Intercostal neuralgia
| Classification according to ICD-10 | |
|---|---|
| R07 | Sore throat and chest |
| G58.0 | Intercostal neuropathy |
| ICD-10 online (WHO version 2019) | |
The term intercostal neuralgia (or intercostal neuralgia ) denotes a nerve pain ( neuralgia ) the chest wall along an intercostal nerve (lat. Inter "between", costa "rib"). Usually there is a pulling, persistent pain.
Symptoms
In intercostal neuralgia, nerve pain occurs in the area of the intercostal nerves in a belt-shaped manner in the chest or back area and is aggravated by coughing or pressing. Persistent pain, which can intensify like attacks and which those affected describe as razor-sharp and grueling, is typical. Fear of death and difficulty breathing are common with severe seizures. Discomfort and sensory disturbances can also occur in the affected areas.
Typical pressure points are next to the spine ( paravertebral ), down from the armpit ( axillary line ) and next to the midline ( median line ) in front ( paramedian ). The pain is caused by irritation of either the nerve root as it exits the spinal cord or the nerves themselves. Each intercostal nerve supplies a very specific area of skin and tissue between the individual ribs, in which the pain is felt.
causes
Various diseases can be responsible for intercostal neuralgia, so that the term intercostal neuralgia describes only a symptom and not a diagnosis. These include diseases of the spine, ribs, lungs or pleura . In the spine, changes due to wear and tear are the cause of the narrowing of nerve roots. Intercostal neuralgia (the post-thoracotomy syndrome ) can also occur after an operative opening of the thorax with possible removal of the ribs . Shingles (herpes zoster) is often the reason.
More rarely, intercostal neuralgia is caused by a disease of the spinal cord , a congenital narrowing of the main artery ( coarctation of the aorta ) or tumors in the area of the airways or the lung membrane .
In a differential diagnosis, diseases of the heart, stomach, liver or gall bladder can also radiate into the associated skin zones.
therapy
Painkillers or anti-rheumatoid drugs ( non-steroidal anti-inflammatory drugs ) that work peripherally, i.e. outside of the brain or spinal cord, can be administered. Muscle relaxation agents are also administered. In the case of extreme pain, centrally acting pain relievers ( opioids ) can also be administered. Therapeutic local anesthesia with a long-acting anesthetic in the form of local and temporary anesthetics or nerve blocks are often more useful. The spinal cord stimulation can be an effective method to alleviate the pain. Ultrasound therapy, which is usually carried out during physiotherapy, also helps, as it adds heat to the muscles and nerves in order to relax them.
