Intercostal neuralgia syndrome. Local painkillers. Which doctor treats intercostal neuralgia

One of the most common causes of chest pain is intercostal neuralgia. This is a disease that occurs when the intercostal nerve is irritated or pinched, the main symptom of which is acute pain. As a rule, intercostal neuralgia affects elderly and old age. This disease also occurs in young people (especially in people leading a sedentary lifestyle, as well as in swimmers) and even sometimes in children (mainly during periods of intensive growth). About why it develops this pathology what are clinical manifestations, the principles of diagnosing and treating it, we will discuss in our article.

What is the intercostal nerve

Less commonly, intercostal neuralgia can develop against the background of the following diseases:

• food poisoning (acute gastroenteritis);
• spondylopathies;
• rib diseases and deformities chest;
• allergic diseases;
• toxic (alcoholic) polyneuropathy;
• diabetes;
• organ diseases digestive tract, causing deficiency in the body of B vitamins ( chronic gastritis, colitis, hepatitis, peptic ulcer stomach and duodenum);
• thoracic aortic aneurysm.

Microtraumas caused by regular excessive physical activity, especially in combination with hypothermia, can also lead to intercostal neuralgia.

Clinical manifestations of intercostal neuralgia

Main symptom of this disease is pain along the intercostal space. The intensity of pain can vary: from sharp, acute, severe, shooting (more often) to constant, medium intensity. The pain intensifies when the patient moves, when coughing and sneezing, and even when breathing. Often a person takes a forced position: leans towards the affected side in order to minimize the range of movements in it. Some patients, when coughing, laughing or sneezing, press their palm firmly against the affected intercostal space for the same purpose: to reduce the range of movements in this area so that it hurts less.

Very often, the pain with intercostal neuralgia intensifies under the fingers of the doctor performing palpation: he easily probes the direction of the pain along the nerve. It is worth noting that patients can characterize their sensations not only as pain, but also as burning, tingling, and in the later stages of the disease - as numbness in the intercostal space.

When the intercostal nerve on the left is damaged, the pain often imitates the sensations of angina pectoris: patients evaluate the pain as burning, with irradiation (spread) to the left arm, scapula, and spine. However, angina pain still does not depend on movements, coughing, laughter, etc., and, moreover, decreases after the patient takes nitroglycerin tablets or its analogues. However, in order not to miss such an important cardiac pathology, in in doubtful cases The doctor prescribes an ECG for the patient. It is important not to confuse intercostal neuralgia with myocardial infarction, because the pain with it is also not reduced by nitroglycerin. Therefore, if pain suddenly arises in the heart area, you should not tempt fate, hoping for the best, but you need to play it safe: call an ambulance and undergo an electrocardiogram.

In some cases, when the nerves of the lower ribs are affected, the nature of the pain may resemble the sensations of renal colic (sudden sharp pain in the lumbar region of a cramping nature, radiating to the leg or groin). In such cases, you should also not delay, but it is important to immediately seek help from specialists. Remember that it is still better to be vigilant regarding your health.

Less commonly, intercostal neuralgia can copy the manifestations of diseases such as pleurisy, stenosis thoracic aorta, mediastinal tumors.

Diagnostics

The doctor will make a diagnosis of typical intercostal neuralgia without much difficulty based on the patient’s complaints, medical history and life history, as well as based on the results of an objective examination:

• upon examination, you will notice possible redness or paleness of the skin over the affected nerve;
• upon palpation, the patient will note pain along 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 pain syndrome patient, he will prescribe additional research methods that will help confirm or refute this or that diagnosis:

• plain radiography of the chest organs;
• Ultrasound of the abdominal organs and retroperitoneal space.

Treatment of intercostal neuralgia

Therapy for this pathology, as a rule, is carried out in 2 directions: alleviating the patient’s condition by reducing, or better yet, relieving pain, and treating the disease against which the neuralgia arose.

In the vast majority of cases, the patient is treated on an outpatient basis. For the first 3-7 days of the disease (depending on its severity), the patient is shown bed rest. Moreover, his bed should be flat, hard, with an orthopedic mattress or a shield placed under a regular mattress. Staying on a bed with a sagging net is strictly contraindicated: it can only worsen the patient’s condition.

General drug treatment

A patient with intercostal neuralgia may be prescribed drugs from the following groups:

Local treatment

First of all, in this section I would like to note dry heat to the affected area. However, it must be a source of indirect heat, such as a knitted item or woolen scarf. Applying hot objects to the affected area is not only unhelpful, but even harmful. With minor heating, local blood flow in the area is activated, but as it cools, the opposite effect will be noted: increased swelling and increased pain.

Ointments and gels containing non-steroidal anti-inflammatory drugs (NSAIDs) can also be used. These are drugs such as dolobene, DIP-relief, fastum-gel and others.

Other ointments or solutions that do not contain NSAIDs, but include anesthetics and substances, also have analgesic effects. reflex action. These are drugs such as menovazine, capsicam, finalgon - they can also be used to treat intercostal neuralgia.

Relatively new dosage form transdermal patches are used to treat this pathology and other inflammatory diseases of the musculoskeletal system. They are impregnated with one or more anti-inflammatory and analgesic substances, which, after being glued to the affected area, are slowly released and have a long-lasting effect directly on the affected nerve. One such drug is Voltaren. A patch with a special composition that does not contain NSAIDs, hormones and other drugs can also be used. habitual substances, however, it has a pronounced analgesic and anti-inflammatory effect - nanoplast forte.

Non-drug treatment

When the acute symptoms of intercostal neuralgia are eliminated, methods will help to quickly restore the functions of the affected areas non-drug treatment, namely:

• therapeutic massage (improves metabolic processes in the paravertebral muscles, tones them, reduces swelling, relieves pain);
• physical therapy (exercises to strengthen the muscle corset spinal column prescribed by a doctor for a specific patient);
• manual therapy (it normalizes the connections between the vertebrae and eliminates pinched nerves);
• acupuncture;
• physiotherapy (magnetic therapy, laser therapy, electrophoresis, UHF).

