What to do with attacks of neuralgia. Intercostal neuralgia: symptoms and causes. Treatment of intercostal neuralgia: new drugs. The difference between the disease and heart disease

Intercostal neuralgia is a reflex pain syndrome that occurs when the intercostal nerves are compressed, irritated or inflamed. Otherwise, it is also called thoracalgia. This phenomenon is unpleasant, as it is accompanied by intense pain.

The clinical symptoms of intercostal neuralgia are very similar to the symptoms of a number of diseases of the internal organs, in particular, the heart. That is why many patients, frightened by an attack of intercostal neuralgia, turn to a cardiologist or begin to self-medicate at home, taking heart medications.

In this regard, along with the lack of proper diagnosis and adequate treatment of neuralgia, it exacerbates the patient's condition. And the loss of time can lead to quite serious complications.

The reasons

Why does intercostal neuralgia occur, and what is it? The main cause of neuralgia is compression and irritation of the intercostal nerves due to inflammatory and degenerative changes in the spine. Most often, the pathology does not occur independently, but develops against the background of another disease.

In this regard, there are certain reasons leading to intercostal neuralgia:

• back and chest injuries;
• hypothermia;
• pathologies of the spine - scoliosis, deforming spondylosis, osteochondrosis, herniated discs;
• internal (diseases of internal organs) and external (medication, the influence of heavy metals) intoxication;
• transferred infectious diseases (tuberculosis, herpes zoster, brucellosis);
• malignant tumors of the lungs and pleura;
• diseases of the nervous system (multiple sclerosis, polyradiculoneuritis);
• reduced immunity;
• allergy.

In the vast majority of cases, the “culprit” is osteochondrosis, which leads to the destruction of cartilage tissue, as a result of which the nerve roots are compressed and sharp pain occurs. Pathological changes in the spinal column cause musculo-tonic syndrome (impaired muscle tone), which greatly complicates the situation.

Symptoms of intercostal neuralgia

In general, intercostal neuralgia is capable of making itself felt with a number of specific symptoms that can be observed both in a complex and selectively. It all depends on the individual characteristics of the organism of each individual person. And it depends on this how clearly these signs will be expressed, as well as on which side - on the left or on the right.

The main symptom of this disease is pain along the intercostal space on the right or left. The intensity of pain can be different: from sharp, acute, pronounced, shooting (more often) to constant, moderate intensity. The pain is aggravated by the movements of the patient, by coughing and sneezing, and even by breathing. Often a person takes a forced position: leans to the affected side in order to minimize the amount of movement in it. Some patients, when coughing, laughing or sneezing, press their palm firmly against the affected intercostal space for the same purpose: to reduce the range of motion in this area so that it hurts less.

In addition, the disease is accompanied by: numbness of the affected areas, muscle tension, convulsions, increased sweating, a feeling of "crawling" on the skin, sleep disturbance, tearfulness. Increased intercostal neuralgia after exercise or stress.

The difference between the symptoms of neuralgia and heart disease

This disease often mimics heart disease. For correct diagnosis, it is important to remember that in pathologies of the cardiovascular system, concomitant changes in pulse and blood pressure are detected. With damage to the intercostal nerves, this pattern is absent.

In addition, with pain syndrome, which is associated with disorders in the work of the heart, a change in body position does not affect the intensity of unpleasant sensations. When an attack of intercostal neuralgia develops, any movement, as well as deep breathing, provokes an increase in pain. The diagnostic criterion is that nitroglycerin or similar drugs do not give a positive effect.

If you doubt or suspect that paroxysmal pain is associated with other diseases, you should seek medical help as soon as possible and not delay treatment. The sooner the disease is diagnosed, the easier it will be to recover.

Scroll diseases with similar symptoms:

• angina;
• shingles;
• myocardial infarction;
• ankylosing spondylitis;
• lung diseases;
• tumor diseases.

It is very important to distinguish intercostal neuralgia in time from other diseases that can even lead to death.

Diagnostics

To figure out how to treat intercostal neuralgia, it is necessary not only to diagnose a symptom, but also to determine the cause of its development.

Differential diagnosis according to clinical manifestations is an important stage in the treatment of patients. First of all, it is necessary to exclude the pathology of the heart, since the treatment of intercostal neuralgia and heart diseases require different methods of therapy, and incorrect diagnosis and lost time in cardiac pathology can be crucial for the patient's condition.

To rule out other diseases, the doctor may prescribe an ECG, X-ray of the lungs, an ultrasound examination of the abdominal organs, and other necessary studies. After the final verification of the diagnosis, you can proceed to the treatment of intercostal neuralgia.

Treatment of intercostal neuralgia

Symptoms of intercostal neuralgia should not be ignored. Yes, and intense pain is unlikely to allow this. The essence of the treatment of neuralgia is as follows:

1. Removal of pain and other manifestations of intercostal neuralgia with the help of tablets.
2. Elimination of pinching and (or) inflammation of the affected nerve.
3. Elimination of the root cause of the disease, which, in fact, leads to the development of intercostal neuralgia.

The treatment regimen includes the use of the following methods:

1. Drug therapy (analgesics and blockades, vitamins);
2. Gentle regimen and restriction of mobility of the spine (thorax) at the level of the lesion, wearing a corset;
3. Physiotherapy treatment;
4. Manual and reflex therapy;
5. Massage and physiotherapy.

If the cause of the disease was the infringement of the roots of the spinal nerves, then only the treatment of the pathology that led to the infringement - osteochondrosis, herniated formation of the intervertebral disc, etc., can cope with neuralgia.

At home, the use of ointments with anti-inflammatory and analgesic effects is shown as a local therapy. Due to the effect of their components, blood circulation in the affected area improves? as well as muscle relaxation.

Physiotherapy and exercise therapy

The effects of electromagnetic and magnetic fields, ultrasound, infrared and UV radiation, electrophoresis and other physiotherapeutic methods perfectly help to fight intercostal neuralgia.

