What are the common causes of pain between the sternum and ribs. How is costochondritis diagnosed and treated. What are the symptoms of pleurisy and fractured ribs. When should you seek immediate medical attention for chest pain.

Costochondritis: A Common Cause of Rib Cage Discomfort

Costochondritis is a frequently encountered condition that causes pain in the rib cage area. This inflammation occurs where the ribs connect to the breastbone (sternum) at joints called costosternal joints. Dr. Rose Taroyan, a family medicine physician at Keck Medicine of USC, explains that costochondritis can result in either sharp or dull pain accompanied by tenderness in the chest region.

What triggers costochondritis? Common causes include:

• Physical trauma to the chest
• Strenuous lifting or exercise
• Prolonged coughing or sneezing

How can you identify costochondritis? The telltale sign is pain when pressure is applied to the area where the rib meets the breastbone. To rule out cardiac issues, your doctor may order an electrocardiogram and potentially additional tests based on your symptoms.

Managing Costochondritis Symptoms

While costochondritis often resolves on its own within a few days to weeks, there are several ways to manage the discomfort:

1. Perform gentle stretching exercises
2. Apply a heating pad to the affected area several times daily
3. Take over-the-counter pain relievers like acetaminophen or ibuprofen
4. Temporarily reduce or avoid activities that exacerbate the pain

Fractured or Bruised Ribs: When Trauma Strikes the Rib Cage

The rib cage plays a crucial role in protecting vital organs such as the heart and lungs. However, this protective function also makes ribs vulnerable to injury during traumatic events. Common causes of rib injuries include:

• Car accidents
• Severe falls
• Physical assaults
• Intense coughing episodes

Is it possible to distinguish between bruised and fractured ribs? Both conditions share similar symptoms, primarily pain that intensifies when breathing or coughing. Your doctor may order a chest X-ray to determine if a fracture is present. In cases of confirmed fractures, a CT scan might be necessary to assess potential lung damage.

The Challenge of Treating Rib Injuries

Unlike other broken bones, ribs cannot be immobilized or placed in a cast. They must continue moving during breathing. Despite the discomfort, it’s crucial to maintain deep breathing to prevent complications such as pneumonia. In fact, respiratory issues like pneumonia occur in nearly one-third of patients with rib fractures.

To support recovery, your doctor may:

• Provide a breathing device to improve lung function
• Prescribe pain medications to ease breathing discomfort

Pleurisy: When Lung Membranes Become Inflamed

Pleurisy is a condition affecting the pleura, which are two layers of tissue lining the chest cavity and the outside of the lungs. Normally, these layers glide smoothly against each other during breathing. However, in pleurisy, inflammation causes them to rub together roughly, resulting in pain with each breath or cough.

What causes pleurisy? Common triggers include:

• Viral infections
• Pneumonia
• Other underlying medical conditions

How do doctors diagnose pleurisy? A key indicator is the presence of a “friction rub” – a sound doctors can hear when listening to your chest with a stethoscope. This occurs due to the inflamed membranes rubbing against each other.

Complications and Treatment of Pleurisy

In some cases, pleurisy can lead to fluid accumulation in the pleural space, causing shortness of breath. To diagnose and treat pleurisy effectively, your doctor may:

1. Order imaging or blood tests to determine the underlying cause
2. Check for fluid buildup in the pleural space
3. Drain excess fluid if necessary
4. Prescribe antibiotics for bacterial infections
5. Recommend over-the-counter pain relievers for symptom management

Recognizing Serious Chest Pain: When to Seek Emergency Care

While many causes of rib cage pain can be managed at home or with routine medical care, certain symptoms warrant immediate attention. You should call 911 or go to the emergency room if you experience:

• Difficulty breathing
• Blue discoloration of the skin
• Severe chest pain

These symptoms could indicate a more serious condition requiring urgent medical intervention.

The Role of Family Medicine in Managing Rib Cage Pain

Family medicine physicians play a crucial role in diagnosing and treating various causes of rib cage pain. They offer comprehensive care that includes:

• Performing screening exams
• Managing chronic medical issues
• Treating injuries
• Providing vaccinations

By establishing a relationship with a family medicine doctor, you can ensure continuity of care and prompt attention to any chest or rib cage concerns that may arise.