Traditional medicine recipes

Traditional medicine methods will also help alleviate the condition of a patient with intercostal neuralgia, but always in combination with traditional treatment by an appointed specialist.

• To reduce pain, you should lubricate the affected area with freshly squeezed radish or horseradish juice.
• You can also prepare a rue tincture for analgesic purposes (2 tablespoons of the raw material, pour 250 ml of boiling water and leave for 14 days). During intense pain, apply compresses to the affected area.
• A lotion made from steamed wormwood will also relieve pain (steam the wormwood, then grind it into a paste, add sea buckthorn oil and apply to the painful area).
• If the patient has geranium growing at home, you can use it. Tear off a leaf and rub it on the affected area, wrap it warmly.
• A gauze compress moistened with flax seed infusion should be applied to the area of ​​the affected nerve.
• You can prepare an ointment using Vaseline and aspen buds. Grind the buds, add Vaseline in a ratio of 1 part Vaseline to 4 parts buds. Rub into areas of greatest pain 2-4 times a day.
• The patient will feel better after a warm bath with sea ​​salt and sage.
• Can be taken orally healing decoction(chamomile flowers, lemon balm leaves, tincture of valerian officinalis, orange skins, honey) - it will strengthen the nervous system as a whole.
• Traditional medicine can also be purchased ready-made at a pharmacy. Such a remedy - pepper patch. Before using it, you need to degrease the affected area with alcohol, dry it well, then apply a patch and wait for the effect. After some time, the skin under the patch will begin to burn. You cannot endure it forcefully; this way you can seriously burn your skin. If intense burning occurs, the patch should be removed.

Prognosis and prevention

With a timely diagnosis and adequate treatment of both the intercostal neuralgia itself and the underlying disease, complete recovery is noted.

It is easy to understand that, due to the many causes of the disease, methods specific prevention it does not exist. To reduce the likelihood of its occurrence, you should promptly treat diseases that may result in intercostal neuralgia, as well as avoid stress, avoid excessive physical exertion and hypothermia.

Intercostal neuralgia- one of the most common causes of chest pain. In most cases intercostal neuralgia observed in elderly and middle-aged people. This disease practically does not occur in children.

Symptoms of intercostal neuralgia

By its nature, intercostal neuralgia is:

• irritation, pinching or inflammation of nerve endings in the intercostal space;
• or pinching of the thoracic roots spinal nerves near the spinal column.

Basically, the pain with intercostal neuralgia is localized in the intercostal space, but pain can radiate along the path of the pinched nerve - in the lower back, in the back, under the scapula. Spastic muscle contractions, redness or paleness of the skin, and loss of skin sensitivity in the area of ​​the affected nerve may occur. The pain with intercostal neuralgia is very strong, burning, constant, without attacks

Intercostal neuralgia - clarifying the diagnosis

Intercostal neuralgia is sometimes confused with heart pain. Although it is not so difficult to distinguish them.

With intercostal neuralgia, the pain intensifies with deep inhalation or exhalation, or any other movement of the body, including coughing or sneezing, or during physical activity. Sometimes it’s painful and you can’t even take a deep breath - attacks of burning pain appear along the intercostal spaces (pain can only be felt on one side of the chest).

Heart pain with angina pectoris does not change with deep inhalation or exhalation, from a change in position or movement in the chest; usually relieved with nitroglycerin; may be accompanied by a disturbance in the rhythm of the pulse, a fall or increase blood pressure.

At intercostal neuralgia the pain may intensify with palpation - you can feel the direction of the pain along the nerve. Aching or paroxysmal pain, spreading along the trunk of the nerve or its branches, may be accompanied by other unpleasant sensations - burning, tingling, numbness. By the way, this is why intercostal neuralgia can cause pain not only in the heart area, but also under the shoulder blade, in the back, and lower back (they can sometimes be confused with kidney pain).

It is important to differentiate an attack of intercostal neuralgia and myocardial infarction, which can also cause severe pain that is not relieved by nitroglycerin. Therefore, when sudden attack pain in the heart area must be caused ambulance and do an electrocardiogram, since a heart attack requires urgent medical attention.

Causes of intercostal neuralgia

There are many reasons that can cause intercostal neuralgia, but, in fact, the pain is caused either by pinching the spinal nerve root in the thoracic spine, or by pinching or irritation of the intercostal nerves in the intercostal space.

Pinched roots are most often caused by various manifestations osteochondrosis, but other causes are also possible (spondylitis, ankylosing spondylitis and others).

However, more often, attacks occur as a result of irritation of the nerve due to its pinching by the intercostal muscles due to inflammation or muscle spasm.

The cause of a spasm and, accordingly, an attack of neuralgia can be mental stress, traumatic effects, excessive physical activity without necessary preparation. Spasm and inflammation of the intercostal muscles can be caused by hypothermia, previous infection. Sometimes intercostal neuralgia occurs due to lung diseases.

Attack intercostal neuralgia may occur due to poisoning, with changes in the spine caused by hormonal disorders in women in menopause. The cause of neuralgia can be allergic diseases, diseases nervous system (multiple sclerosis, polyradiculoneuritis). Possible development of intercostal neuralgia with aortic aneurysm, diseases internal organs, after suffering a herpetic infection.

Also, the cause of neuralgia can be microtrauma due to constant physical stress(for example, when lifting heavy objects), especially in combination with hypothermia.

The development of the disease can be caused by alcohol abuse (due to the toxic effects of alcohol on the nervous system), as well as diabetes mellitus and a lack of B vitamins in the body (observed with stomach and duodenal ulcers, gastritis, hepatitis, colitis) - due to a violation metabolism in nervous tissue.

It should be noted that symptoms resembling intercostal neuralgia, are possible due to excessive tone (spasm) of one or more back muscles. In this case, an increase in pain is typical when the affected muscle is stretched (bending forward, moving the shoulder or shoulder blade).

What is intercostal neuralgia? What are its reasons? How to treat intercostal neuralgia?

Candidate of Medical Sciences talks about the causes and symptoms of intercostal neuralgia and new treatment methods. E.L. Shakhramanova, doctor of the consultative and outpatient department of the Research Institute of Rheumatology.