Massage

It improves metabolic processes and blood flow, relaxes muscles, normalizes the conduction of nerve impulses, and has a slight analgesic effect. The duration of the course of treatment is 10 sessions.

Manual therapy

The effect of massage is fixed by manual therapy. During its implementation, the chiropractor works with his hands directly on the displaced vertebrae. During this action, the vertebrae return to their original position, the spaces between the vertebrae expand, and the pinched nerves are released. The method is effective, but if the technique is violated, serious complications are possible.

How to treat intercostal neuralgia at home

If for some reason it is not possible to seek help from a doctor, you can resort to folk methods. Traditional medicine also has many proven self-help recipes to relieve the symptoms of intercostal neuralgia.

So, the following can be considered the most effective folk remedies for the treatment of intercostal neuralgia at home:

1. Rubbing the affected area with alcohol has a good effect. infusion of birch buds or tincture of valerian. The substances that make up these tinctures act similarly to the components of industrial ointments. But you should not apply compresses with alcohol at night, since alcohol can cause skin burns.
2. Warming up also helps, but the thermal effect in case of intercostal neuralgia should not be direct, that is, do not apply a heating pad, hot potato or egg, but wrap yourself in a downy scarf, a knitted woolen thing. If you strongly heat the painful place, the pain will go away for a short time and then such an effect will only increase the swelling of the soft tissues and bring even greater pain.
3. Good to take inside peppermint decoction: 200 ml. boil water, add 1 tablespoon of dried peppermint leaves to boiling water, insist. Take 100 ml. in the morning and in the evening. You can add 2 teaspoons of honey to the decoction.
4. Pain along the nerves helps to reduce horseradish or black radish juice, which must be rubbed into the affected areas, as well as compresses with steamed flax seeds.
5. You should take 4 tbsp. tablespoons of dry sage and pour them with one glass of hot water. Let this decoction brew for 60 minutes, then strain. The resulting tincture should be poured into a bath (not higher than 37 degrees), pour sea salt there (4 tablespoons) and take a bath before going to bed for no longer than 10 minutes, for 10 days.

But we should not forget that all self-help home remedies only relieve pain for a while, but do not eliminate its main cause. Therefore, your main task is to undergo a full examination and, if necessary, a course of treatment as soon as possible (in order to avoid possible complications).

Prevention

The essence of the prevention of intercostal neuralgia is the observance of elementary rules, such as:

1. Monitor your diet and lifestyle.
2. Avoid hypothermia.
3. Avoid spinal injury.
4. Timely treat internal diseases of the musculoskeletal system.
5. Exercise daily, especially when your work activity is related to sedentary work. Maintain correct posture.
6. In the presence of any internal disease of infectious or non-infectious origin, seek help from doctors, carry out a full course of treatment, this will help to avoid possible complications.

Which doctor to contact

With the appearance of acute pain in the chest, you can contact a therapist who will definitely refer the patient to an electrocardiogram and x-ray of the chest organs. After ruling out heart and lung diseases, the patient will be treated by a neurologist. A physiotherapist, a specialist in physiotherapy exercises and massage, a reflexologist, and a chiropractor take part in the treatment of the disease.

Intercostal neuralgia is a disease that develops as a result of a pinched nerve between the ribs. The signs of the disease are almost identical to the symptoms that accompany disorders of the functioning of the cardiovascular system, so they are often confused. The term literally translates as nerve pain, the pathology is accompanied by strong pain sensations, which are aggravated by inhalation, rotation of the body, etc. Medication will help in the treatment of the disease, pills for intercostal neuralgia are prescribed by a doctor based on examinations and tests. Lack of treatment and diagnosis can lead to serious consequences, so you should seek medical help as soon as possible.

The reasons can be very different, among them:

• pathological changes in the intercostal nerves as a result of damage to their membranes;
• trauma, microtrauma;
• external intoxication (taking certain medications, heavy metals, bacterial toxins);
• internal intoxication resulting from diseases of internal organs;
• pathology of the spine and musculoskeletal apparatus;
• diseases of infectious etiology (polyradiculoneuritis, tuberculosis, herpes zoster).

Risk factors also include weakened immunity, alcohol abuse, diseases of the endocrine system, chronic fatigue, diseases of the digestive tract caused by vitamin B deficiency, heart pathology, hormonal changes, age factor.

The disease most often develops under the successive or simultaneous influence of several factors.

What are intercostal neuralgia symptoms and treatment? The disease is very difficult from the very beginning, the main symptom is a pronounced pain syndrome in the intercostal space, which spreads along the length of the nerve. The intensity of pain increases with loud talking, coughing, turning the body, on inspiration, its duration starts from several hours and lasts up to several days.

The primary signs of the disease also include a sharp increase in pain on palpation, complete or partial loss of sensitivity in the affected area of ​​the skin.

Secondary symptoms:

• pale skin;
• tearfulness;
• convulsions;
• sleep disorders;
• increased sweating.

The specialist should pay attention to the characteristic symptoms of the underlying disease, osteochondrosis is accompanied by feelings of weakness in the hands, decreased sensitivity, and back pain.

The consequences in themselves do not pose a great danger to the health of the patient, but the ongoing pain can greatly ruin life. Sustained pain syndrome in combination with negative emotions can provoke angina pectoris, hypertensive crisis, less often myocardial infarction.
As a result of severe pain, sleep is disturbed, which also leads to a decrease in working capacity and a deterioration in the quality of life.
The peculiarity of the disease is that the pain syndrome increases with inspiration, the patient tries not to breathe deeply, as a result of oxygen deficiency, hypoxia develops.