Understanding Chest Wall Pain: Beyond Costochondritis

While costochondritis is a common cause of chest wall pain, it’s important to be aware of other conditions that can affect this area. The chest wall encompasses the structures surrounding the lungs, including the ribs and sternum. Two additional conditions that can cause discomfort in this region are Tietze Syndrome and Intercostal Neuralgia.

Tietze Syndrome: A Close Relative of Costochondritis

How does Tietze Syndrome differ from costochondritis? While both conditions involve inflammation of the costal cartilage, Tietze Syndrome is characterized by swelling of the affected area, which is not typically present in costochondritis. The pain in Tietze Syndrome may also radiate to the arms and shoulders.

Intercostal Neuralgia: When Nerves Are the Culprit

What causes intercostal neuralgia? This condition results from damage or irritation to the nerves running between the ribs. It can lead to sharp, burning pain in the chest wall that may worsen with movement or breathing. Common causes include:

• Trauma to the chest area
• Surgical procedures
• Shingles infections

How is intercostal neuralgia treated? Management often involves a combination of pain medications, nerve blocks, and in some cases, surgical interventions to relieve pressure on the affected nerves.

Differential Diagnosis: Distinguishing Chest Wall Pain from Cardiac Issues

Given the potential severity of cardiac conditions, it’s crucial to differentiate chest wall pain from heart-related problems. How do doctors make this distinction?

1. Careful history taking: Understanding the nature, duration, and triggers of the pain
2. Physical examination: Assessing for localized tenderness or reproducible pain
3. Diagnostic tests: Electrocardiograms, blood tests for cardiac enzymes, and imaging studies when necessary

Why is this differentiation important? While chest wall pain conditions are often benign, albeit uncomfortable, cardiac issues can be life-threatening and require immediate intervention. Your healthcare provider will work diligently to ensure an accurate diagnosis and appropriate treatment plan.

Lifestyle Modifications and Prevention Strategies for Rib Cage Pain

While some causes of rib cage pain are unavoidable, there are steps you can take to reduce your risk or manage existing conditions more effectively. What lifestyle changes can help?

• Maintain good posture to reduce strain on the chest wall
• Practice proper lifting techniques to avoid injury
• Engage in regular, low-impact exercise to strengthen the chest and back muscles
• Manage stress through relaxation techniques or mindfulness practices
• Quit smoking to improve overall respiratory health

How can you prevent exacerbations of existing conditions? If you have a known chest wall condition, consider these strategies:

1. Avoid activities that consistently trigger pain
2. Use supportive devices or braces as recommended by your healthcare provider
3. Apply heat or cold therapy as directed for symptom relief
4. Maintain a healthy weight to reduce stress on your joints and muscles

The Importance of Proper Breathing Techniques

Can specific breathing exercises help manage rib cage pain? Many healthcare providers recommend diaphragmatic breathing or other controlled breathing techniques to reduce strain on the chest wall and promote relaxation. These exercises can be particularly beneficial for individuals with costochondritis or pleurisy.

Complementary and Alternative Approaches to Rib Cage Pain Management

While conventional medical treatments are essential for managing rib cage pain, some individuals find relief through complementary approaches. What alternative therapies might be beneficial?

• Acupuncture: May help reduce inflammation and alleviate pain
• Massage therapy: Can relax tense muscles and improve circulation in the affected area
• Herbal remedies: Some herbs with anti-inflammatory properties may offer relief (consult with a healthcare provider before use)
• Yoga or gentle stretching: Can improve flexibility and reduce muscle tension

How effective are these complementary approaches? While scientific evidence varies, many individuals report subjective improvements in pain and overall well-being. It’s crucial to discuss any alternative treatments with your healthcare provider to ensure they are safe and appropriate for your specific condition.

The Role of Nutrition in Managing Inflammation

Can dietary changes impact rib cage pain? Some research suggests that an anti-inflammatory diet may help reduce overall inflammation in the body, potentially benefiting conditions like costochondritis. Foods that may have anti-inflammatory effects include:

• Fatty fish rich in omega-3 fatty acids
• Colorful fruits and vegetables high in antioxidants
• Nuts and seeds
• Olive oil and other healthy fats

While dietary changes alone are unlikely to resolve rib cage pain, they may complement other treatment approaches and contribute to overall health and well-being.