Treatment of intercostal neuralgia

Treatment of intercostal neuralgia usually consists of two stages. First, it is necessary to relieve the pain that accompanies intercostal neuralgia, then it is necessary to treat the disease that caused the nerve injury.

In the first week of the disease, it is better to observe bed rest for 1-3 days, preferably lying on a hard surface; it is best to place a shield under the mattress. To relieve pain, painkillers are prescribed, usually from NSAID groups, which not only relieve pain, but also have an anti-inflammatory effect. In addition, muscle relaxants are prescribed to relieve muscle spasms and sedatives. B vitamins (B1, B6, B12) are recommended - they help restore damaged nerve structures. During attacks, light, dry heat helps.

After the acute symptoms have been relieved, it is necessary to carry out a diagnosis and determine the cause that caused the attack of intercostal neuralgia. If this is any general disease(infectious, cold, allergic, diabetes, nervous system disease, depression) - it is necessary to treat it.

If intercostal neuralgia is caused by a disease of the spine, that is, it is of a vertebrogenic nature, comprehensive treatment of the spine is recommended. To restore the correct physiological position of the thoracic and cervical spine in cases of intercostal neuralgia, courses of therapeutic massage, manual therapy, and physical therapy are conducted.

Good effect for vertebrogenic intercostal neuralgia, physiotherapy, acupuncture, and laser therapy are given. To prevent the disease from developing into chronic form With frequent attacks, you need to reduce physical activity, do not abuse alcohol, and avoid stressful situations if possible.

In the first week of the disease, it is better to observe bed rest for 1-3 days, preferably lying on a hard surface; it is best to place a shield under the mattress. During attacks, light, dry heat helps.

To relieve pain, take painkillers and sedatives. Physiotherapy, acupuncture, and laser therapy provide good results for intercostal neuralgia. It is advisable to take B vitamins (B1, B6, B12). To prevent the disease from becoming chronic with frequent attacks, you need to reduce physical activity, not abuse alcohol, and avoid stressful situations if possible.

To restore the correct physiological position of the thoracic and cervical spine in cases of intercostal neuralgia, courses of therapeutic massage, manual therapy, and physical therapy are conducted.

If conservative treatment does not help, then it is carried out surgery(for example, osteochondrosis or disc herniation, which cause attacks of intercostal neuralgia).

Treatment of intercostal neuralgia with a new drug - NANOPLAST forte therapeutic patch

With therapeutic treatment of intercostal neuralgia Various drugs are used, such as NSAIDs, analgesics, etc. All these drugs are effective, but long-term use may harm the body. Therefore it is very important to minimize side effects and increase the effectiveness of treatment of intercostal neuralgia. A new generation drug - an anti-inflammatory pain reliever - can help with this. medical plaster NANOPLAST forte.

In the treatment of intercostal neuralgia, the therapeutic plaster NANOPLAST forte is highly effective, it relieves pain and inflammation, improves blood circulation in the affected area, and allows you to reduce the dose of painkillers and anti-inflammatory drugs.

For intercostal neuralgia, the therapeutic plaster NANOPLAST forte is applied to the intercostal area (avoiding the heart area) or to the projection of the exit of the spinal nerves, usually pinched due to osteochondrosis to the right or left of the spine in the thoracic region - depending on the location of the pain. Maybe simultaneous use patch in the intercostal area (where the pain is localized) and at the site of the projection of the corresponding nerve in the thoracic spine. It is usually recommended to use the patch in the morning for 12 hours, but it can also be used at night. Course duration treatment of intercostal neuralgia medicinal patch - from 9 days.

High efficiency, unique composition, long-lasting (up to 12 hours!) therapeutic effect, ease of use and affordable price make NANOPLAST forte the drug of choice in the treatment of intercostal neuralgia.

Intercostal neuralgia(Neuralgia intercostale - lat.) - this is, if we say in simple words, compression and pinching (and sometimes irritation) of nerves and nerve ganglia located in the intercostal area (see figure below).

Definition and meaning of types of neuralgic pain

The treatment of this disease should be treated with particular care - first of all (before treatment, and this is IMPORTANT), it is necessary to determine whether this is really intercostal neuralgia?

Intercostal neuralgia is a difficult disease, considering a large number of nerve ganglia and their location

Among the most “popular” neurological diseases(neuralgia), the main symptom of which is acute pain, This neuralgia also exists. That is why is a reason to contact not only a neurologist, but also other doctors who deal with problems of acute pain: a therapist, a surgeon, and sometimes a traumatologist, especially if this neuralgia has been present for a long time.

Sometimes, with this neuralgia, chest and side pain are so strong that often not only the linear ambulance team goes to such patients, especially on the first day medical care, but also a specialized cardiology team. By the way, young mothers often experience intercostal neuralgia while breastfeeding.

In this article we will talk about the most common causes of intercostal neuralgia, its key symptoms that will distinguish it from acute and emergency conditions, as well as treatment on the first day of development of intercostal neuralgia, that is, before the first visit to a neurologist, or before calling a local therapist at home.

Symptoms of the disease

Intercostal neuralgia is a multifaceted disease and symptoms such as most likely also relate to neuralgia of the intercostal nerves. Let us list the most striking and understandable symptoms that most likely indicate intercostal neuralgia:

• Main sign diseases – This strong pain in the chest. If you show it with your hand, then, most likely, the hand will describe an arc from the spine to the front surface, along the ribs (in other words, the right or left side, under the hand);
• Pain has a clear connection with movement– strengthening occurs when turning, raising the arm;
• Pain especially intensifying with a deep breath, due to incomplete breathing is possible;
• Also the pain “responds” to any sudden shock. This is coughing, sneezing, straining, laughing. Therefore, you should cough, or ask those around you to lightly tap the edge of your palm on your back or side. A sharp increase in pain will indicate neuralgia.
• This nature of pain is called “radicular”. Pain strikes like lightning like a blow electric current. Sometimes the patient “freezes” without completing the movement. The popular apt “term” – lumbago – becomes clear.

In women, intercostal neuralgia can radiate to.