Treatment
How to treat intercostal neuralgia, what helps, what to drink, what medicines? It is impossible to find out the cause of the pain on your own, if symptoms occur, you should immediately consult a doctor. When making a diagnosis, not only the examination data are taken into account, but also the presence of other diseases, against which pathology can develop. It must be borne in mind that the treatment of the disease depends on the underlying cause; for osteochondrosis or a herniated disc, therapy should be appropriate.

Important - During exacerbations, it is recommended to observe bed rest, the mattress should be hard. Dry heat will help improve the condition, it is recommended to put mustard plasters, apply warm sand in a cloth bag to the affected area.

What pills to take, can painkillers be used, where and how to be treated, do I need to take antibiotics? Therapy with drugs in this case is quite extensive, the treatment is aimed at relieving pain, eliminating inflammation and muscle spasms. The main symptom of the disease is severe pain, it is necessary to get rid of it as soon as possible. At the first stage, the doctor prescribes painkillers for neuralgia.

NSAIDs

This group of drugs has a pronounced anti-inflammatory effect, which also leads to the elimination of pain, as a result, the general condition improves. The most popular drugs are voltaren for intercostal, indomethacin, diclofenac, ibuprofen and others. The drugs are available in tablets, injections and suppositories. How long to take the medicine for pain? The duration of therapy is 5-7 days. Nimid gel for external use also refers to NSAIDs.

Muscle relaxants

Muscle relaxants have anti-spasmodic properties, and spasms are one of the main causes of the disease. The doctor prescribes the following pills for intercostal neuralgia: tizanidine, midokalm, sirdadul, baclofen. Medicines of this group have relaxing properties, as a result of reducing pressure on the inflamed nerve, the pain syndrome decreases, the duration of therapy is determined by the doctor.

Analgesics

Analgesics are drugs for pain, their use helps prevent new attacks. One of the most effective drugs is nemisil, it has pronounced anti-inflammatory properties. After taking it, there is a decrease in pain and temperature, side effects are most often absent. Analgesic tablets for neuralgia are available in the form of granules for a solution, they must be taken orally, the effect is noticeable after 30 minutes, there are no attacks for 7-8 hours after taking the medicine.

After eliminating the pain effect, the doctor prescribes pills for neuralgia with other properties.

Medicines are recommended for use with unbearable pain, the release form can be different: injections, gels, ointments. Their main feature lies in the limited time of action, with their help you can briefly get rid of bouts of severe pain. This group includes lidocaine and novocaine derivatives.

Neuroprotectors

The action of drugs is aimed at normalizing and improving metabolic processes in the brain and peripheral nervous system. With neuralgic manifestations, neurobin, milgam, mexidol are most often prescribed. Pepper patch shows an excellent effect, it has anti-inflammatory, warming, analgesic and relaxing effects.

B vitamins

B vitamins - their action is aimed at blocking inflammatory processes in the nervous tissues, as well as replenishing the missing beneficial trace elements. They also have immunomodulatory properties, neutralize the side effects of taking other medications. Such tablets for neuralgia are recommended for taking with alcohol dependence, diabetes mellitus, and violations of the functioning of the organs of the gastrointestinal tract.

Sedative drugs

Sedative tablets for intercostal neuralgia have a calming effect. Constant pain can cause not only a deterioration in the patient's condition, but also significantly reduces the quality of life. Preparations for the treatment of such conditions help to relax muscles and relieve tension. Often they contain components of plant origin, among them herbs melissa, chamomile, valerine. Infusions of these plants also have similar properties, they can be used alone or in combination with other herbs. The doctor may also prescribe plant-based syrups that have relaxing properties. Essential oils of mint, lavender have a similar effect, they can be burned in an aroma lamp.

Pills for neuralgia based on the venom of poisonous snakes and bees require special attention. Pharmacies offer a large selection of topical medicines based on poison. The poison warms up the skin, stimulates blood circulation, promotes the elimination of toxins, and stimulates metabolic processes in the body. Such drugs for intercostal neuralgia are available in the form of ointments and gels, applied directly to the affected area, with the exception of the heart area. In this case, caution should be exercised, since medicines are prohibited for use during pregnancy, with allergies to components, and heart pathologies. One of the most famous drugs is developed on the basis of bee venom apizatron, it has analgesic properties, stimulates blood circulation, reduces inflammation. Viprosal ointment contains viper venom, it relieves pain, stimulates blood circulation. The auxiliary components of camphor and fir extracts included in its composition have anesthetic properties.

Do I need to take antibiotics

Do antibiotics help with neuralgia, what should I drink with intercostal pathology? Antibacterial drugs for the disease are ineffective, but they can help in the treatment of pathologies that led to the development of the disease. Pain syndrome can occur as a result of swelling of the nerve root caused by muscle spasm that occurred after an acute respiratory illness. The doctor may prescribe antibiotics for neuralgia to treat the infection, the choice depends on the clinical picture. It should also be borne in mind that there are a large number of viruses, in the fight against which the use of antibacterial agents is also inappropriate.

The herpes virus can also cause severe post-herpetic neuralgic pain, and symptoms of herpes zoster may be a signal to seek medical help. A narrow strip of spots along the intercostal space requires urgent medical attention and antibiotic therapy, the lack of treatment will lead to the further development of the disease. The likelihood of being affected by the disease is high among patients who have had shingles and smallpox (both of these diseases develop due to the penetration of the herpes virus into the body). An excellent prophylactic in this case is vaccination against smallpox.

Important: Taking medications is a mandatory component of therapy; to achieve the maximum effect, it is also recommended to use physiotherapy procedures.

Treatment of intercostal neuralgia involves the following procedures, they can be used simultaneously or separately:

• laser therapy;
• UHF therapy;
• electrophoresis with the use of analgin, lidocaine, novocaine;
• acupuncture;
• osteopathy;
• massage;
• manual therapy.

During treatment, physical activity should also be limited; after removing the acute forms of the disease, the doctor selects the elements of exercise therapy. An excellent therapeutic effect is observed after yoga, gymnastics, swimming.