Long-Term Outlook and Follow-Up Care for Rib Cage Pain Conditions

What can patients expect in terms of long-term prognosis for rib cage pain conditions? The outlook varies depending on the specific cause:

• Costochondritis: Often resolves within weeks to months, but can recur
• Fractured ribs: Typically heal within 6-8 weeks, though pain may persist longer
• Pleurisy: Duration depends on the underlying cause, but most cases improve with treatment

How should patients approach follow-up care? Regular check-ins with your healthcare provider are essential to monitor progress and adjust treatment plans as needed. Be prepared to discuss:

1. Changes in pain levels or character
2. Effectiveness of current treatments
3. Any new symptoms or concerns
4. Impact on daily activities and quality of life

By maintaining open communication with your healthcare team, you can ensure optimal management of your rib cage pain and address any complications or recurrences promptly.

The Psychological Impact of Chronic Pain

How does persistent rib cage pain affect mental health? Chronic pain conditions can take a toll on emotional well-being, potentially leading to anxiety, depression, or sleep disturbances. It’s important to address these psychological aspects as part of a comprehensive treatment plan. Your healthcare provider may recommend:

• Cognitive-behavioral therapy to develop coping strategies
• Mindfulness techniques for pain management
• Support groups to connect with others facing similar challenges
• Referral to a mental health professional if needed

By addressing both the physical and emotional aspects of rib cage pain, patients can work towards improved overall health and quality of life.

3 Reasons You Might Have Rib Cage Pain

Learn the symptoms of each condition and what treatment to expect.

Pain in your chest can be scary — you may even be worried you’re having a heart attack. But the pain you’re experiencing might not actually be coming from one of your organs. The ribs themselves, and the area surrounding them, can also cause discomfort. Here are three conditions that can cause rib cage pain, and the telltale symptoms doctors use to tell them apart.

1. Bruised or fractured rib

Your rib cage provides a crucial function: to protect your heart, lungs and other vital organs. But this may also mean they take the brunt of the damage in the case of trauma, such as a car accident, steep fall, physical assault or even intense coughing. A bruised rib means the bone is not actually cracked, but it still may have sustained damage. Symptoms for bruised and broken ribs are much the same: pain, particularly when breathing or coughing.

Telltale sign: Injured ribs cause pain when breathing, coughing, twisting or bending.

Your doctor may order a chest X-ray to determine if you’ve fractured your rib. If you have, a CT scan will help determine whether your lungs have been injured.

Ribs obviously can’t be put in a cast or immobilized, like other broken bones. Plus, they need to keep moving when you breathe. Even if it hurts, it’s important to breathe deeply, so you can keep your lungs clear. Failing to do so may result in pneumonia. Respiratory complications, like pneumonia, occur in nearly a third of patients with rib fractures. Your doctor may give you a device to breathe into, to help improve your lung function, and pain medications to make breathing easier, until your broken or bruised rib heals.

2. Costochondritis

You may not have heard of this condition, but it’s actually a common cause of rib cage pain. All but two of your ribs are attached to your sternum, or breastbone, by cartilage.

“This area where the ribs meet the breastbone, called costosternal joints, can become inflamed,” says Rose Taroyan, MD, a family medicine physician at Keck Medicine of USC and clinical associate professor of family medicine at the Keck School of Medicine of USC.

Dr. Taroyan explains that costochondritis causes pain (it can be either sharp or dull) and tenderness in your chest. It may result from a blow to the chest, heavy lifting or hard exercise, or sustained coughing and sneezing.

Telltale sign: When the area where the rib meets the breastbone is pressed, you’ll feel pain.

Your doctor may order an electrocardiogram to rule out any cardiac issues. Depending on whether you have any other symptoms, your doctor may also order additional tests. If you’re diagnosed with costochondritis, though, it usually goes away on its own in a few days to a few weeks.

“You can do stretching exercises, put a heating pad on the painful area a few times a day, and take pain relievers, such as acetaminophen or ibuprofen,” Dr. Taroyan says. “And any activity you do that causes or reliably exacerbates the pain should be reduced and/or stopped, at least temporarily.”

3. Pleurisy

Lining the inside of your chest cavity and the outside of your lungs are two layers of tissue called pleura; the area between these layers is called the pleural space. The layers generally glide against each other smoothly as you inhale and exhale.

With pleurisy, the layers become inflamed due to a viral infection, pneumonia or other medical condition and rub together roughly, causing pain every time you breathe or cough. Fluid may also collect in the pleural space, causing shortness of breath.

Telltale sign: Doctors can actually hear the membranes rubbing together, called a friction rub, when they listen to your chest with a stethoscope.