Uncharacteristic signs of an attack of intercostal neuralgia

To make it clearer, these are signs the presence of which shows that the patient most likely has such a person, and such a person should be treated especially carefully, because the disease may turn out to be much more serious than banal neuralgia.

• The patient's condition is calm. He's trying to find comfortable position, but there is never obvious suffering on the face, restless eyes. The patient does not experience anxiety, and even more so, there is no fear of death, anxiety and tossing, which often occurs during a heart attack;
• There is no pallor, sticky cold sweat, decreased blood pressure, acrocyanosis (blueness of the lips, tip of the nose, ears, fingertips);
• There is no retrosternal localization of pain, which rather radiates to the jaw, left arm, and is of a pressing and burning nature;
• There is no feeling as if “a stake was stuck in the middle” (as with intercostal neuralgia), and there is no desire to lie down, bent “in half”, as during an attack acute pancreatitis.

BE CAREFUL! If there is a suspicion of a cardiac cause of pain, as well as acute pancreatitis, or a stomach ulcer, then you must first call an ambulance and give validol or nitroglycerin under the tongue. In the event that you are mistaken, then in case of intercostal neuralgia there will be no harm from the drug, but in case of an attack coronary disease heart this drug can save lives.

Reasons for development

Intercostal neuralgia is a multifactorial disease. Anything that can cause compression of the intercostal nerve, or inflammation, can ultimately result in severe pain:

• Sudden hypothermia of the back and chest (including driving with the side window open in a car, even in summer), after sweating during winter work such as clearing snow;
• Sudden movement, injury, falling on your side or back, slipping on ice, as well as carrying heavy objects and especially the moment of putting them on your back;
• Compromised intervertebral discs, which can compress the intercostal nerves at typical points of exit from the spine in osteochondrosis of the thoracic spine;
• In women, the cause of attacks of intercostal neuralgia may be the systematic wearing of tight underwear - incorrect selection of a bra, especially with “underwires” and in subjects of “graceful proportions”.
• An important cause, finally, is the herpes simplex virus. Only with this viral disease along the intercostal nerves does a vesicular rash appear above them. The blisters are similar to those with chickenpox; they dry out, forming crusts that then fall off. Their formation is accompanied by burning and discomfort. Provoking factors for the development of this type of nerve inflammation are decreased immunity, frequent colds, and sore throats. In addition, this type of neuralgia develops only in people who previously (usually in childhood) had chickenpox. They are the vast majority.

Most importantly, the illusion of improvement after the rash disappears is futile. Therefore this type intercostal neuralgia and is called "", that is, arising after herpes.

This painful burning pain, which can deprive a person of sleep for many years, is caused by a neuropathic effect, a specific degeneration of the nerves. It occurs under the influence of the neurotropic herpes virus, which does not disappear from the body, but remains in the nervous system, passing into a “dormant state.”

Therefore, looking ahead, we must immediately say that everything is decided by the day, and even the hours. It is at the first signs of formation blistering rash It is immediately necessary to prescribe modern antiviral drugs - acyclovir, Zovirax, both topically, in the form of ointments and creams, and orally. Any delay and attempt to prescribe another type of therapy will be ineffective, which will ultimately lead to persistent, burning pain.

Intercostal neuralgia can also be a sign - be careful.

Treatment of intercostal neuralgia

Before treatment, you must first get it by first visiting a therapist, then go to a neurologist in the direction.

Treat intercostal neuralgia It’s simply necessary, read what will happen and what to expect. When intercostal neuralgia occurs, first of all, you need to make it a rule: never take it before visiting a doctor. This can lead to “blurring” and “smearing” of the picture. acute pancreatic necrosis, perforated stomach ulcer and other disasters in the abdominal cavity, and the time for emergency surgery will be lost. Of the ways first aid suitable:

• Rub peppermint essential oil into the intercostal spaces in a ratio of 1 drop of essential oil to 5 drops of vegetable oil. Has a distracting effect;
• We recommend the “Kuznetsov applicator” (other names: needle applicator, Kuznetsov applicator, yoga mat). People call this remedy “lie on pins and needles.” It is recommended to apply for 20 - 30 minutes, and then rub in the oil; (generally a great thing and not only for intercostal neuralgia)

• In addition to essential oil, you can topically use gels containing anti-inflammatory substances, for example, Fastum - gel, Dolobene. These drugs have a cooling effect;

After examination by a doctor and confirmation of the diagnosis, medications can be used orally and parenterally (intramuscularly). These include:

• Muscle relaxants central action(Mydocalm, Sirdalud). Allows you to reduce pain by influencing the reduction of muscle spasm and reducing muscle swelling, therefore, reducing compression on the nerve;
• Non-steroidal anti-inflammatory drugs: Movalis, Celebrex, Nalgesin. Better to appoint intramuscular injection ampoule of the drug 1 time per day for 3 to 5 days, no more. Then - switch to taking pills. Those patients who have gastritis, gastric ulcers, or heartburn should take omeprazole (20 mg twice a day) along with these drugs.
• Concentrated multivitamin preparations, such as Milgamma Compositum. It is rational to prescribe intramuscularly for 10-14 days.
• As a local anesthetic therapy, you can use patches that release lidocaine slowly, such as Versatis. This patch can be compared to a “soft blockade” without. For example, if you attach it to a painful place at night, you can ensure a restful sleep.

A big plus local therapy is the absence system effect: drugs do not pass through the liver, so their concentration does not decrease.

If intercostal neuralgia “has arrived,” then an important component in therapy, especially in the first day or two, is to prevent swelling in the area of ​​inflammation. This can be achieved by limiting fluid intake, or in cases of severe pain, prescribing potassium-sparing diuretics can be used. Such “soft” drugs include Veroshpiron.

It is also important to comply with the protective regime: avoid drafts, do not wrap yourself up, especially in the first day. When edema is severe, stimulation of blood flow is not required. A good solution would be to use it for sleeping.

Physiotherapeutic techniques, massage, manual therapy can be used only when a pronounced exacerbation is eliminated and the pain syndrome is relieved - no earlier than 5-7 days.