Important: The doctor prescribes treatment for each patient separately, a special scheme allows you to prevent the transformation of the disease into a chronic form, to avoid the development of complications.

Surgical intervention

Sometimes there is a need to use radical techniques, the doctor makes such a decision in the presence of the following indications:
herniated discs;
progressive osteochondrosis, accompanied by the development of destructive processes in the spine;
various neoplasms;
other diseases of the spine requiring surgical intervention.

Conclusion

Intercostal neuralgia is a rather serious disease that affects men and women of different ages. Pathology is accompanied by severe pain, which can greatly ruin your life, so it is recommended to consult a doctor as soon as possible. The specialist prescribes medicines for the disease based on personal data, therapy includes taking medications (NSAIDs, muscle relaxants, analgesics, neuroprotectors, B vitamins, sedatives, drugs based on poison). An important element of treatment is physiotherapy, if there are some indications, a surgical operation is performed.

Burning or shooting pain in the intercostal space, back or under the shoulder blades, aggravated by coughing or sneezing, increased sweating, numbness of certain areas of the skin, severe muscle spasms - all these are the initial symptoms of intercostal neuralgia. Depending on the condition of the patient, the doctor prescribes medication and physiotherapy. In addition to the main treatment, you can use all kinds of folk remedies. Thus, with the diagnosis of intercostal neuralgia, home treatment will achieve the maximum effect.

From generation to generation, a variety of recipes are passed on with which you can get rid of neuralgic pain. These can be compresses, ointments, lotions, therapeutic baths, decoctions or rubbing based on natural remedies. They are able to have a warming effect, relieve pain or eliminate residual symptoms.

The constricting pain associated with damage to the nerve endings in the intercostal space is very similar to the symptoms. In some cases, with destructive processes in the 5th, 6th and 7th vertebrae, the pain is similar to an exacerbation of appendicitis. Therefore, it is important to understand that folk remedies give a successful result only if the following conditions are met:

• an accurate diagnosis is established;
• therapy is combined with medication;
• the doctor constantly monitors the treatment.

Intercostal neuralgia - treatment with ointments and rubbing

When relieving pain, various ointments and rubbing give a good result. To get the best effect, the product should be applied to the sore spot, wrapped in a warm scarf and covered with a blanket.

For the manufacture of rubbing, various components can be used. The most common are:

Turpentine and Vaseline. By combining them in a ratio of 1: 2 and thoroughly mixing, you can apply for rubbing into a sore spot for a warming effect.

Black radish juice. Having passed the black radish through a meat grinder, squeeze the juice from the resulting mass and immediately rub it into the skin. To obtain the desired effect, it is enough to carry out the procedure daily for two weeks.

Iodine and glycerin. The components are combined in a 1:1 ratio and applied to the affected area of ​​the back, without affecting the area of ​​the spine.

Sage tea. 4 tbsp follows. spoons of dried sage pre-fill with boiled water and insist for an hour. Pour the filtered liquid into a bath of warm water. The pain relief treatment should be taken 10 minutes before bedtime and repeated daily for 10 days.

Intercostal neuralgia(synonym - " thoracic sciatica) is a neurological pathology resulting from damage or compression of the intercostal nerves, manifested in the form of pain.

The pain experienced by patients with intercostal neuralgia is one of the most severe. On a scale, it ranks third, on a par with acute kidney pain.

Intercostal neuralgia is often confused with other diseases, especially if the pain occurs on the left (imitates the pathology of the heart, stomach). Often even experienced doctors are misled.

Anatomical features

Anatomy of the intercostal nerves:

• Nerve bundles exit from the anterior part of the thoracic spinal cord, performing a motor function, and from the posterior part, a sensitive one.
• Then, inside the spinal canal, the anterior and posterior bundles unite to form the thoracic nerves of the spinal cord. In total, there are 12 pairs of nerves in the thoracic region, corresponding to the number of segments of the spinal cord.
• The spinal nerve exits the spinal canal through the intervertebral foramen.
• Outside the spine, the thoracic nerve divides into two bundles: anterior and posterior. The back goes to the muscles of the back. The anterior bundle, in fact, is the intercostal nerve. The first intercostal nerve runs along the edge of the rib. All the rest are in the thickness of the intercostal muscles that fill the gaps between the ribs.

Types of nerve fibers that make up the intercostal nerve:

• motor- innervate the intercostal muscles, the diaphragm, provide respiratory movements;
• sensitive- provide skin and other types of sensitivity;
• vegetative- control the functions of blood vessels, sweat glands, etc.

Causes of intercostal neuralgia

Causes of intercostal neuralgia:

