Reviewed by: Mr William Sharples BSc (Hons) – Pain Management Expert
Last Updated: September 2025
Key Takeaways
- Intercostal neuralgia is characterized by sharp, burning, or tingling nerve pain along the rib cage, usually on one side.
- Common causes include traumatic injuries, viral infections (especially shingles), and idiopathic cases with no clear cause.
- Effective management combines medications, medical procedures, lifestyle changes, and psychological support.
Understanding Intercostal Neuralgia
Intercostal neuralgia is a nerve pain condition affecting the intercostal nerves between the ribs. It typically causes sharp, burning, or tingling pain that can be constant or intermittent, often radiating from the back to the chest or even the shoulder blade and lower pelvis. The pain is usually unilateral (one-sided) and can significantly impact daily life.
Common Symptoms
- Sharp, burning, or stabbing pain along the rib cage
- Tingling and numbness in the affected area
- In severe cases, involuntary muscle twitching
- Pain may worsen with breathing, movement, or touch
- Referred pain to the shoulder blade or lower pelvis
Severe or unexplained chest pain should always be evaluated by a healthcare professional to rule out other serious conditions.
Causes of Intercostal Neuralgia
Traumatic Injuries
Rib fractures, chest wall injuries, or surgical trauma can damage the intercostal nerves, leading to persistent neuropathic pain.1
Viral Infections
Shingles (herpes zoster) is a common cause. The virus can inflame spinal nerve roots, causing severe pain and sometimes postherpetic neuralgia. Vaccination and early antiviral treatment are key preventive measures.
Idiopathic Intercostal Neuralgia
In some cases, no clear cause is found (idiopathic). These cases require careful evaluation and a tailored management plan.
Diagnosing Intercostal Neuralgia
Physical Examination
Doctors assess pain patterns, check for allodynia (pain from light touch), and may use nerve conduction studies to confirm diagnosis and rule out other nerve issues.
Imaging Tests
MRI scans help exclude other causes of chest pain and reveal nerve inflammation or compression, guiding targeted treatment.
Treatment Options for Intercostal Neuralgia
Management is often multidisciplinary, combining medications, procedures, and complementary therapies.
Over-the-Counter Medications
NSAIDs and topical lidocaine gels or patches can provide temporary pain relief.
Prescription Medications
Antidepressants, anticonvulsants, and sometimes opioids may be used for severe or chronic pain. These require careful monitoring due to potential side effects and dependence.
Medical Procedures
Intercostal nerve blocks and thoracic epidural injections deliver local anesthetics and corticosteroids to reduce pain and inflammation. Pulsed radiofrequency ablation may provide longer-term relief for chronic cases. These procedures are often performed under ultrasound guidance for precision.2
For neuralgia in other regions, nerve blocks such as the occipital nerve block may be considered.
Prolotherapy
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat Intercostal Neuralgia.
Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with Intercostal Neuralgia.
As prolotherapy is helping to treat the root cause of Intercostal Neuralgia, it is deemed to be a permanent fix, preventing the symptoms from returning.
Disclaimer: The information provided in this section is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Prolotherapy may not be suitable for everyone, and outcomes can vary. Always seek the guidance of a qualified healthcare professional regarding your specific medical condition or treatment options. Never disregard professional medical advice or delay seeking it because of information you have read here.
Complementary Therapies
Physical activity (walking, swimming), mindfulness, and stress management can help reduce chronic pain symptoms. Early antiviral treatment for shingles can prevent postherpetic neuralgia.
Managing Chronic Pain
Long-term Medication Use
Long-term use of prescription medications should be closely monitored due to risks of side effects and dependence.
Lifestyle Adjustments
Regular exercise, stress management, and good sleep hygiene can improve pain control and quality of life.
Psychological Support
Counseling, cognitive-behavioral therapy, and support groups help address the emotional impact of chronic pain.
Prevention Tips
Avoiding Trauma
Use protective gear during sports and physical activities to reduce the risk of chest injuries.
Vaccination and Early Treatment
Shingles vaccination and prompt antiviral treatment can prevent herpes zoster-related neuralgia.
Summary
Intercostal neuralgia is a complex nerve pain condition that can significantly affect quality of life. Accurate diagnosis and a multidisciplinary approach—including medications, procedures, lifestyle changes, and psychological support—are key to effective management. Prevention through trauma avoidance and vaccination is also important.
Frequently Asked Questions
What is intercostal neuralgia?
Intercostal neuralgia is nerve pain caused by irritation or injury to the intercostal nerves between the ribs, resulting in sharp, burning, or stabbing pain.
What are the common symptoms of intercostal neuralgia?
Sharp, burning, or stabbing pain along the rib cage, tingling, numbness, and sometimes muscle twitching or difficulty breathing.
What causes intercostal neuralgia?
Traumatic injuries, viral infections (shingles), or idiopathic (unknown) causes.
How is intercostal neuralgia diagnosed?
Through physical examination, pain pattern assessment, and imaging (MRI) to confirm nerve involvement and rule out other causes.
What are the treatment options for intercostal neuralgia?
Medications (NSAIDs, anticonvulsants, antidepressants), nerve blocks, prolotherapy, and complementary therapies. Consult a healthcare provider for a personalized plan.
Contact ProHealth Clinic Today for Your FREE 15-Minute Discovery Call
Don’t let Intercostal Neuralgia control your life any longer. Join the thousands of patients who have found lasting relief through prolotherapy at ProHealth Clinic.
Get in Touch
- Phone: +44 1234 380345
- Email: info@prohealthclinic.co.uk
Our Clinic Locations
- London: 104 Harley Street, Marylebone, W1G 7JD
- Manchester: The Hadley Clinic, 64 Bridge Street, M3 3BN
- Bedford: The Village Medical Centre, Kingswood Way, MK40 4GH
All clinics offer the same award-winning prolotherapy treatment with convenient appointment times, including evenings and weekends.
Author Bio
Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating Intercostal Neuralgia, with patients travelling to see him from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with Intercostal Neuralgia and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Mr Eaton’s expertise has been featured in many national news and media publications, including The Telegraph, The Daily Mail, The Daily Express, Women’s Health Magazine, and The Scotsman.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
LinkedIn profile
References
- Bordoni, B., & Lagana, M. M. (2019). Intercostal Neuralgia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537299/
- Kumar, K., & Rizvi, S. (2014). Intercostal neuralgia: A review. Journal of Clinical and Diagnostic Research, 8(6), NE01–NE04. https://doi.org/10.7860/JCDR/2014/8192.4442
- ProHealth Clinic case studies and clinical experience, 2024.
- Centers for Disease Control and Prevention (CDC). Shingles (Herpes Zoster) Vaccination. https://www.cdc.gov/vaccines/vpd/shingles/public/index.html
- National Health Service (NHS). (2023). Intercostal neuralgia. https://www.nhs.uk/conditions/intercostal-neuralgia/
Disclaimer: This article is for informational purposes only and does not substitute for professional medical advice. Always consult your healthcare provider before making treatment decisions.