One of the most common causes of pain in the chest is intercostal neuralgia. This disease occurs when irritation or infringement of the intercostal nerve, the main symptom of which is acute pain. As a rule, intercostal neuralgia affects elderly and senile people. Also, this disease occurs in young people (especially in people leading sedentary lifestyle, as well as swimmers) and even sometimes in children (mainly during the period of intensive growth). About why this pathology develops, what are the clinical manifestations, the principles of diagnosis and treatment of it, we'll talk in our article.
- 1What is the intercostal nerve
- 2Causes of intercostal neuralgia
- 3Clinical manifestations of intercostal neuralgia
5Treatment of intercostal neuralgia
- 5.1General medical treatment
- 5.2Local treatment
- 5.3Non-drug treatment
- 5.4Recipes of traditional medicine
- 6Prognosis and prevention
What is the intercostal nerve
From the spinal cord in the thoracic part of his department, 12 pairs of spinal nerves leave. They are formed by sensitive, motor and sympathetic fibers. Each nerve passes through the intercostal space along the lower edge of the rib below the corresponding intercostal vessel between the external and internal intercostal muscles responsible for exhaling and inhaling. With intercostal neuralgia painful impulses spread along nerve fibers to the spinal cord, and then to the brain. Man as a result of this feels pain.
Causes of intercostal neuralgia
The causes of intercostal neuralgia are many, but the essence of them all boils down to two:
- irritation or entrapment of the intercostal nerve in the intercostal space;
- pinching spine nerve root in the thoracic spine.
Pinching roots, as a rule, occurs against the backdrop of such diseases of the spine as osteochondrosis of the thoracic part of the spine, ankylosing spondylitis (Bechterew's disease), spondylitis, intervertebral hernia, progressive kyphosis, and others.
Most cases of intercostal neuralgia is the result of exactly the stimulation or pinching of the nerve with the fibers of the intercostal muscles in the intercostal space.
Spasm of muscles can arise due to traumatic injury, increased physical exertion without warm-up, and psycho-emotional stress.
Inflammation of the external and internal intercostal muscles and the spasm associated with it occur against the background of general or local hypothermia, infectious diseases (in particular, herpes).
Less often intercostal neuralgia can develop against the background of the following diseases:
- food toxicoinfection (acute gastroenteritis);
- diseases of the ribs and deformation of the chest;
- multiple sclerosis;
- allergic diseases;
- toxic (alcoholic) polyneuropathy;
- diseases of the digestive tract, causing a deficiency in the body of B vitamins (chronic gastritis, colitis, hepatitis, peptic ulcer of the stomach and duodenum);
- aneurysm of the thoracic aorta.
Microtrauma, obtained by regular excessive physical exertion, especially in combination with hypothermia, can also cause intercostal neuralgia.
Clinical manifestations of intercostal neuralgia
The main symptom of this disease is pain along the intercostal space. The intensity of pain can be different: from sharp, sharp, pronounced, shooting (more often) to a constant, medium intensity. Pain is worse when the patient moves, when coughing and sneezing, and even with breathing. Often a person takes a forced position: leans into the affected side to minimize the amount of movement in it. Some patients with coughing, laughing or sneezing firmly press the palm to the affected intercostal space with the same goal: to reduce the amount of movement in this area, so that it hurts less.
Very often pain with intercostal neuralgia increases under the fingers of a doctor who conducts palpation: he easily probes the direction of pain along the nerve. It should be noted that patients can characterize their sensations not only as a pain, but as a burning sensation, tingling, and in the late stages of the disease - as numbness in the intercostal space.
With the involvement of the intercostal nerve on the left, the pain often simulates sensations in angina pectoris: patients evaluate pain as baking, with irradiation (spread) in the left arm, scapula, spine. However, angina pectoris still does not depend on movements, coughing, laughing and other, and, in addition, decreases after taking the pill nitroglycerin or its analogues. Nevertheless, in order not to miss such an important cardiac pathology, in doubtful cases the doctor appoints an ECG patient. It is important not to confuse intercostal neuralgia with myocardial infarction, because the pain with it also does not decrease from nitroglycerin. Therefore, with a sudden pain in the heart, you should not try fate, hoping for the best, but you need to be safe: call an ambulance and go through electrocardiography.
In a number of cases, when the nerves of the lower ribs are affected, the nature of pain may resemble sensations in renal colic (sudden sharp pains in the lumbar region of a cramping character, radiating in the leg or groin). In such cases, too, do not pull, and it is important to immediately seek help from specialists. Remember, it's better to be vigilant about your health.
Less often intercostal neuralgia can copy manifestations of such diseases as pleurisy, stenosis of the thoracic aorta, mediastinal tumors.
Diagnosis of typical intercostal neuralgia the doctor will put out without any difficulties on the basis of complaints of the patient, the history of the disease and life, and also based on the results of objective examination:
- when examined, the possible redness or blanching of the skin over the affected nerve will attract attention;
- at palpation, the patient will note soreness in the course of the affected intercostal space;
- examination of the heart (palpation, percussion, auscultation) will not show any pathological changes in this organ.
If a specialist has doubts about the nature of the patient's pain syndrome, he will appoint him additional methods of research that will help confirm or refute a diagnosis:
- X-ray of the chest;
- Ultrasound of the abdominal cavity and retroperitoneal space.