Cause	Description
Sharp awkward movements.	With a sharp movement, a short-term compression of the intercostal nerve can occur. This leads to pain.
Osteochondrosis of the thoracic spine.	A degenerative disease characterized by destruction of the intervertebral discs. Factors leading to the development of neuralgia: Reducing the height of the intervertebral discs. As a result of their destruction, subsidence of the spinal column occurs. The vertebrae approach each other, the diameter of the intervertebral foramens decreases, and the spinal nerves passing through them are compressed. The development of the inflammatory process. It often captures the exit of the nerve from the spinal canal. Biologically active substances, leukocytes and antibodies accumulate in the inflammatory focus, causing irritation of the nerve. Pathological changes in the vertebrae. Bone outgrowths form on the bodies of the vertebrae - osteophytes. They compress the nerves passing through the intervertebral foramen.
Injuries	Types of injuries leading to intercostal neuralgia: back and chest injuries; rib fractures; vertebral fractures, especially compression, when the vertebra seems to be flattened in height. During an injury, nerve irritation occurs. In the remote period, pain may be due to the retraction of the nerve into the scar or compression of the callus.
Infectious diseases	Infections that most often lead to the development of intercostal neuralgia: common colds, especially flu; shingles (herpesvirus infection). Pathogenic microorganisms, once in the human body, release toxins that can spread through the bloodstream. They can cause damage to the intercostal and other nerves.
hypothermia	Cold causes irritation of the intercostal nerves, leading to attacks of intercostal neuralgia.
Increased physical activity	With excessive physical strain, microtrauma of the intercostal muscles occurs.
Radiculopathy (radicular syndrome)	Radiculopathy - compression of the spinal root. In this case, irritation and pain syndrome extend to the intercostal nerve.
Herniated disc	A disease characterized by protrusion of the intervertebral disc beyond the vertebrae. The prolapsed part of the disc compresses the nerve emerging from the intervertebral foramen. In the thoracic spine, spinal hernias are rare, since the vertebrae are connected to the ribs and take part in the formation of the chest, they are securely fixed.
Tumors of the spine, spinal cord, surrounding tissues	Tumors in the area where the nerves pass through the spinal foramen, reaching a sufficiently large size, cause their compression.
Spondylolisthesis	It is rare in the thoracic spine. It is characterized by slipping of the overlying vertebra from the underlying forward. As a result, both the spinal cord and the nerves extending from it are compressed.
Congenital malformations of the vertebrae and ribs	wedge-shaped vertebrae: the right part of the vertebra is lower than the left or vice versa, resulting in a distortion of the spine, compression of one or more spinal nerves; absence or doubling of a rib: in this case, the spine takes on an incorrect configuration; spondylolysis: the body and the vertebral arch are located separately, they are not connected, as a result of which the body gradually shifts forward, the shape of the intervertebral foramen is disturbed.
lead poisoning	Lead is toxic to nerve tissue.
Alcohol abuse	Ethyl alcohol has a toxic effect on the nervous tissue.
Osteoporosis	A disease characterized by rarefaction, destruction of bone tissue. This leads to a decrease in the height of the vertebrae, their deformations, and increased fragility.
Hormonal disorders	menopause: hormonal changes in menopause lead to the destruction of bone tissue, osteoporosis; diabetes: the disease leads to a violation of blood circulation in small vessels, the supply of oxygen to the bones.
Hypovitaminosis	With a lack of vitamins of group B, metabolic processes in the nervous tissue are disturbed. During rickets, – hypovitaminosisD, - there is a deformation of the bones, which can subsequently lead to compression of the nerves.
Scoliosis and severe posture disorders	With a significant curvature of the spinal column, conditions arise for compression of the intervertebral nerves.
Bechterew's disease (ankylosing spondylitis)	Chronic disease of the intervertebral joints, leading to deformities of the spinal column.
Vertebral hemangioma	A rare condition when a benign vascular tumor, a hemangioma, is located in the thickness of the vertebral body. It makes the vertebrae more fragile and prone to injury.

