How to relieve pain in neuralgia

Intercostal neuralgia is not life-threatening, but it can cause a lot of suffering.And also frighten - because in its manifestations it sometimes resembles a heart attack.And even doctors without examination can not always clearly distinguish between these diseases.What is intercostal neuralgia, why it occurs and how it manifests itself, as well as modern methods of diagnosis, treatment and prevention of this pathology, we will tell in detail in the article.

What is intercostal neuralgia and how to recognize it? This is a condition that occurs due to damage, compression or irritation of the intercostal nerves.

There are 24 intercostal nerves (12 pairs) in the human body. They are all anterior branches of the thoracic spinal nerves - from the first to the 12th vertebrae of the thoracic region (Th1-Th12). The first pair partially innervates the shoulder girdle, and the last pair runs below the edge of the rib arch (12th rib). It is also called the subcostal nerves. The intercostal nerves are responsible for skin sensitivity and mobility of the muscles of the chest, as well as the upper abdomen. They regulate breathing movements, and when damaged or irritated, they transmit pain sensations.

Features of pain with intercostal neuralgia:

• by nature it is stabbing, burning, shooting, penetrating;
• occurs in the intercostal spaces, usually pointwise. It can “pass” through the entire chest - from the spine to the sternum. In most cases, intercostal pain is unilateral;
• intensifies with movement - this is extremely characteristic, typical for intercostal neuralgia sign. Pain appears or sharply increases with a sharp turn of the torso, deep breathing and especially - coughing, laughing, sneezing. However, this symptom can occur in other diseases - for example, inflammation of the thoracic pleura (pleurisy);
• may irradiate - spread to the back, shoulder, abdomen. Sometimes this makes diagnosis very difficult.

Since intercostal neuralgia affects the nerves responsible for skin sensitivity, patients may complain of tingling, burning or numbness in a certain area (zone of innervation).

It is believed that pain in the intercostal muscles is easy to distinguish from a heart attack. In angina pectoris or heart attack, the pain is dull, squeezing or burning, NOT pinpointed (occupies a certain area), radiates to the left shoulder blade, lower jaw or left arm. Heart attack is also very often accompanied by sweating, weakness, pale skin, panic, fear of death, shortness of breath.

There is also a diagnostic test with nitroglycerin - in an angina attack, the pill “works wonders” and the pain goes away in 5 minutes, and in an intercostal nerve impingement - no change.

But in fact, both the first and the second diagnosis require confirmation or exclusion - and for this you need to at least perform an electrocardiogram (ECG). With severe intercostal pain, too, you can experience panic and difficulty breathing, as in a heart attack, and in a heart attack with erased manifestations - feel some vague pain without other symptoms.

The pain of dry pleurisy is also very similar to intercostal neuralgia, but it is usually accompanied by cough and fever.

In rare cases, gastritis or peptic ulcer may mimic nerve damage, but careful questioning of the patient usually reveals the relationship of pain to food intake or hunger, as well as other complaints - heartburn, belching, etc.

Causes of intercostal neuralgia

The main cause of intercostal neuralgia is spinal disorders. These include osteochondrosis, disc protrusions, intervertebral hernias, spondyloarthrosis (degenerative changes in the joints of the vertebrae). Bony overgrowths or fibrous bulges squeeze the nerve roots and provoke the appearance of acute pain.

Intercostal neuralgia can also be the result of thoracic trauma or even tumors, such as osteoblastoma of the thoracic spine.

Thoracic surgery, prosthetic heart valves, and other surgical procedures can also cause acute intercostal pain syndrome.

Separately, it is worth considering neuralgia that occurs after shingles - Herpes zoster. In medicine, it is so called “postherpetic neuralgia”. In this disease, a burning pain occurs between the ribs (along the course of the intercostal nerves). Unlike ordinary intercostal neuralgia, this pain is constant and very persistent - it can persist for weeks and even months (in rare cases - years).

It is not difficult to distinguish postherpetic neuralgia from intercostal neuralgia: with shingles, rashes appear along the course of the intercostal nerves - vesicles filled with clear fluid. In addition, these diseases differ in the type of pain (we mentioned this above).

To the provoking factors that increase the risk of developing intercostal neuralgia include hypothermia and - according to some reports - stress. However, their influence on the intercostal nerves is indirect - against the background of hypothermia may occur myositis and spasm of the chest muscles, which in turn will lead to inflammation of nerve roots and their impingement. And chronic stress reduces the body's defenses and its ability to fight the inflammatory process.

Methods of diagnosing intercostal neuralgia

Intercostal neuralgia can not be seen by eye or on X-ray, but it can be suspected by characteristic manifestations. First of all, the doctor asks the patient in detail about the pain syndrome - what is the nature of the pain, when it occurs and from what passes, where it spreads.

Then the neurologist usually asks to show where exactly it hurts, and deeply inhale and exhale, as well as make a few sharp movements (arm swings, turns of the torso, coughing). Point localization of pain (a person shows with a finger) and its intensification with movements speak in favor of intercostal neuralgia.

When examining can draw attention to violations of posture, curvature of the spine (hyperlordosis, scoliosis, pronounced kyphosis), as well as forced position of the body - for example, tilt in the direction of the lesion. It helps to reduce unpleasant sensations. If in the chest area along the course of the intercostal nerves clearly visible area of redness or rashes in the form of vesicles - most likely, we are talking about shingles.

When palpation is usually noted painin the area of the intercostal spaces.

If necessary, the doctor refers the patient to additional tests to rule out other, more serious diseases:

• ECG - angina attack, myocardial infarction;
• X-ray of the chest organs - pleurisy, pneumonia (inflammation of the lungs), rib fractures, bronchial and lung tumors, metastases to the thoracic vertebrae;
• MRI - osteochondrosis, protrusions, intervertebral hernias, nerve root lesions, spinal cord abnormalities.