Pain relief for severe intercostal neuralgia and emergency care

In the first two or three days, a sharp attack of intercostal neuralgia can deprive a person of rest and sleep, because the pain can be very strong and for an indefinite period of time. Such pain, in addition to insomnia, can provoke deterioration in health. For example, the back may aggravate the following conditions:

• provocation of increased blood pressure, the development of a hypertensive crisis, the appearance of thrombotic complications - for example, transient ischemic attack or the development of stroke;
• exacerbation of gastrointestinal diseases: chronic constipation, exacerbation of hemorrhoids (since the slightest straining provokes increased pain and also forces a person to avoid bowel movements);
• transition of an acute pain state to a chronic pain syndrome, development of depression.

From the above it follows that sharp pain in case of intercostal neuralgia, it is necessary to urgently stop, but this should be done only after excluding another cause of the disease: myocardial infarction, an attack of acute pancreatitis, atypical renal colic. If this necessary stage completed, then anesthesia is carried out by the following means:

• application of patches with local anesthetics. Currently, cutaneous applications with lidocaine have become the drug of choice for the treatment of intercostal neuralgia on the first day of the disease. One of these patches is Versatis.

The use of skin patches for severe neurological pain (especially when there is intercostal neuralgia) has long been tested in the West, Europe and the USA. Sometimes even patches containing narcotic analgesics, such as the opiate fentanyl, are used. Indications also include neurological pain in herpes zoster.

IN Russian Federation Such patches are a “luxury” even for cancer patients.

• intramuscular injections of NSAIDs (), such as Ketonal, Baralgin, which have a pronounced anti-inflammatory effect. Then, on days 2-3, they are replaced with NSAIDs, which most affect the inflammatory response: meloxicam, celecoxib.

• Performing a blockade. It is carried out in a neurological hospital, a treatment room of a polyclinic, in as a last resort, blockade if other methods are ineffective, can be carried out at home. Novocaine, adrenaline, and B vitamins are administered. The result is pain relief, elimination of blood flow due to the vasoconstrictor effect of adrenaline, which reduces inflammation, and vitamins will enhance the trophism of nervous tissue;

• Local remedies have a good analgesic effect: ointments with bee and snake venom - Apizartron, Viprosal. The poison components they contain improve local blood circulation, promote the removal of metabolic products from the source of inflammation, and reduce pain impulses;

• It is worth cautioning against the use of ointments with a pronounced warming effect, such as Finalgon, Capsicum. (Due to numerous requests, our neurologist wrote an article - “ “) These ointments should be applied to the lumbar region, knees, ankles, elbow joints. And rubbing into the chest area and intense burning can contribute to a reflex increase in blood pressure, which can lead to a hypertensive crisis. Preference should be given to ointments and gels with a cooling effect, such as Dolobene;

• you can also use combinations of aromatic oils based on menthol, which has a distracting effect;
• Physiotherapeutic pain-relieving techniques that work on the basis of reflex regulation are justified: acupuncture (acupuncture), acupressure.

The use of massage with warming techniques, rubbing, and manual techniques is prohibited until severe inflammation and constant pain subside.

Also, during the first few days, with severe pain, it is possible to prescribe sleeping pills and sedatives. Over-the-counter products include:

• Glycine (dissolve at night, 2 tablets);
• preparations based on herbal components: Novo - Passit, Persen - Forte.
• It is not recommended to take herbal soothing decoctions in large volumes - a glass or more - since excess fluid intake at night can lead to increased swelling.

After removal acute attack pain, it is necessary to remember the principles of preventing intercostal neuralgia. They consist of preventing overloads, sudden movements, injuries, hypothermia, maintaining a motor regimen, and engaging in physical education and sports for health purposes.

The methods described here for relieving pain during the most acute period of intercostal neuralgia, despite the insignificant list of drugs, cover almost all classes of compounds and techniques. Only highly specialized issues remained unexamined, for example, the treatment of neuropathic pain during the development of postherpetic neuralgia, which remains one of the most complex problems neurology. These methods will definitely be discussed in future articles.

Video from a popular show. It clearly explains what intercostal neuralgia is, how to detect it and how to treat it. Under the title “When you don’t need to go to the doctor or intercostal neuralgia”:

Neuralgia is usually called pain caused not by an organ or part of the body, but directly by the nerve itself. In the case of intercostal neuralgia, pain is caused by damage or compression of the nerves passing between the ribs.

What is intercostal neuralgia

Intercostal neuralgia is a syndrome characterized by intense pain in the chest area, or more precisely, in the intercostal space. The disease occurs mainly in old age, but its occurrence in children is also possible. The incidence of the disease in men and women is approximately the same.

The intercostal nerves come from the thoracic spine and contain fibers for various purposes - sensory, motor and sympathetic. There are a total of 12 pairs of intercostal nerves. Passing between the ribs, they innervate the muscles and skin of the chest, abdomen and peritoneum.

It is customary to distinguish two main types of intercostal neuralgia - radicular, caused by pinching of the roots of nerve fibers in the spine, and reflex, caused by muscle spasm in the intercostal space.

Also, depending on whether the pain is felt on one side of the chest or on both, intercostal neuralgia can be unilateral or bilateral. The disease is of a bilateral type, most often caused by herpes. It is worth keeping in mind that damage to the intercostal nerve on one side can lead to pain on both sides of the body - due to the fact that the nerve fibers are partially intertwined.

The disease does not pose an immediate threat to life, although it causes a lot of pain for the patient. discomfort. However, in some cases, the cause of neuralgia may be hidden serious diseases, such as tumors. In addition, pain may worsen general state patient, lead to insomnia, hypertensive crises, etc. It should also be borne in mind that dysfunction of the intercostal nerve can negatively affect the process of supplying blood to tissues.

Intercostal neuralgia: symptoms

The area where pain occurs is the intercostal space. The pain is shooting or burning in nature. The intensity and duration of pain may vary from patient to patient. Sometimes the patient may feel only a slight burning sensation, and sometimes - severe pain, intensifying with each breath. Often, the patient can feel a wave of pain spreading along the intercostal nerve. When pressing on the place where the nerve goes, the pain can intensify many times. At night, the pain usually does not decrease, which can lead to insomnia.