Signs of intercostal neuralgia

Symptom (group of symptoms)	Explanation
Pain in the area of ​​the affected nerve	Leading symptom of intercostal neuralgia. The pain is very intense and takes the third position in the generally accepted scale (severe pain). May be comparable to hepatic or renal colic. Pain duration: constant; in the form of seizures. The nature of the pain: dull; aching; burning; penetrating. Most often, the pain occurs on one side, spreads along the affected nerve, as it encircles half of the chest.
Increased pain during movement and physical activity	Factors that can provoke an increase and the occurrence of pain in intercostal neuralgia: A drug* Description Mode of application** Analgin (syn.: Metamizole Sodium, Baralgin, Spazdolzin). One of the most common drugs used for pain of various origins. It has analgesic, to a lesser extent - anti-inflammatory and antipyretic effect. Release forms: tablets of 0.05, 0.1, 0.15 (for children) and 0.5 g. solution for injections 1 - 2 ml 25% - 50%. Application for neuralgia: In tablets: Adults: 0.25 - 0.5 g 2 - 3 times a day. Children: 5 - 10 mg per kilogram of body weight per day. In injections: Adults: 1 - 2 ml of 25% - 50% solution 2 - 3 times a day. Children: 0.1 - 0.2 ml of a 50% solution for every 10 kg of body weight. Tempalgin Combined drug. Includes Analgin and Tempidin (light tranquilizer). Adults take 1 tablet for pain. Baralgin (synonyms: Bral, Spazgan, Spazmalgon, Spazmalgin) It is a combination drug with a pronounced analgesic effect. Compound: analgin- analgesic and anti-inflammatory agent; pitofenone hydrochloride- a means of blocking nerve impulses in the autonomic nervous system; fenpiverinium bromide- a means of blocking nerve impulses in the autonomic nervous system. Release forms: in tablets; in ampoules for injection. Application (adults): in tablets: take 1 tablet for pain 1-3 times a day; in injections: inject the solution intramuscularly or intravenously (slowly!) for pain. Ketorolac (syn.: Ketalgin, Ketorol) Strong pain reliever. The strongest among non-hormonal and narcotic drugs. Release forms: tablets of 0.01 g; solution in ampoules of 3% - 1 ml. Application: Intravenously and intramuscularly, Ketorol is prescribed at a dosage of 0.01 - 0.03 g every 6 - 8 hours. The maximum daily dose is 0.09 g. Ortofen (syn.: Diclofenac, Voltaren, Clofenac, Ultrafen, Etifenac) It has a pronounced anti-inflammatory and analgesic effect. Release forms: tablets 0.015 (for children) and 0.025 (for adults) g; solution for injection 75 mg - 3 ml. *Hereinafter, when describing medicinal products: the information is for informational purposes only. Treatment must be prescribed by a doctor. Self-administration of drugs can lead to negative consequences. **Here and below in the description of drugs. Source: Mashkovsky M.D., “Medicines - edition 15, revised. and add. ”, Moscow, LLC Publishing House“ New Wave ”, 2005 What ointments are used in the treatment of intercostal neuralgia? Name of the ointment Description Mode of application Voltaren (Ortofen) Anti-inflammatory and analgesic drug Diclofenac in the form of an ointment. It is applied directly to the place where the pain is localized. Apply 3-4 times a day, 2-3 grams of ointment to the sore spot. Ketonal cream and Ketonal gel Pain reliever Ketorol in the form of a gel and cream. It is applied directly to the place where the pain is localized. Apply a small amount of cream or gel 2 times a day to the affected area. Rub well into the skin. The course of treatment should be continued for no more than 7 days. Apizartron German-made ointment based on bee venom. effects: irritates the nerve endings of the skin; enhances blood flow; accelerates the excretion of biologically active substances that support the inflammatory process; eliminates pain. Application: squeeze 3-5 cm of ointment onto the finger; apply a layer of ointment 1 mm thick on the sore spot; leave for 2-3 minutes, then cleanse the skin. At the site of application of the ointment, redness, a feeling of warmth should occur. Apizartron is used 2-3 times a day. Viprosal B Combined ointment. Compound: viper venom - irritates the nerve endings on the skin, thereby eliminating pain; turpentine ointment - warming effect; camphor - like viper venom, has an irritating effect on the skin nerve endings. Rub the ointment 1-2 times a day on the sore spot. The course of treatment is continued depending on the doctor's prescriptions. Ointment Menovazin Compound: 2.5 g of menthol: irritates the nerve endings of the skin, dilates the subcutaneous vessels, enhances the analgesic effect, creates a feeling of coolness; 1 g benzocaine: is a local anesthetic, eliminates pain; 1 g procaine: is a local anesthetic, relieves pain. Menovazin is applied to a sore spot and carefully rubbed into the skin 2-3 times a day. The duration of the course of treatment is determined by the doctor. Turpentine ointment effects: local irritation of the nerve endings of the skin; anesthesia; destruction of pathogens (turpentine is an antiseptic). Rub into the skin at the site of pain localization 1-2 times a day. Finalgon An ointment made up of 2-butoxyethyl alcohol and vanillanonamide. effects: warming due to the expansion of blood vessels; anti-inflammatory; anesthetic. The drug is available in tubes, the kit includes a special applicator. It is necessary to squeeze 0.5 cm of ointment onto the applicator, apply to the sore spot and rub thoroughly. Wrap in woolen cloth. Finalgon has an effect 20-30 minutes after application. Vitamin preparations that are prescribed for intercostal neuralgia When a nerve is compressed, its nutrition and functioning are disturbed. Therefore, with intercostal neuralgia, vitamin preparations are prescribed that help improve metabolic processes in the nervous tissue. Name of the drug Description Application methods VitaminB1 (Thiamin) One of the most important vitamins for nervous tissue. Takes part in metabolic processes, protects nerve cells from free radicals. The drug is available in ampoules of 1 and 2 ml as a solution of 2.5% and 5%. Administer one ampoule intramuscularly every other day. Calcium pantothenate Substance belonging to the group of vitamins. Participates in education mediators- compounds that ensure the transmission of impulses between nerve cells. Release forms: in tablets of 0.1 g; solution in 10% ampoules - 2, 5 and 10 ml; solution in ampoules 25% - 2 ml. Application: In the form of tablets: adults: 0.1 - 0.2 g 2 to 4 times a day; children 1 - 3 years old at 0.005 - 0.01 g; children 3 - 14 years old 0.1 - 0.2 g per reception. In the form of injections: adults: 1 - 2 ml of a 20% solution or 2 - 4 ml of a 10% solution 1 or 2 times a day; children under 3 years old: 0.5 - 1.0 ml of a 10% solution 1 or 2 times a day; children 3 - 14 years old: 1 - 2 ml of a 10% solution 1 or 2 times a day. Vitamin B6 (Thiamin) Thiamine is one of the most important vitamins for the functioning of the nervous system. He takes part in the exchange of amino acids, the synthesis of certain mediators (substances that ensure the transmission of a nerve impulse between individual nerve cells). Release form: 1.0%, 2.5% and 5% solution in 1 ml and 2 ml ampoules. Mode of application: adults: 0.05 - 0.1 g per day every other day; children: 0.02 g per day every other day. Usually, the introduction of vitamin B6 is alternated with the introduction of vitamin B1 - every other day. Pentovit Complex vitamin preparation. Compound: vitamin B1 ( thiamine chloride); vitamin B6 ( pyridoxine hydrochloride); nicotinamide; vitamin B12 (cyanocobalamid). Physiotherapy for intercostal neuralgia Procedure name Mechanism of action in intercostal neuralgia Application Laser (quantum) therapy The impact of a laser beam on the affected area. effects: anti-inflammatory; antiallergic; increase in protective reactions of tissues; improved regeneration; vasodilatation, improvement of blood flow, acceleration of the excretion of substances involved in the inflammatory reaction. The impact of the laser beam is exerted at the points where the nerves emerge from the intervertebral foramens: from the back, to the right and left of the spinal column. The duration of the procedure is up to 10 minutes. The general course consists of 10 - 15 procedures. Electrophoresis with drugs Electrophoresis is a method of physiotherapy that involves the introduction of drugs into the human body through the skin using a weak electric current. With intercostal neuralgia, electrophoresis is done with analgin (pain reliever), novocaine (anesthetic). Two electrodes are applied to the skin in the affected area: positive and negative. Between the electrodes and the skin is placed a pad of tissue moistened with a solution of the medicinal substance. The device is adjusted in such a way that the patient feels a slight tingling sensation on the skin. The session lasts