Intercostal neuralgia
The content of the article:
- Intercostal neuralgia causes and risk factors
- Forms of the disease
- Intercostal neuralgia symptoms
- Diagnostics of the intercostal neuralgia
- Intercostal neuralgia treatment
- Possible complications and consequences
- Forecast
- Prevention
Intercostal neuralgia is a lesion of the intercostal nerves, accompanied by intense pain. The pathology itself does not pose a danger to life, however, under the symptoms of intercostal neuralgia, serious diseases can be masked, 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 and 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 provide innervation to the skin and muscles of the peritoneum, costal and diaphragmatic parts of the pleura, the anterior abdominal wall, breast, chest. Neuralgia occurs when the roots of the intercostal nerves are squeezed at the point where they exit from the spine, usually as a result of muscle spasm.
Intercostal neuralgia occurs equally often in men and women. Disease susceptibility increases with age.
Synonyms: intercostal nerve neuralgia, thoracic sciatica.
Intercostal neuralgia causes and risk factors
The most common causes of intercostal nerve neuralgia are:
- osteochondrosis, spondylitis, ankylosing spondylitis and other diseases of the thoracic spine;
- tumors of the thoracic spinal cord;
- excessive physical activity;
- sudden unsuccessful movement;
- chest trauma;
- forced uncomfortable body position;
- general hypothermia of the body, hypothermia of the chest and back;
- pathology of the upper gastrointestinal tract;
- herpes infection.
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 the period of intensive growth of the bone skeleton.
Intercostal neuralgia may result from excessive exercise
The contributing factors are:
- metabolic disorders (diabetes mellitus);
- age-related changes in blood vessels;
- immunodeficiency;
- diseases of the nervous system;
- infectious and inflammatory diseases;
- intoxication of the body;
- inconvenient 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 be disguised as a cardiac pathology;
- reflex - occurs due to muscle tension in the intercostal spaces.
Depending on the localization, 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.
Intercostal neuralgia symptoms
The main symptom of intercostal neuralgia is paroxysmal piercing pain, which can be shooting, burning, stabbing, resembling an electric shock. The pain increases with laughing, coughing, deep breathing, turning the body, lifting the upper limbs. In addition, the pain sensations increase with palpation of the affected area, and may become unbearable for the patient. The patient assumes 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 be of different localization. In women, against the background of hormonal changes in the climacteric 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, in the left side of the chest. Depending on the location of the lesion, pain can be given to the region of the heart, scapula, epigastrium. With the localization of pain along one or two intercostal nerves, it can acquire a shingles in nature.
In women, pain with intercostal neuralgia can be given to the mammary gland.
A characteristic feature of intercostal neuralgia is that pain does not diminish at night. In the early stages of the disease, pain in the chest may be less intense, manifest as tingling, but increase with the progression of the pathology. Pain with intercostal neuralgia can be both unilateral and bilateral. During the first few days after the onset of the pathological condition, attacks of intercostal neuralgia can lead to sleep disturbances (up to insomnia) and a deterioration in the patient's general condition.
In children, intercostal neuralgia is manifested by 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 creeping creeps;
- shortness of breath (due to incomplete breathing during bouts of pain); etc.
Signs of intercostal neuralgia, which is caused by a herpes viral infection, are a rash on the skin and itching that occurs 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. In place of the elements of the rash during the period of convalescence, there is a temporary hyperpigmentation of the skin.
Diagnostics of the intercostal neuralgia
The primary diagnosis of intercostal neuralgia is carried out on the basis of complaints and collection of anamnesis, as well as an objective examination of the patient. Often, the data obtained is sufficient to diagnose the disease. In difficult 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, hernias);
- X-ray examination of the chest and spine in frontal, lateral and oblique projections;
- electroneurography (in case of suspicion of the consequences of injuries);
- electrocardiography (to exclude diseases of the cardiovascular system);
- ultrasound procedure;
- contrasting discography;
- gastroscopy (to exclude pathologies of the gastrointestinal tract);
- general and biochemical blood test;
- general urine analysis;
- serological blood test; etc.
Diagnosis of intercostal neuralgia involves an X-ray examination
The information content of computed tomography increases when it is carried out together with an X-ray contrast examination of the cerebrospinal fluid pathways of the spinal cord (myelography).
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 degree of damage.
Differential diagnosis of intercostal neuralgia with other diseases is required:
- cardiovascular pathologies (angina pectoris, ischemic heart disease, myocardial infarction);
- intervertebral hernia;
- chest sciatica;
- pleurisy;
- lung cancer and other neoplasms of the chest;
- diseases of the gastrointestinal tract (gastritis, acute pancreatitis, gastric ulcer);
- atypical pneumonia;
- renal colic; and etc.
Intercostal neuralgia treatment
Patients with intercostal neuralgia are shown bed rest for several days to several weeks.
Acute pain syndrome accompanying intercostal neuralgia is stopped by parenteral administration of analgesics. If this is not enough, they resort to novocaine blockade of intercostal nerves. After the intensity of pain decreases, the patient is transferred to parenteral administration of pain medications.
With severe pain syndrome, novocaine blockade is performed
Treatment of intercostal neuralgia is complex. With increased muscle tone, centrally acting muscle relaxants are used. Edema in the affected area is eliminated with diuretic drugs, 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. According to indications, non-steroidal anti-inflammatory drugs are used (for patients with heartburn, gastritis or peptic ulcer disease, their appointment 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 herpes infection, antiviral drugs, antihistamines are prescribed. Treatment is complemented by the topical application of antiherpetic drugs in the form of an ointment.
As a supplement to the main treatment of intercostal neuralgia in the area of pain localization, mustard plasters, compresses, anti-inflammatory drugs in the form of gels and ointments can be used. The positive side of the use of topical drugs for intercostal neuralgia is that these drugs do not pass through the liver, therefore, their concentration does not decrease.
It is necessary to exclude stress on the body, stress, alcohol.
After the acute symptoms subside, physiotherapy is prescribed in order to accelerate remission and prevent relapses. The therapeutic effect is provided by the following methods:
- ultraviolet radiation of the chest;
- UHF therapy;
- electrophoresis of drugs;
- darsonvalization;
- mud therapy, paraffin therapy.
Physiotherapy and manual therapy are used after the relief of acute symptoms of intercostal neuralgia
In the event of intercostal neuralgia due to displacement of the vertebrae or osteochondrosis, gentle manual therapy or traction of the spinal column can be performed. In case of intercostal neuralgia, which develops against the background of pathologies of the spine, it is recommended to supplement the main treatment with physiotherapy exercises, including a complex of restorative exercises.
With intercostal neuralgia caused by a neoplasm, 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 the subsequent development of pathologies of muscles and internal organs;
- scoliosis;
- chronic pain syndrome;
- exacerbation of chronic diseases of the digestive system;
- increased blood pressure, hypertensive crisis;
- transient ischemic attack, stroke;
- an attack of angina pectoris against a background of intense pain; and etc.
Forecast
With timely therapy, the prognosis of the disease is favorable. In the case of intercostal neuralgia caused by herpes infection, relapses are common.
Prevention
Specific prevention of intercostal nerve neuralgia has not been developed, restorative measures will help prevent the development of pathology. Recommended:
- a healthy lifestyle, including regular moderate physical activity and a balanced diet;
- hardening of the body;
- timely treatment of diseases of the spine, chest injuries, pathologies of internal organs;
- measures to help prevent curvature of the spine or treat an existing curvature;
- avoiding hypothermia of the body;
- work in comfortable conditions, with a prolonged forced position of the body, take breaks for a short warm-up.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