Based on your symptoms, your doctor may order imaging or blood tests to help determine the underlying cause of the pleurisy and to see if fluid has built up. If it has, the fluid may need to be drained. If the fluid is a result of a bacterial infection, you’ll be given antibiotics. If it’s from a virus, it may have to run its course, but over-the-counter pain relievers may help to reduce your symptoms.

With any rib cage pain, if you can’t breathe, your skin turns blue or you have severe chest pain, call 911 or go to the emergency room right away.

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Tina Donvito

Tina Donvito is a freelance writer covering health, culture, travel and parenting.

3 Types of Chest Wall Pain: Costochondritis, Tietze Syndrome, and Intercostal Neuralgia

The chest wall is considered to be the structures surrounding the lungs. It includes the ribs and sternum. Chest wall pain is felt from the breast, rib cage, or a chest muscle. The pain may be experienced with certain movements or if pressure is applied. It can occur on one side of the chest or may spread across the entire chest area.

Chest pain should never be ignored. Seek emergency medical assistance if chest pain is present. Although there are many types of chest wall pain, musculoskeletal conditions are the most common. Three causes of chest wall pain include costochondritis, Tietze syndrome, and intercostal neuralgia.

Costochondritis occurs when the cartilage in the upper rib cage that attaches to the sternum becomes inflamed. This area is called the sternocostal joint, and the pain ranges from mild to severe. This particular type of pain is often described as mimicking a heart attack.

Symptoms of costochondritis include, but are not limited to, the following:

• Left-side chest pain
• Sharp, aching, or pressure-like pain
• Pain in more than one rib
• Pain radiates to the arms and shoulders
• Pain worsens when taking a deep breath, coughing, sneezing, or moving the chest wall
• Pain decreases when idle

The exact cause of costochondritis is unknown. It may be associated with trauma, arthritis, tumors, or illnesses. It can also occur due to physical strain, such as severe coughing. Costochondritis tends to be more prevalent in women over 40.

A health history will be obtained, and a physical examination will be conducted. The physical exam may include pressing on the breastbone, moving the rib cage and arms in an effort to re-create the pain, and looking for swelling. Certain tests may be ordered to rule out other conditions.

Although it can last for several weeks, costochondritis is typically harmless and leaves on its own. Treatment for costochondritis is aimed to relieve pain. It may include anti-inflammatory medications, such as ibuprofen or naproxen, transcutaneous electrical nerve stimulation (TENS), stretching exercises, and avoiding activities that increase symptoms. If the pain is severe, a physician may prescribe anti-seizure medication, antidepressants, or opioids.

Costochondritis and Tietze syndrome pain are very similar; however, if swelling accompanies the pain, Tietze syndrome is typically diagnosed. Tietze syndrome is rare and can appear suddenly. The affected area normally involves the second or third rib. Tietze syndrome pain may be confused with the pain of a heart attack.

Symptoms of Tietze syndrome may appear and disappear suddenly and include, but are not limited to, the following:

• Chest pain in a small area (mild or severe, dull or sharp)
• Redness
• Pain that can extend to the neck, arms and shoulders
• Swelling
• Tenderness
• Pain that worsens when coughing, sneezing, laughing, hugging, exercising, breathing deeply, wearing a seatbelt, or lying down

While the exact cause of Tietze syndrome is unknown, it may be associated with small traumas to the chest wall. It may also result from respiratory infections, physical activity strain, or extreme coughing spells. Tietze syndrome may also be a result of psoriatic arthritis and is more common in older children and adults under 40.

There is no specific test for a Tietze syndrome diagnosis. A health care professional will obtain a medical history and perform a physical examination that may involve pressing on the chest. Certain testing may be ordered to rule out other conditions.

Symptoms of Tietze syndrome often disappear with no treatment. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may help relieve pain and inflammation. If pain is severe, a physician may recommend corticosteroid injections into the joint area to reduce pain and swelling.

Intercostal neuralgia is a type of neuropathic (nerve) pain that involves the nerves that arise from the spinal cord and lie beneath the ribs. These nerves are connected to the muscles of the rib cage, skin, and chest cavity.

The main symptom of intercostal neuralgia is pain around the ribs, in the upper chest, or in the upper back. Other symptoms include, but are not limited to, the following:

• Pain that is burning, spasmodic, shooting or sharp
• Pain that worsens with certain activities, such as taking a deep breath, laughing, coughing, or sneezing
• Referred pain that originates from the intercostal nerves but is felt in the shoulder blades or pelvis
• Pressure, tingling or numbness around the ribs or in the upper chest or back

In severe cases, muscle twitching, loss of appetite, paralysis, or muscle atrophy can occur.