about 5 minutes. The total number of sessions is 10. UHF therapy UHF therapy is the impact on the human body by an electric field of ultrahigh frequency. Therapeutic effects in neuralgia: increased blood and lymph flow; reduction of tissue edema caused by the inflammatory process; expansion of capillaries, small arteries; reducing the impact on tissues of toxic substances and pathogens. During the procedure, plates are placed on the patient's body that generate ultra-high frequency electric currents. In this case, the patient should lie on a wooden couch or bed. The device is adjusted in such a way that the patient feels warm in the area of ​​​​the plates. The session lasts from 5 to 10 minutes. The total duration of the course is 10-15 sessions. Darsonval Electric currents Darsonval, which are applied in physical therapy, have four characteristics: high frequency, high voltage, small force, fast decay. Therapeutic effects in intercostal neuralgia: local irritation (during the procedure, tingling, redness of the skin is noted); activation of defense mechanisms; increased blood flow in small vessels. The working part of the apparatus for darsonvalization is a glass tube. Electric discharges are created in it, and it is she who is used to massage the affected area with intercostal neuralgia. Sparks jump between the tube and the skin, as a result of which a tingling sensation is felt, a characteristic crackle is heard. The duration of the procedure is 5-10 minutes. The total number of sessions is 10. Is massage effective for intercostal neuralgia? Medical massage is effective in intercostal neuralgia, so it is almost always included in the overall treatment program. Effects of massage in intercostal neuralgia improvement of blood flow in capillaries and small arteries; increased metabolic processes in tissues, accelerated elimination of toxins and substances involved in the development of the inflammatory process; heating of the skin and tissues located under it; improvement of blood supply and activation of regenerative processes in muscles; analgesic effect; improving the function of the nervous tissue, improving the conduction of nerve impulses; general calming effect. What areas of the body are massaged for intercostal neuralgia? on the back; on the chest (front). What conditions must be met? before the first session, the massage therapist should clarify with the patient on which side and at what level the pain occurs; massage should be started on the opposite, healthy side, and then move on to the sick one; with bilateral intercostal neuralgia, massage begins from the place where the pain is the weakest; the actions of the massage therapist must be careful, it is necessary to avoid rough exposure. How is the massage performed? First, the patient lies on his stomach on a massage table, a special pillow is placed under the chest. Do a back massage. Then he rolls over on his back, doing a chest massage. What is the session duration? The first massage session is held for 15 minutes. During subsequent sessions, the time is increased. What is the total duration of the course? 10 sessions. Acupuncture for intercostal neuralgia Acupuncture (acupuncture) is a branch of traditional Chinese medicine that practices the introduction of thin metal needles into specific points on the body. Effects of acupuncture: anesthetic; anti-inflammatory; calming; increase in protective mechanisms; increased blood flow and metabolism in the focus area. In modern clinics, acupuncture belongs to a separate area of ​​medicine - reflexology. Many hospitals have rooms where acupuncture is practiced. This method is often used as part of a comprehensive treatment program for intercostal neuralgia. Manual therapy for intercostal neuralgia In most cases, intercostal neuralgia is associated with compression of the nerve exiting through the intervertebral foramen. Thus, this pathological condition is within the competence of the manual therapist. Effects that a chiropractor seeks to achieve in a patient with intercostal neuralgia: elimination of nerve compression and pain; posture normalization; improvement of the overall function of the musculoskeletal system. Osteopathy for intercostal neuralgia Osteopathy is a branch of medicine that involves the impact on the root cause. The osteopathic doctor, with the help of light movements, pressure, etc., tries to eliminate factors that caused compression of the nerve in the intervertebral foramen: deformations of bone structures(joints between vertebrae, ribs); excessive tension of the intercostal muscles, back muscles; violation of the outflow of blood, lymph; pathological tension of the ligaments. Osteopathy is somewhat reminiscent of massage and manual therapy, but the effect is lighter, more accurate. Therapeutic exercise for intercostal neuralgia With intercostal neuralgia, it is necessary to limit any physical activity. As the attacks subside, the patient begins to engage in physiotherapy exercises under the supervision of a specialist. Swimming is beneficial for patients with intercostal neuralgia. How to treat severe neuralgia? If, despite treatment, severe pain persists with intercostal neuralgia, then treatment is carried out in a hospital, stronger drugs are prescribed: blockade- chipping of the nerve area with anesthetic solutions (novocaine, etc.); tranquilizers- medicines that eliminate anxiety and excessive nervous tension caused by constant pain; sedatives means of various groups. Indications for surgical treatment of intercostal neuralgia: herniated disc; pronounced osteochondrosis, accompanied by significant changes in the spinal column; various spinal tumors, spinal cord, surrounding tissues; other diseases of the spine requiring surgical treatment. How to treat intercostal neuralgia at home? Neuralgia is a disease that is often accompanied by very severe pain, it is treated for a long time and with great difficulty. Therefore, it is worth visiting a neurologist in any case. It is necessary to understand the causes and understand how serious the disease is. Can be used at home(After consulting with your doctor!): anti-inflammatory and warming ointments; folk remedies(see below); home physiotherapy devices: Darsonval, devices for magnetotherapy; call a masseur to the house; independently use various massagers. Alternative methods of treatment of intercostal neuralgia Method Description Wearing a wool shawl Wrap a sore spot with a woolen shawl, walk like this during the day. effects: warming; increased blood flow; reduction of pain sensations. Compress of ginger, turmeric, pepper Ingredients: hot chili pepper - 0.5 teaspoon; dried ginger root powder - 2 teaspoons; turmeric powder - 1 teaspoon. Cooking method: mix all components with a small amount of warm water until a homogeneous slurry is obtained; smear a piece of fabric with the resulting composition; apply to a sore spot, wrap with a bandage; wear as long as possible until it starts to burn badly. effects: warming up; increased blood flow; reduction of pain, acceleration of metabolism and removal of toxic products, inflammatory agents from the focus. Tincture of aloe, celandine, red pepper Ingredients: one red bitter pepper of medium size; crushed aloe leaf of medium size; 1 tablespoon of crushed celandine leaves; 0.5 l of vodka. Cooking: pour the ingredients with vodka; insist for 10 days in a dark place; later store in the refrigerator. Application: Rub into the sore spot 2-3 times a day until the symptoms stop bothering. Tincture of calendula and meadowsweet Ingredients: 30 g dried and chopped meadowsweet root, or 20 g fresh flowers; 5 g of calendula flowers; 0.2 l of vodka. Cooking: pour vegetable raw materials with 200 ml of vodka; place for 30 minutes a container with tincture in hot, but not boiling water; then pull out, leave for another 2 hours in a dark place; filter through cheesecloth. Application: Rub the sore spot 2-3 times a day. Warming up with a boiled egg Hard boil an egg, remove the shell. Cut in half, cool slightly. Attach both halves with slices to the sore spot, walk like this until they cool down. This method must be used carefully so as not to get burned. hot tub Take a hot bath for 15 minutes. Then rub the sore spot with an ointment composed of one part of ammonia and two parts of unrefined vegetable oil. How is intercostal neuralgia treated during pregnancy? The treatment regimen for intercostal neuralgia in pregnant women is not much different from the standard one. Peculiarities: most painkillers injections and pills are contraindicated during pregnancy; mainly ointments are used, only as directed by a doctor; vitamin therapy is carried out; it is necessary to conduct a comprehensive diagnosis in order to clearly distinguish intercostal neuralgia from other diseases; self-medication is unacceptable, as it can harm both the woman herself and the child.