But with intercostal neuralgia, the symptoms may not be entirely typical. For example, pain may also radiate to the scapula, epigastric region, lower back, collarbone, in women - into the mammary glands.

Symptoms of intercostal neuralgia also include some indirect signs: increased sweating, muscle twitching, loss of skin sensitivity in the area where the damaged intercostal nerve is located, paleness or redness of the skin, swelling. The symptoms of neuralgia may also be similar in appearance to pain caused by other diseases. For example, when a nerve running in the area of ​​the lower rib is irritated, pain occurs that resembles renal colic.

But first of all, the symptoms and nature of pain in neuralgia should be separated from the signs of cardiovascular diseases, in particular coronary disease. Left-sided neuralgia is especially often disguised as angina.

Features that distinguish neuralgia and its symptoms from heart disease

Here are the typical characteristics and symptoms that are characteristic of intercostal neuralgia pain (as opposed to angina pain):

• The intensity of pain changes with changes in body position - bending, turning. When taking a deep breath, coughing or sneezing, the pain intensifies.
• The pain can be partially or completely relieved by taking sedatives and sedatives - Corvalol, valerian.
• The pain lasts for hours and even days.
• The pain is not relieved by taking vasodilators.
• The nature of the pain is in no way related to physical activity (meaning loads not associated with changes in the position of the body, for example, walking).
• The pain is not accompanied by heart rhythm disturbances.

It is worth noting that angina pectoris and neuralgia can have a number of similar symptoms, such as changes in blood pressure or shortness of breath, although the mechanism of their occurrence is different in both cases.

Lichen alba is treated on an outpatient basis. Photo: Andrei_R/Shutterstock.com

Causes of neuralgia

The most common cause of the disease is osteochondrosis. This disease causes compression of the nerve roots in the intervertebral discs.

Hypothermia, working in an uncomfortable position, draft, colds, neurological diseases, diseases of internal organs, intoxication - all this can also provoke the appearance of intercostal neuralgia. The causes of the syndrome may also lie in damage to the nerve sheaths (demyelination). It is possible that intercostal neuralgia may occur as a result of rib fractures and spinal injuries. In children, neuralgia may be associated with birth injuries or disturbances in the formation of the skeleton.

Among infectious causes intercostal neuralgia, herpes zoster should be put in first place in terms of prevalence. Neuralgia can also be caused by diseases such as tuberculosis and influenza.

Factors contributing to neuralgia:

• diabetes
• age-related vascular diseases
• lack of immunity
• deficiency of vitamins, primarily group B
• hypertension
• hormonal changes

In most cases, the immediate cause of intercostal neuralgia is muscle spasm which leads to compression of the nerves.

Diagnostics

When making a diagnosis, neuralgia must be differentiated from pain caused by diseases of the spine not associated with osteochondrosis or trauma (for example, spondylitis or ankylosing spondylitis), pleurisy, diseases of the gastrointestinal tract, kidneys, oncological diseases, as well as from diseases of the cardiovascular system.

To clarify the diagnosis, first of all, analysis of symptoms and visual inspection patient, listening to the heart, lungs and palpating the rib area. However, in some cases it can be difficult to set accurate diagnosis, based on these data, can therefore be assigned additional research. Clinical researches may include a cardiogram, radiography, X-ray and magnetic tomography, electroneurography, myelography, ultrasound, blood and urine tests.

Photo: Room's Studio/Shutterstock.com

Treatment of intercostal neuralgia

Intercostal neuralgia - what to do if you have pain in the chest area? First of all, you need to figure out whether this is really intercostal neuralgia or some more dangerous disease. Indeed, with intercostal neuralgia, the symptoms often copy the symptoms of diseases of the internal organs. AND self-treatment, in the event that the diagnosis was made incorrectly by the patient himself, can lead to dire consequences. In addition, neuralgia different people may differ in causes and intensity, and effective treatment each time may have its own characteristics. Therefore, if there are characteristic features, indicating intercostal neuralgia, you should consult a therapist. Only a doctor can correctly recognize the symptoms and prescribe treatment.

The treatment strategy consists of three stages:

1. Relief of pain using painkillers
2. Eliminating the immediate cause of pinched or damaged nerve
3. Treatment of those pathologies that caused nerve irritation

Traditional medicine

IN traditional medicine usually used following methods treatment of intercostal neuralgia:

• Medication therapy (analgesics, anti-inflammatory drugs, vitamins)
• Physiotherapy
• Limitation of spinal mobility (for example, with the help of corsets)
• Manual and reflex therapy
• Massage
• Physiotherapy

Treatment in most cases is conservative, although in case of advanced disease and ineffectiveness of other methods, surgical intervention can also be used. Treatment methods for right-sided and left-sided intercostal neuralgia are not fundamentally different. During exacerbation of the disease, bed rest is usually indicated, but the patient is recommended to lie on a hard surface.

Drugs

Relief of severe pain is usually done with injections of painkillers - novocaine blockades. If the pain is moderate, it is preferable to take oral analgesics. Also, for intercostal neuralgia, muscle relaxants are prescribed to help relax muscles, diuretics to relieve swelling, sedatives and antidepressants - to relieve stress state. Ointments or patches with anti-inflammatory and analgesic substances can be used locally. In case of intercostal neuralgia caused by herpes, drugs that fight viruses are prescribed.

Treatment methods for intercostal neuralgia caused by osteochondrosis

If the root cause of the disease is osteochondrosis, then the fight against neuralgia should be aimed primarily at its treatment. In this case, methods such as physiotherapy, massage and manual therapy provide great help.

Physiotherapeutic procedures are one of the most effective methods in the treatment of the consequences of osteochondrosis. These may include the use of ultrasound, magnetic fields, electric current, laser, UV and IR radiation.

The massage is designed to strengthen and relax muscles, as well as improve blood flow in tissues. Manual therapy is aimed, first of all, at restoring the configuration of the spine and eliminating displacements of individual vertebrae.