Treatment of intercostal neuralgia
Therapy of this pathology, as a rule, is carried out in two directions: the alleviation of the patient's condition by reduction, and better - the removal of pain, and treatment of the disease, against which neuralgia arose.
In the vast majority of cases, the patient undergoes outpatient treatment. The first 3-7 days of the disease (depending on the degree of its severity) the patient is shown bed rest. And his bed should be even, firm, with an orthopedic mattress or a shield placed under the usual mattress. Staying on a bed with a sagging net is categorically contraindicated: because of her, the condition of the patient can only worsen.
General medical treatment
Patients with intercostal neuralgia may be prescribed drugs of the following groups:
- nonsteroidal anti-inflammatory drugs (meloxicam, diclofenac, rofecoxib and others): they not only relieve pain, but also have a pronounced anti-inflammatory effect not only on the affected nerve, but also on, say, an osteochondrosis affected vertebrae; can be administered in the form of injections, tablets or suppositories (suppositories);
- muscle relaxants (midokalm, crowd, sirdalud) - reduce the severity of spasm of striated muscle;
- remedies that calm the nervous system (usually vegetable - sedasene, persen, novo-passit and others);
- B group vitamins (neurobion, neurorubin, milgamma and others) restore damaged nervous structures, improving the impulse between them.
First of all, in this section I want to note the dry heat on the affected area. However, it must be a source of indirect heat, for example, a knitted thing or a woolen shawl. Hot items to apply to the affected area is not only unhelpful, but even harmful. If there is a slight warming up, the local blood flow in the area is activated, but as the cooling proceeds, the reverse effect will be noted: an increase in the edema and an intensification of the pain syndrome.
Also, ointments and gels containing non-steroidal anti-inflammatory drugs (NSAIDs) can be used. These are such drugs as Dolobien, DIP-Relief, Fastum-gel and others.
Analgesic effects have other ointments or solutions that do not contain NSAIDs, but include anesthetics, reflex agents. These are drugs such as menovazine, capsicum, finalgon - they can also be used to treat intercostal neuralgia.
A relatively new dosage form for the treatment of this pathology and other inflammatory diseases of the musculoskeletal system are transdermal patches. They are impregnated with one or more anti-inflammatory and analgesic substances, which, after gluing on the affected area is slowly released and continues to exert its effects directly on the affected nerve. One of these drugs is voltaren. You can also use a patch with a special composition that does not contain NSAIDs, hormones and other habitual substances, but it has a pronounced analgesic and anti-inflammatory effect - nanoplast forte.
When acute symptoms of intercostal neuralgia are eliminated, methods of non-drug treatment will help to restore the functions of affected areas more quickly, namely:
- therapeutic massage (improves metabolic processes in the near-vertebral muscles, leads them into tone, reduces puffiness, relieves pain);
- exercise therapy (exercises to strengthen the muscular corset of the spine, prescribed by a doctor for a particular patient);
- manual therapy (by it the connections between vertebrae are normalized, the infringement of nerves is eliminated);
- physiotherapy (magnetotherapy, laser therapy, electrophoresis, UHF).
Recipes of traditional medicine
To facilitate the condition of the patient with intercostal neuralgia will help and methods of traditional medicine, but necessarily in conjunction with the traditional treatment appointed by a specialist.
- To reduce pain, you should lubricate the affected area with freshly squeezed radish juice or horseradish.
- Also with an anesthetic goal, you can prepare a tincture of rue (2 tbsp. l. pour 250 ml of boiling water and insist for 14 days). During intense pain, make compresses on the affected area.
- Will remove the pain syndrome and lotion from the melted wormwood (steam wormwood, then rub it into a mushy state, add sea buckthorn oil and apply to a painful place).
- If the geranium grows at home, you can use it. Tear off the sheet and rub it with the affected area, heat it up.
- To the area of the affected nerve should be attached gauze compress, moistened with infusion of flax seeds.
- You can prepare an ointment using vaseline and kidney aspen. Grind the kidneys, add petrolatum in the ratio of 1 part of petroleum jelly to 4 parts of the kidneys. Rub in places of greatest soreness 2-4 times a day.
- The patient will feel better after a warm bath with sea salt and sage.
- You can take inside the healing broth (chamomile flowers, melissa leaves, tincture of valerian medicinal, orange skins, honey) - it will strengthen the nervous system as a whole.
- Traditional medicine can be purchased and ready - in a pharmacy. Such a remedy is pepper plaster. Before using it, it is necessary to degrease the area of damage with alcohol, dry it well, then apply a patch and wait for the effect. After a while, the skin under the band-aid will begin to burn. You can not endure through strength, in this way you can seriously burn the skin. When the intense burning occurs, the patch should be removed.
Prognosis and prevention
With a timely diagnosis and adequate therapy for both intercostal neuralgia and the underlying disease, complete recovery is noted.
It is easy to understand that, in view of the many causes of the disease, the methods of specific prevention do not exist. To reduce the likelihood of its occurrence, it is timely to treat diseases, the consequence of which can become intercostal neuralgia, as well as avoid stress, avoid excessive physical exertion and hypothermia.