The etiology of the disease is different. Often, intercostal dystonia is masked by symptoms of cardiac, gastrointestinal, pulmonary, and renal diseases, which makes it difficult to conduct timely diagnosis and treatment, and leads to complications. Due to the variety of symptoms, treatment is carried out by a therapist, vertebrologist, neuropathologist, cardiologist, gastroenterologist, pulmonologist, oncologist.

Causes of pathology

Intercostal neuralgia occurs due to the following reasons:

• hypothermia;
• infectious processes in the body;
• traumatic damage to the nerves in injuries of the spine and chest;
• compression of the nerves by the muscular apparatus of the chest and back, due to exorbitant physical exertion, prolonged exposure to an uncomfortable position, chronic vertebrogenic pain syndrome, malignant processes in the lungs and pleura, aortic aneurysm;
• irritation of the intercostal nerves due to diseases of the spine - osteochondrosis, spondylosis, intervertebral hernia, scoliosis;
• dysfunction of the costovertebral joints due to their deformation (arthrosis, trauma);
• curvature of the spine, deformities of the chest;
• pathologies of the nervous system - polyradiculoneuritis, multiple sclerosis;
• intoxication with certain medicines, alcohol, salts of heavy metals, ionizing radiation;
• somatic and endocrine diseases, in particular, diseases of the gastrointestinal tract (GIT) and diabetes mellitus;
• weakened immunity;
• group B hypovitaminosis, anemia;
• the use of tight underwear in women;
• intensive growth of the skeleton in children;
• age-related changes in the elderly.

Forms

According to the pathogenetic factor, there are 2 main forms of the disease:

• radicular - due to irritation of the roots of the spinal cord, characterized by severe pain in the chest, similar to the heart;
• reflex - caused by muscle tension in the intercostal spaces.

According to the symmetry of the lesion, one- and two-sided dystonia is distinguished. Bilateral intercostal neuralgia often occurs against the background of herpes infection, radiation intoxication, immunodeficiency.

Depending on the location of the pain occurs:

1. In the upper chest, around the collarbones - irradiation due to irritation or compression of the nerve roots in the lower spine. Algia is felt during torso tilts, when turning the head, it radiates to the neck, arm, shoulder on the side of the lesion.
2. Behind the sternum, between the shoulder blades - neuralgia of the thoracic spine.
3. Between the shoulder blades, below the armpit, left side, nipple area - scapular-costal dystonia. Algia can last for a long time, be aching or short-term, stabbing. It is felt during inhalation and exhalation.
4. In the anterior chest - near the sternum, in the armpits. The pain is long aching.

Based on the type of damaged nerve fibers, the symptoms of neuralgia are as follows:

• sensitive bundles - piercing pain;
• motor - shortness of breath (impaired motor functions of the muscles and diaphragm);
• vegetative - vegetative symptoms;
• mixed option.

signs

One of the main signs of intercostal neuralgia is intercostal pain (thoracalgia), which has the following features:

• spreads along the intercostal space from the spine to the sternum;
• aggravated by sudden movements, laughter, coughing, sneezing, turning the torso, raising arms, touching the affected area;
• more often it has a paroxysmal burning, shooting character, “like a shock”, but it can also be aching;
• during an attack lasting a few seconds - 2-3 minutes. the patient freezes, holds his breath while inhaling, tries to avoid any movements;
• duration and intensity may vary, does not depend on the time of day (does not decrease at night);
• the patient is forced to be in a certain position in order to minimize the range of motion;
• radiates to different areas depending on the localization - to the mammary gland, the heart region in women, at the level of the lower ribs on the left side, the scapular, epigastric region in men;
• is girdle in nature, if it is localized along the course of 1-2 intercostal nerves;
• there is an increase in intensity as the disease progresses.

Other symptoms of intercostal neuralgia:

• sleep disturbance (insomnia);
• in children - convulsions, hyperexcitability, speech disorders;
• muscle spasms and numbness at the site of injury;
• increased sweating;
• hyperemia or pallor of the skin in the affected area;
• dyspnea;
• paresthesia - a feeling of "crawling", "running of electric current";
• itching with herpetic etiology, then a rash in the intercostal space, appearing on the 2nd-4th day of pain. The rash is represented by pink spots that turn into bubbles that dry out over time. After the bubbles, temporary pigmentation remains on the skin.

Diagnostics

Diagnosis is based on complaints, history taking, objective examination of the patient. During the collection of anamnesis, the doctor asks about past injuries, operations, the patient's lifestyle, chronic diseases, takes into account age-related changes.