Intercostal neuralgia is a rare pain condition involving the intercostal nerves that supply the muscles between the ribs. In patients with intercostal neuralgia, bands of pain around the rib cage are experienced. The pain is usually intermittent and spasmodic. Intensity can vary, depending on a number of factors. This condition is usually treated by a neurologist, which is a physician who specializes in conditions involving the nerves. Treatment usually also involves a pain specialist who helps address the associated pain.

Patients can develop intercostal neuralgia in the wake of an injury that damages the nerves or as a result of a degenerative disease that pinches or otherwise damages the nerves. Typically, people experience pain while breathing, coughing, and laughing. They may also experience pain during exertion. Intercostal neuralgia can manifest as tingling, numbness, itchiness, or pain and sometimes all of these sensations are experienced at various times. In some cases, the pain is searing and is sometimes described as being “like a lightning bolt."

Diagnosis of this condition can be complicated. It can mimic other conditions and a physician who does not have experience with intercostal neuralgia may not understand the reports made by the patient. Patients with chronic pain conditions also sometimes encounter resistance from care providers who are concerned about drug-seeking behavior and fear that a patient is claiming to be in pain when this is not the case. The sometimes erratic nature of pain conditions can further complicate matters, as a patient may have varying pain levels that make it hard to narrow down the location and cause of the pain.

Immediate management of intercostal neuralgia includes the administration of analgesic medication to manage pain, along with anti-inflammatory drugs to reduce inflammation around the nerves. A doctor can administer an injection of local anesthetic for a patient experiencing extreme pain. Some other options can include physical therapy and massage, depending on the situation. Some patients also pursue complementary and alternative therapy under the guidance of a care practitioner.

If these measures are not effective, more aggressive treatments for intercostal neuralgia are available. Nerve stimulation sometimes provides benefits for some patients. This option will usually be tested with external stimulation first, and if the patient experiences relief, an internal device may be implanted. Finally, if a nerve does not respond to any treatments, it can be severed in a surgical procedure so that it will stop sending pain signals to the brain.