves are connected to the muscles of the rib cage, skin and chest cavity.

Treatments for intercostal neuralgia

Treatment for intercostal neuralgia involves reducing pain in the affected nerves. Many treatment options are available: topical treatments, prescription medications, injections and surgery.

Topical treatments

Topical treatments, such as gels or patches containing lidocaine or capsaicin, may help reduce pain. They are available both over-the-counter and via prescription.

Prescription medications

Prescription medications, such as antidepressants, anticonvulsants and pain medications, are also used to treat intercostal neuralgia.

• Antidepressants
  Antidepressants are often prescribed for nerve pain even when an individual has not been diagnosed with depression. The exact way antidepressants reduce pain is not known, but it is thought that they may increase neurotransmitters that reduce pain signals. The most effective antidepressants prescribed for nerve pain are tricyclic antidepressants, such as amitriptyline and doxepin. These are usually prescribed at a lower dose than would be prescribed for depression. Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine and venlafaxine, can also be prescribed for nerve pain. These medications have fewer side effects than tricyclic antidepressants but may not be as effective.
• Anticonvulsants
  Though initially intended to prevent seizures, anticonvulsants may also be prescribed to reduce nerve pain. Anticonvulsants may help calm pain signals from the nerves. To reduce any side effects, anticonvulsants are usually started at a low dose and gradually increased. They can take three to four weeks to become effective. Anticonvulsants prescribed for intercostal neuralgia may include carbamazepine, gabapentin and pregabalin.
• Pain Medications
  For severe pain, prescription pain medications may be utilized. Opioid-aspirin or opioid-acetaminophen may be needed in severe cases of intercostal neuralgia.

Injections

In addition to medications, a nerve block may be used to reduce pain. A nerve block is an injection which contains a local anesthetic, with or without corticosteroids, to reduce inflammation and pain. An intercostal nerve block is given in the area just under an individual’s rib. Physicians typically use X-rays to ensure precise administration of the injection. A nerve block may take a few days to take effect.

An alternative type of injection used for intercostal neuralgia is a thoracic epidural injection in which anti-inflammatory medication is injected into the area around the spinal cord.

Surgery

In severe cases of intercostal neuralgia, particularly in cases resulting from injury during surgery, a surgical procedure known as intercostal neurectomy may be recommended. The affected nerve is cut or removed during this procedure. Researchers at Johns Hopkins University found that neurectomy was effective in reducing pain in people for whom more conservative measures did not work.

In most cases of intercostal neuralgia, a combination of topical treatments, prescription medications and injections is effective for pain reduction.