Does intercostal neuralgia always require a detailed examination? No. If the doctor sees a typical clinical picture of this disease, the patient has no other complaints and risk factors (e.g., advanced age, diabetes, prolonged cough, smoking, etc.), no alarming symptoms are detected during the examination, then the diagnosis can be established clinically (without additional examination).

How to treat intercostal neuralgia?

Treatment of neuralgia necessarily includes pain relief and elimination of muscle spasm - an almost invariable companion of this pathology.

Muscle spasm occurs reflexively - in response to severe pain. But at the same time, it intensifies it even more due to compression of nerve roots and creates a vicious circle. Without muscle relaxation, even the strongest analgesics will help only temporarily.

To relieve the pain of intercostal neuralgia, doctors prescribe non-steroidal anti-inflammatory drugs (NSAIDs):

• diclofenac;
• ibuprofen;
• naproxen;
• meloxicam and others.

They simultaneously reduce pain syndrome and reduce the intensity of the inflammatory process.

In severe pain, for a quick and persistent effect, you can use combined drugs - for example, tablets “from neuralgia” Antinevralgic. They contain 3 active substances - paracetamol 150 mg, acetylsalicylic acid 250 mg and caffeine 20 mg. This combination allows you to quickly relieve the patient's condition.

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Antinevralgic P, 20 tablets, Sanofi

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Antinevralgic Sinus, 12 tablets, Sanofi

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Also in intercostal neuralgia can be used injections (in the severe course of the disease), capsules, granules for the preparation of oral solutions and topical agents (ointments, creams, gels).

Effective “relaxant” drugs for intercostal neuralgia are myorelaxants:

• thiocolchicoside;
• tolperisone;
• cyclobenzaprine, and others.

Myorelaxants, too, can be used in various dosage forms - for example, in the form of tablets, injections, creams and others.

If the effectiveness of NSAIDs and myorelaxants is insufficient, the doctor can supplement therapy with anticonvulsants (pregabalin or gabapentin) - these drugs are effective for neuropathic pain. They stabilize overactive nerve endings and thus reduce the pain syndrome.

If NSAIDs, myorelaxants and other medications do not bring relief - the doctor may recommend an intercostal nerve block. This is the administration of a local anesthetic (e.g., lidocaine) and, if necessary, glucocorticoid hormone. In most cases, the blockade provides pronounced and persistent analgesia (pain relief).

Folk methods of treatment of intercostal neuralgia

Intercostal neuralgia is usually accompanied by severe pain, so people try to alleviate their condition in various ways, including folk medicine - from chamomile tea to applying cabbage leaf.

But since the basis of the pathology is impingement / inflammation of the nerve root and muscle spasm, the most effective will be “warming and relaxing” methods - dry heat and warm baths (you can add herbal decoctions - succession, chamomile, mint, lemon balm, sage, as well as coniferous extract or sea salt).

Diet and vitamins for intercostal neuralgia

Intercostal neuralgia is not directly related to the digestive system or metabolism, so it does not require any special diet. But doctors still recommend including in the diet the necessary macro- and microelements, vitamins, as well as “anti-inflammatory” products. These can be:

• fatty sea fish and vegetable oils, nuts rich in omega-3 fatty acids;
• berries (blueberries, raspberries), citrus fruits, green vegetables, tomatoes - sources of antioxidants;
• turmeric and ginger - they are known for their anti-inflammatory and even analgesic properties. Important! Ginger is forbidden for use in peptic ulcer disease, hypertension, pregnancy and others.

In addition, with neuralgia you need to take care of the nerves themselves. And in this we will help us vitamins B - because they restore damaged nerve fibers and reduce the intensity of inflammation.

What foods contain B vitamins:

• thiamine (B1) - pork, liver, whole grain products, nuts, sunflower seeds, legumes, potatoes. Vitamin B1 improves the conduction of nerve impulses and normalizes the nervous system;
• pyridoxine (B6) - fish, potatoes, bananas, nuts, seeds, legumes, whole grain products. This vitamin is essential for the production of neurotransmitters responsible for the transmission of nerve impulses. It helps to reduce hyperactivity of nerve fibers and reduce pain;
• cyanocobalamin (B12) - meat, fish, dairy products, eggs, fortified foods (e.g., some plant milk and cereals). Without vitamin B12, myelin - a substance that covers nerve fibers and protects them from damage - is not formed.

In intercostal neuralgia, the doctor can also recommend “pharmacy” B vitamins. In high doses, they not only improve the condition of the nerves, but also reduce the pain syndrome.

Prevention of intercostal neuralgia

Intercostal neuralgia is a very unpleasant pathology, so it is better to take care of its prevention in time, than then swallow handfuls of pain pills. Doctors recommend

• watch your posture. Correct posture = healthy spine;
• treat spinal conditions in a timely manner;
• avoid heavy physical exertion and sudden movements;
• be physically active (but within reasonable limits);
• eat a balanced diet, not forgetting B vitamins;
• maintain a normal weight;
• take “minutes of relaxation”.

Useful physical exercises in intercostal neuralgia are stretching exercises, which will help prevent the appearance of muscle clamps, as well as yoga, Pilates, swimming. But with acute root impingement, physical activity is best avoided, so as not to increase pain. In such a situation, kinesitherapy is very useful (only under the supervision of a specialist!).

When should I consult a doctor?

A doctor should be consulted at the onset of any pain behind the sternum. This symptom is very insidious, as it can occur in a variety of diseases and, most importantly, in myocardial infarction.

Do not lie at home in the hope that “it will go away” - be sure to consult a doctor to determine the cause of pain and select the right treatment.