Intercostal neuralgia is a condition that causes sharp, burning, or aching pain along the intercostal nerves, which run between the ribs. These nerves can become irritated or injured due to trauma, surgery, inflammation, or viral infections, resulting in chronic chest wall or upper abdominal pain that may wrap around the side of the body.
Unlike cardiac or musculoskeletal chest pain, intercostal neuralgia stems from the nerve itself and often requires a targeted, nerve-focused approach to treatment.
Common Causes of Intercostal Neuralgia
Intercostal neuralgia can develop from a variety of sources, including:
Trauma or rib fractures
Thoracic spine surgery or chest surgery (e.g., mastectomy, thoracotomy)
Shingles (Herpes Zoster)
Postherpetic neuralgia following shingles
Nerve entrapment or compression
Muscle overuse or spasm in the chest or upper back
Idiopathic cases (no clear cause identified)
Symptoms
Burning, sharp, or stabbing pain in the chest, side, or upper abdomen
Pain that follows a rib in a band-like pattern
Tingling, numbness, or hypersensitivity in the affected area
Worsening of symptoms with coughing, deep breathing, or movement
Tenderness when pressing on the affected rib or intercostal space
Conservative Treatment Options
Medications
NSAIDs or acetaminophen for mild pain and inflammation
Neuropathic agents such as gabapentin, pregabalin, or amitriptyline
Muscle relaxants for associated muscle tightness or spasm
Physical Therapy
Stretching and posture correction to reduce nerve irritation
Manual therapy and gentle mobilization
Breathing exercises to decrease chest wall tension
Topical Agents
Lidocaine patches or capsaicin cream for localized nerve pain relief
Interventional Pain Management Options
For persistent or severe cases, interventional procedures can directly target the affected nerve and provide more lasting relief:
Intercostal Nerve Block
An injection of local anesthetic and corticosteroid around the intercostal nerve
Provides diagnostic clarity and therapeutic relief
Often performed under ultrasound or fluoroscopic guidance for precision
Pulsed Radiofrequency (PRF) or Thermal Radiofrequency Ablation (RFA)
Used for chronic, refractory cases of intercostal neuralgia
RFA disrupts pain transmission by applying heat to the targeted nerve
PRF is a non-destructive alternative that modulates nerve signaling
Epidural Steroid Injection (for thoracic nerve root involvement)
Reduces inflammation if the pain is originating from a compressed thoracic nerve root in the spine
Neuromodulation
Peripheral nerve stimulation (PNS) may be considered for complex or recurrent intercostal neuralgia
When to See a Specialist
If you experience:
Ongoing or worsening chest wall pain
Pain unresponsive to medication or physical therapy
Pain that wraps around the ribs or increases with movement or touch
...you may benefit from a comprehensive pain evaluation and advanced treatment options.
Relief from Nerve Pain Starts Here
At Parkview Spine & Pain, we offer precision-guided diagnosis and treatment for intercostal neuralgia. Whether your symptoms began after surgery, shingles, or an injury, our tailored approach—including intercostal nerve blocks and advanced radiofrequency ablation—can help restore your comfort and mobility.
👉 Schedule a consultation today to take the first step toward lasting relief from rib and chest wall nerve pain.