Intercostal neuralgia may result from irritation, inflammation, or compression of the intercostal nerves. Those diagnosed with a viral infection, such as shingles, or who have experienced trauma to the chest or abdomen resulting in nerve compression are at increased risk.

A health history will be obtained, and a physical examination will be conducted. During a deep breath, a health care professional may press between the area of the ribs. If pain is present, intercostal neuralgia may be diagnosed. Certain testing may be ordered to rule out other conditions.

Lidocaine patches and capsaicin creams may offer temporary pain relief. An antidepressant or anticonvulsant can treat nerve-related pain. If pain is severe, opioids may be prescribed. Other treatment options include nerve blocks, thoracic epidural injection, and pulsed radiofrequency. Therapies to help include physical therapy, relaxation therapy, and cognitive therapy.

Intercostal neuralgia – symptoms, treatment, causes, signs

This disease is treated by Neurologist

The information provided on this page should not be used for self-treatment or self-diagnosis. If you suspect a disease, you should seek help from a qualified specialist. Only your doctor can diagnose and prescribe treatment.

Article content:

• Causes
• Symptoms
• Forms of the disease
• Diagnostics
• Treatment of intercostal neuralgia
• Prophylaxis
• Complications

What is intercostal neuralgia?

Intercostal neuralgia is an inflammation of the intercostal nerves. This pathological condition is manifested by acute, paroxysmal pain in the intercostal space. Pain extends from the spine to the sternum.

How to identify the disease? The diagnosis is made on the basis of a survey and examination of the patient. To exclude diseases with a similar clinical picture, additional examinations may be prescribed. How to relieve pain and cure the disease? The main directions are symptomatic, anti-inflammatory, etiotropic treatment. During periods of remission, physiotherapy gives a good effect.

Causes

What causes neuralgia? The main causes of the development of the disease are:

• pathology of the spine;
• curvature of the spine;
• increased or uneven load on the spine;
• uncontrolled intake of certain drugs;
• neoplasms of various etiologies in the region of the sternum, ribs, spine;
• mechanical damage to the chest and spine resulting from trauma or surgery;
• diseases of the nervous system;
• infections;
• sudden increase in intra-abdominal pressure;
• constant high loads on the abdominal muscles.

In addition, pathological changes in the intercostal nerves can occur against the background of diseases of the digestive system, respiration, thyroid gland, kidneys, immunodeficiency states. A similar clinical picture can be observed in adolescents during intensive growth of skeletal muscles.

Symptoms

The main sign of this pathology is pain in the chest. A person experiences severe, paroxysmal pain, which intensifies with a deep breath, coughing. The pain is localized between the ribs and is often accompanied by numbness, burning. Unpleasant sensations can appear in other parts of the body.

Symptoms of intercostal neuralgia resemble a heart attack, but there are several differences that allow you to differentiate between heart problems and inflammation of the nerves. With neuralgia, the pain is constant, does not change the intensity, while the pressure and pulse indicators are within the normal range.

How else does the disease manifest itself? In addition to pain, symptoms such as anemia or flushing of the skin, muscle contraction, hyperhidrosis can be observed. If the first unpleasant symptoms occur in women or men, you should immediately consult a doctor for an examination and a course of therapy.

Forms of the disease

By origin, there are primary (occurs independently) and secondary (is one of the symptoms of another pathology) neuralgia. In addition, reflex (is the result of a negative effect on peripheral receptors) and radicular (due to constant irritation of the roots of the spinal cord) form of the disease.

In addition, the following types of pathology are distinguished:

• musculoskeletal;
• psychogenic;
• vertebrogenic;
• chronic;
• sharp;
• during pregnancy.

Each of the above types has its own symptoms and treatment features.

Diagnostics

Many patients are interested in which doctor to contact for this pathology? The diagnosis is made by a neurologist. Neuralgia delivers extremely unpleasant sensations to the patient, but does not pose a threat to life.

Therefore, this pathology is often a diagnosis of exclusion. Its clinical signs are similar to those of many severe heart diseases. Therefore, the primary task of the specialist is to exclude these pathologies with the help of a comprehensive examination of the patient.