Folk remedies

Neuralgia is not at all modern phenomenon. Our great-grandfathers knew very well what kind of scourge this was, but they also knew how to treat it. ethnoscience has developed many effective methods that can be successfully used today. After all, it is not always possible to see a doctor if an attack of illness occurs suddenly.

Rubbing the affected area has a good effect. alcohol tincture birch buds or valerian. General warming of the body with warm clothes or a woolen scarf also helps. Local heating of the painful area using heating pads is ineffective and can only worsen the condition.

From funds for internal reception It is worth mentioning peppermint decoction. It is prepared like this: 1 tablespoon of dry leaves is infused in 200 g of boiling water. You should drink 100 g of the decoction in the morning and evening.

Prevention

It is well known that any disease is easier to prevent than to treat. This is also true for neuralgia.

• Monitor your diet and lifestyle
• Avoid hypothermia and drafts
• Avoid strenuous physical work
• Avoid injury to the ribs and spine
• Monitor correct posture and do strengthening exercises, especially if your job is sedentary
• Treat in a timely manner infectious diseases and diseases of the musculoskeletal system

Many people, especially older people, experience symptoms of intercostal neuralgia. This disease is the most common pathology of the nervous system. As a rule, neuralgia of this kind is caused by diseases of the spine, but it can also appear due to other pathological processes body. Doctors consider the disease not too dangerous for human health, but it provokes severe pain, which interferes with leading a normal, quiet life. To cure neuralgia, you need symptomatic treatment and therapy that eliminates the cause of the disease.

What is intercostal neuralgia

Intercostal neuralgia (another name is thoracalgia) is pinching, irritation or compression of the spinal nerve. Due to the nature of the pain (on the left, in the heart area or under the heart), during the first attacks, many patients confuse the disease with cardiovascular pathologies, for example, a heart attack. It is also important to differentiate intercostal neuralgia from stomach pain, renal colic. From heart attack The pathology is different in that it does not change blood pressure or pulse, and nitroglycerin does not help relieve symptoms. The pain intensifies with movement.

Pain with intercostal neuralgia can occur in different parts of the patient’s body near the spine: throughout the chest, on the right or left side of the back, under the shoulder blades. Often painful sensations are encircling in nature. As a rule, intercostal neuralgia develops due to the course of other diseases of the spine: osteochondrosis, scoliosis, tumors and incorrect position vertebrae In addition, the disease can be caused by the following factors:

• Long-term exposure to low temperatures.
• Inflammatory diseases.
• Injuries to the ribs, chest, spine.
• Tumors localized in spinal cord.
• Poisoning of the body.
• Nerve damage.
• Spondylitis, kyphosis, other diseases of the spine.
• Diabetes.
• Age-related changes.
• Severe strain in the back muscles.
• Fatigue, stress.
• Herpes.
• Pleurisy.
• Pathological changes in the chest.
• Rib diseases.
• Aortic aneurysm.
• Hormonal changes.
• Rapid growth (in children).
• Climacteric, post-menopausal period (in women).

You should not independently diagnose intercostal neuralgia when similar symptoms appear and begin treatment, because it may hide a serious disease in which it is necessary urgent intervention doctor Methods for diagnosing the disease include examination of the patient, tests and examination with special devices. How to determine the presence of intercostal neuralgia:

• Ultrasound. Not the main method of examination for intercostal neuralgia (due to high density bone tissue).
• X-ray. Helps to see abnormalities in the structure of a person’s bones.
• CT scan. The tomogram will show bone and soft tissue.
• Myelography. When examined in spinal canal a contrast agent is injected, with which you can see changes in soft tissues due to the disease.
• Contrasting discography. A contrast agent is injected into the area of ​​the intervertebral disc.
• MRI. Allows you to fully examine the structure of damaged tissue or bone structures.
• Electrospondylography. Helps identify pathology initial stage occurrence.

Women who are pregnant and breastfeeding require a particularly careful approach to therapy after diagnosis of the disease, because many medications are contraindicated for them. Intercostal neuralgia can occur due to severe stress on the back. If the pain is tolerable, women should be prescribed physical therapy, yoga or other exercise to relieve acute symptoms of the disease.

Symptoms and signs of the disease

The nerves of the spine have large branches, so when they are damaged, the pain often imitates cardiovascular diseases. For example, there may be unpleasant sensations in the thoracic region on the left, radiating to the scapula. In the treatment of left intercostal neuralgia, unlike heart diseases, sedatives such as Corvalol, Validol help. The frequency of pain attacks is significantly reduced when taking them. Painful sensations may become stronger during turns, inhalations, changes in body position, when sudden movements.

The pain associated with intercostal neuralgia can be dull, sharp, burning, or paroxysmal. It can last from several minutes to several days, and often goes away after sleeping in a comfortable position. In addition, the disease is accompanied by: numbness of the affected areas, muscle tension, convulsions, increased sweating, a feeling of “crawling goosebumps” on the skin, sleep disturbance, tearfulness. Intercostal neuralgia increases after physical exercise or loads.

Methods for treating the disease at home

Treatment of intercostal neuralgia at home is carried out different methods. The main task in acute period diseases - to relieve pain, which can be extremely painful for the patient. Along with taking painkillers, it is necessary to influence the cause of the pathology and carry out appropriate therapy.

Modern treatment back pain has long gone away easy fix unpleasant sensations. It is important to treat not the manifestations, but their cause. An example of such an integrated approach is the addition of NSAIDs with neurotropic vitamins (B1, B6, B12). B vitamins not only help eliminate pain faster than when taking NSAIDs alone (for example, diclofenac sodium), but also have a beneficial effect on physiological processes in the nerve fiber, stimulate nutrition and restoration of the structure of the nervous tissue. Thus, the optimal addition to NSAIDs is the drug Neuromultivit in injections, which includes three vitamins B1, B6, B12 in therapeutic dosages. The use of neurotropic vitamins in high therapeutic doses allows you to consolidate the analgesic effect, promotes recovery nerve fiber, thanks to which it is possible to achieve long-term remission of pain. Treatment with the drug begins with daily injections for 5-10 days, then switches to maintenance administration, 2-3 injections per week for two to three weeks.

