The most common complaint among health problems is pain. Although pain complaints are encountered in almost every part of the body; The complaint of pain in some tissues may be felt more severely than others. In particular, pain caused by nerve tissues seriously affects the quality of life of patients. One of these pain complaints is rib pain.
What is Rib Pain (Intercostal Neuralgia)?
Rib pain or intercostal neuralgia, which is felt due to various disorders that occur in the intercostal vessels and nerve bundles under the ribs. are severe pain. Since rib pain, which can also be felt as chest pain, indicates different health problems due to the tissue it originates from, it should be differentiated from chest pain belonging to the organs located in the chest cavity.
Rib pains can be felt on the anterior chest wall; It can be felt in the chest side wall or back, upper abdomen or neck region along the anatomical region where the nerve from which it originates travels. Again, since the causes of rib pain are caused by different health problems, it is important to determine the underlying cause correctly in order for the treatment to be correct and effective. The vertebrae running between the th and the 20th are called thoracic vertebrae. (T1 –T12) A total of 12 pairs of rib bones are articulated to these vertebrae. Anatomically, one artery, vein and nerve tissue are located under each rib bone, and this vascular-nerve bundle provides blood supply and nerve stimulation of the chest wall. Responsible for pain and temperature sensations. These areas, called dermatomes, are limited to the nerve of each rib. Since the developing pain complaint is a nervous pain; felt as a sudden, sharp, burning, or electric shock. Again, since the chest wall and rib cage move with respiration, Since it is associated with movements of the large arms, head and abdomen, it causes frequent stimulation of nervous tissue. Therefore, rib pain can be severe, affecting the quality of life adversely.
What Causes Rib Pain?
Intercostal neuralgia is generally felt due to damage to the nerves that run under the ribs due to the effects of various disorders. Accordingly, in the following situations, pain under the right rib or pain under the left rib may occur depending on the affected body half. . Depending on this, left rib pain or right rib pain may occur.
- Viral infections: Various viral infections such as chickenpox infect nerve cells and cause the development of various rash diseases such as shingles. As a result, severe pain felt along the nerve tissue may develop.
- Inflammatory diseases: Some rheumatological diseases such as rheumatoid arthritis can cause rib pain with inflammation of the chest wall.
- Tumors: Benign or malignant tumors arising in the rib bones can cause rib pain by causing damage to the nerve tissue. Various joint diseases in which the junction points with the cartilage structures in the cage are affected may result in rib pain. (costochondritis)
- Nerve entrapments: Rib pain may occur in various diseases that compress the nerve tissue anatomically.
- Nervous diseases : In various nervous system diseases, which are also expressed as neuropathy, in which the nerve tissues are affected, rib pain may develop in conditions where the rib nerves are affected.
- Surgical interventions: In various surgical operations that result in the opening of the chest wall (such as thoracotomy) Pain complaints may occur due to injury to the nerve tissue.
- Incorrect movements: Especially in high-speed and contact sports activities such as wrestling, skiing, football, the musculoskeletal system forming the chest wall is handled. Nerve tissues may be damaged due to excessive strain on the breasts and may result in rib pain. Rib pains are common due to reasons such as stretching and stretching. Rib pain may occur during pregnancy as a result of the baby kicking in the last trimester. (Tietze syndrome)
What are the Symptoms of Rib Pain?
The most important symptom of rib pain is in the anterior or lateral wall of the chest, back or waist, upper abdomen or felt in the neck area; Sudden onset, severe, sharp, burning or electric shock pain. However, the following symptoms may also accompany rib pain:
- Sensation of chest tightness
- Tingling
- Loss of feeling
- Breathing or exacerbation of pain with movement
- Sudden contractions or weakness in the chest muscles
- Itching, rash or redness of the skin
How to Diagnose Rib Pain?
Intercostal neuralgia should be carefully evaluated by a specialist physician. Because a wide variety of health problems can cause chest pain, it can often be confused with intercostal neuralgia. Since the treatment of health problems is different from each other, it is very important to diagnose intercostal neuralgia correctly. If the physician deems necessary, he can confirm the diagnosis by applying additional imaging and laboratory tests. In this context,
- direct radiological radiographs,
- computed tomography (CT),
- ultrasound or
- magnetic resonance (MR) imaging are very useful in diagnosis .
What is done in the treatment of rib pain?
After the diagnosis of intercostal neuralgia is made, the treatment is planned depending on the characteristics of the patient and the severity of the symptoms. In this context, the following methods are frequently used in the treatment.
In mild rib pains, lidocaine pain relief gels, tapes or skin ointments applied over the skin are used.
Drug therapy is another method used. Accordingly, although non-steroidal anti-inflammatory drugs (NSAIDs) can be given, they are often insufficient to relieve pain. In this case, some antiepileptic drugs, narcotic analgesics or antidepressants are often prescribed. Especially since some antidepressant drugs have analgesic properties, they are very useful in the treatment.
In severe cases, interventional treatments for numbing the nerve tissue under the ribs may be preferred. In this method, called nerve block, the physician detects the application area with the help of imaging methods and injects local anesthetic and steroid-containing solution into the nerve tissue with the help of infection. With the help of the solution, both pain control is provided and inflammation in the nerve tissue is eliminated. Treatment with nerve block can show its effect for months.
Another interventional treatment method is thoracic epidural injection. In this method, which is based on the principle of injecting anti-inflammatory drugs into the epidural space in the back of the spine, pain control can be achieved along the chest wall.
Pain control can be achieved by stimulating the nerve tissue under the ribs with the help of injected electrodes with the radiofrequency method.
Acupuncture is another treatment method used. The importance of alternative treatment methods emerges, especially due to the resistance of intercostal neuralgia to various treatment methods and its chronic course. With the acupuncture method, rib pain can be controlled and long-term recovery can be achieved with the help of various needles injected.
Read: 18