At the first appointment, the doctor interviews the patient, collects an anamnesis, assesses his current state of health. During the examination, the specialist determines the exact location of the pain, detects sensory disturbances, notices the characteristic forced posture that the patient takes to reduce pain.

Based on the data obtained, a preliminary diagnosis is made, after which the patient is sent for additional examinations in order to conduct a differential diagnosis.

The main methods of instrumental diagnostics are:

• ECG — diagnose possible pathologies of the heart and blood vessels;
• Ultrasound of the abdominal cavity and myocardium – exclude diseases of the heart and digestive organs with a similar clinical picture;
• MRI, CT are the most informative methods of visualization of internal organs and tissues today, they can be used to obtain clear layered images, determine the localization of the affected nerves, detect signs of destruction of their sheath or neoplasms that compress the nerves and cause pain attacks;
• gastroscopy – with the help of this examination, pathologies of the stomach are detected, which cause pain similar in symptoms to neuralgia.

Treatment of intercostal neuralgia

How to treat intercostal neuralgia? If the pain is not associated with a herpes infection (in this case, you may need to take anticonvulsants to relieve severe pain), then the treatment does not cause any particular difficulties.

The therapy of the disease is complex and is aimed primarily at stopping the causative factor and removing unpleasant symptoms.

How to relieve pain in case of intercostal neuralgia?

The following are the main stages of therapy in adults:

• during the acute period, the patient needs rest, he is prescribed bed rest, taking B vitamins, NSAIDs, and drugs to restore the function of the affected nerves;
• after the removal of acute attacks, physiotherapy, massage, manual therapy, acupuncture are indicated to consolidate the results and prevent relapses.

If the disease is caused by the herpes virus, then antihistamine and antiviral drugs are indicated. Treatment should be started as soon as possible, possibly even before test results are available.

The main goals of therapy in the acute period are to relieve pain and swelling of the nerves and muscle tissue. How is inflammation treated and how to get rid of pain? To relieve pain and inflammation, the patient is prescribed analgesics (intramuscularly, orally or rectally), glucocorticosteroids, muscle relaxants, sedatives, NSAIDs, B vitamins. If severe edema appears, diuretics are indicated.

What helps with very severe, excruciating pain? In this case, blockades are carried out with solutions of anesthetics along the affected nerve. During periods of remission, sanatorium treatment (therapeutic baths, mud therapy) is recommended.

If conservative treatment does not help and pain attacks are permanent, then it is necessary to conduct an additional examination of the patient in order to identify the true causes of the disease.

Prevention

To minimize the risk of developing this pathology, the following recommendations should be observed:

• do not get cold, avoid drafts;
• give up a sedentary lifestyle;
• regularly sanitize foci of chronic infection in the body;
• engage in physical education, do exercises – this will help to avoid congestion;
• strengthen the body’s immune defenses;
• avoid stress and nervous tension as much as possible;
• monitor posture;
• eat right;
• during sedentary work, regularly take breaks to warm up;
• take a multivitamin periodically;
• observe safety rules when lifting weights;
• regularly undergo preventive examinations – this will help to identify possible health problems at an early stage, which will facilitate subsequent treatment and improve the prognosis.

Complications

How dangerous is the disease and what are the consequences? If untreated, the patient may experience the following complications:

• chronic pain in the chest, back, ribs, which prevent the patient from fully moving and greatly reduce the quality of life;
• respiratory failure, pneumonia;
• feeling of stiffness and weakness in the chest, decreased range of motion of the shoulders.

In severe long-term neuralgia can cause an attack of angina pectoris or provoke a hypertensive crisis. In addition, constant pain adversely affects the mental state of the patient and greatly complicates his life. He cannot sleep normally, move, play sports, perform elementary work.

• Pain in the thoracic spine. Isaikin A.I., Kavelina A.V. Neurology, neuropsychiatry, psychosomatics, 2013. p.74-78
• Symptoms of manifestation of vegetovascular dystonia in adolescence. Elzhurkaeva L.R. Colloquium-journal, 2020.

Article published on : 07/05/2013
Last updated : 04/20/2023

See also

Multiple sclerosis and its treatment

Vegetovascular dystonia

Symptoms and treatment of epilepsy

Intercostal neuralgia and pain in the heart: how to distinguish?

Some diseases are so skillfully “disguised” that they puzzle not only those who have health complaints, but also doctors. One area that needs special attention is all health problems that cause (or mimic) heart pain.

What does the pain in intercostal neuralgia look like?