To reduce pain, doctors recommend wearing a corset that supports the spine and relieves stress on the nerves. In addition, dry heat helps to cope with pain, which does not harm the body - this method is suitable for pregnant women who do not resort to treatment with pills. To prevent attacks, doctors advise patients to sit less and not take awkward positions, sleep on a flat surface, avoid heavy physical activity as much as possible, but moderate exercise, on the contrary, should be made part of the daily routine.

Drug treatment

Drug treatment will help the patient quickly relieve excruciating pain. To get rid of intercostal neuralgia with the help of medications, therapy is approached in a comprehensive manner: analgesics, anti-inflammatory drugs, and muscle relaxants are prescribed. How to treat intercostal neuralgia with medications:

• Relieve pain. Drugs such as ibuprofen, diclofenac, and ketoprofen help with this. These are non-steroidal anti-inflammatory drugs that quickly eliminate the symptom of intercostal neuralgia, but they should not be taken by people who have problems with the gastrointestinal tract. In this case, the tablets Movalis, Sedalgin, Panadol, Pentalgin, Baralgetas will help. It is advisable to take the pill immediately after the onset of symptoms of the disease - so an attack it will go faster.
• Make a blockade. This is necessary when the patient has severe pain from a disease for which conventional pills do not help. Then they give injections of novocaine, lidocaine, hydrocortisone or diclofenac.
• Use pepper patch. It will help relieve pain from intercostal neuralgia for several days.
• Eliminate back muscle spasm. Drugs from the group of muscle relaxants will help with this: Tizanidine, Mydocalm, Clonazepam.
• Get rid of numbness. B vitamins often help restore the structure of nerves.
• Apply ointment. There are drugs with a pronounced analgesic effect, for example, Finalgon, Fastum-gel. Improve blood circulation, metabolic processes products such as Apisatron, Viproxal will help the skin. Chondroxide ointment will help correct the mobility of the spine with intercostal neuralgia.

Treatment of neuralgia with cupping

Cupping massage is effective procedure, helping to get rid of intercostal neuralgia together with medicines. This method improves lymphatic drainage, blood circulation, and promotes tissue regeneration. Before performing a massage, a person must thoroughly clean the areas of the skin where the cups will be placed. Next, its surface is lubricated with heated oil - eucalyptus or olive. When attaching the cans, the method of igniting the cotton wool inside, and then placing them on the back, or the mechanical method of removing air (in modern cans) can be used.

When doing a cupping massage at home for intercostal neuralgia, you need to remember that the devices should only slightly absorb the skin, lifting it no more than one and a half centimeters. After attaching the can, begin the massage: to influence the back, you need to move the device from bottom to top, as you go lymphatic vessels. You should not place jars on the spine itself. If performed correctly, the procedure will not cause pain to the patient, and the effect of treating the disease will not take long to arrive.

Physiotherapy and exercise therapy

Physiotherapeutic methods are no less effective than treatment medications. To get rid of neuralgia, doctors prescribe dynamic current to the patient, along with which therapeutic agents are introduced into the body. Intercostal neuralgia is also treated with ultrasound, which provides micromassage to the affected areas. So that the patient can painlessly cope with the disease, treatment with paraffin, mud, and ozokerite is prescribed. Medical Physical Culture will help the patient strengthen the back muscles, thereby relieving the load on the spine and coping with the pressure on the affected nerve.

Acupuncture

Acupuncture (acupuncture) is an ancient method of treating diseases, including neuralgia. During it, biologically active points are pierced with special, thinnest needles. Impact on certain areas with the help of these devices improves blood flow, metabolic processes, relieves pain, and eliminates muscle imbalance during exacerbation. For neuralgia, doctors usually prescribe two or three courses of acupuncture (one course is about ten procedures, but depends on the severity of the disease). To achieve the desired effect, take a break of two months.

Acupressure

Acupressure is a treatment method for alternative medicine, which, however, has been proving its effectiveness in the treatment of intercostal neuralgia for many years. The essence of the method is to influence biologically active points associated with certain organs. The methods of influence are different: light stroking or touching points, pressure with a finger or palm, strong deep pressure (can be done either with a finger or with special devices, grains, matches).

Pressing and stroking should be carried out perpendicular to the surface of the skin. If this is stroking, it should be continuous and performed at the same pace from the beginning to the end of the procedure. For intercostal neuralgia, as a rule, about 10-15 procedures are needed to significantly reduce pain. The patient can do the massage independently after consultation with a professional. Diagram of the location of some points from intercostal neuralgia in the photo:

Folk remedies for pain relief

1. Indoor geranium. Tear off a leaf from the plant, rub it on the areas affected by pain, wrap yourself in a woolen blanket or scarf - this will help reduce pain in the area of ​​intercostal neuralgia.
2. Product with beeswax, honey, onion. To prepare the ointment, mix onion juice, white lily bulb juice, a little honey and beeswax. Apply the mixture to the sore area, wrap yourself well to provide warmth, and go to bed.
3. Mumiyo with propolis. These remedies have long been known for the treatment of intercostal neuralgia. Their joint use provides restoration of affected tissues, removal inflammatory processes. To enhance the effect, the mixture is used not only externally, but also taken internally.
4. Yarrow. To prepare an infusion with this plant, pour a glass of boiling water over a large spoon of the herb and leave for an hour, wrapped in a towel or blanket. Strain the resulting solution. When it cools down, take a tablespoon three times a day to relieve pain from intercostal neuralgia.
5. Turpentine with Vaseline. Mix the products in a ratio of one to two, rub into the affected areas. Over time, intercostal neuralgia will subside.

Video: how to recognize and treat intercostal neuralgia

It is extremely important to correctly recognize intercostal neuralgia so as not to confuse it with heart disease, stomach disease, kidney disease, or a heart attack. When the nerve is first damaged, people may panic, not understanding what is happening. The leading cardiologist talks in detail about the signs of intercostal neuralgia, which is characterized by a specific area of ​​pain, its aching or stabbing nature, shortness of breath, worsening with inspiration, and helps to understand how it differs from heart disease. Watch the video, which will help you recognize pathologies and tell you how to treat neuralgia.