We have already talked about the causes and symptoms of the development of intercostal neuralgia more than once. You can read more about this disease here. We only recall that neuralgia occurs when the vertebral discs compress any of the intercostal nerves. Due to compression or irritation of the nerve, severe pain occurs.
What does pain in intercostal neuralgia look like? It is very acute, often occurs when moving, bending over, sneezing, coughing, with any physical effort, deep breaths. It hurts, as a rule, in the side, between the ribs, sometimes in the chest area. This is the insidiousness of intercostal neuralgia. Symptoms of neuralgia can be confused with symptoms of heart disease. This happens especially often in cases where, due to compression or irritation of the nerve, a person literally cannot breathe. The pain when breathing in can be so severe that it feels like the heart is about to stop. It is also possible to confuse intercostal neuralgia with a heart attack or other cardiac problem due to the fact that pain can be felt in the shoulder, shoulder blade, arm. Many people know that such a symptom is associated with dangerous heart diseases, so they get scared.

How to distinguish pain in the heart from intercostal neuralgia?

• In intercostal neuralgia, the pain is fairly well localized, even if it is not very sharp. It hurts between the ribs, under the shoulder blade, in the back, pricks in the side – basically it is felt as a “prick” or a pain point. In addition, when it hurts directly between the ribs, the place where the pain is localized is unpleasant to touch, the area itself can be very painful or sensitive to touch.
• The skin in the affected area may turn red or pale, sometimes the pain is accompanied by uncontrolled muscle contractions in the affected area.
• If there is a suspicion that it is not intercostal neuralgia that hurts, but the heart, it is better to immediately take a nitroglycerin tablet. Usually, heart pain subsides when taking the drug, and cardiological drugs do not work on intercostal neuralgia. With intercostal neuralgia, there is no change in pressure, the pulse also does not change.
• Pay attention to one more important feature: heart pain retains its character on inhalation and exhalation, when bending, any movements. With intercostal neuralgia, the pain either goes away or gets worse with movement.
• If the pain appeared suddenly, without movement, at rest, then this is most likely not the heart, but an infringement of the intercostal nerve.
• Pain in intercostal neuralgia is usually sharp, and pain in the heart is aching in nature.

Is it possible to make an independent decision about treatment based on the described symptoms?

In theory, each person knows his body well and can guess how serious this or that condition is. However, when it comes to heart-like pains, it is better not to experiment.

First of all , if the heart hurts, then it threatens with really serious consequences. This may be an attack of angina pectoris, and if the pain gives in the shoulder, the arm hurts or goes numb, for example, a stroke or heart attack is possible. In such a situation, urgent medical care is needed, so such pain cannot be ignored.

Secondly, , if the pain occurs due to intercostal neuralgia, this condition must also be treated. The danger is that the nerve root remains pinched for a long time. This means that after a while it will begin to die. At the same time, pain in the side, back pain, pain that radiates to the arm may decrease, but this should hardly be considered a good symptom: when the nerve dies, signal transmission to a certain area will be disrupted. As a result, sensitivity will be disturbed in the area where the dead nerve connected with the spinal cord. The degree of sensory impairment can be different: from numbness to complete loss of sensitivity.

In any case, it is best to consult a doctor and get advice on the right treatment. With heart disease and with intercostal neuralgia, they will be completely different, and different specialists treat these pathologies: a cardiologist deals with heart problems, and a neuropathologist usually prescribes the treatment of intercostal neuralgia.

1. The treatment of intercostal neuralgia includes various measures. Since osteochondrosis is often the cause of the disease, a full-fledged complex treatment is not complete without therapeutic exercises, physiotherapy, swimming, massage – that is, measures aimed at improving the condition of the spine.
2. Since the nerve root suffers in intercostal neuralgia, which causes acute pain in the side, under the shoulder blade, in the back, the therapy includes pain relief. With severe pain, even injectable drugs have to be used, but most often it is possible to get by with local anesthetics (ointments, creams with diclofenac, ibuprofen or other non-steroidal anti-inflammatory active substances), as well as taking NSAIDs in tablets. However, all these remedies, although they reduce pain, do not have a positive effect on the nerve.
3. Treatment of intercostal neuralgia according to modern standards involves the use of a complex of vitamins of group B (B1 and B6), and it is optimal that vitamin B1 is contained in the preparation in a fat-soluble form, known as “benfotiamine” – as in the preparation Milgamma tablets.