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Intercostal Neuralgia/Post Thoracotomy Pain

Intercostal neuralgia is caused by inflammation, damage or compression to the intercostal nerves. These nerves lie between each of the twelve ribs. Post-thoracotomy pain is felt in the back and chest region following surgery in the chest. As much as 50 percent of patients may experience persistent pain following a thoracotomy, and as much as 30 percent of patients may continue to experience the pain for four to five years after the surgery or even permanently.

Post-thoracotomy pain syndrome (PTPS) is most likely felt to be a combination of damage to the intercostal nerves that unfortunately, may not be avoidable, as well as damage to the muscles between the ribs.


Intercostal neuralgia is described as pain that wraps around your chest, sometimes described as a band radiating from the back of the body to the front chest or upper abdomen. The pain may be described as burning, spasm-like, aching, gnawing and stabbing.  The pain may worsen with sudden movements of the chest such as laughing, coughing or taking deep breaths with exertion.

In patients who had a thoracotomy surgery, they may experience pain that radiates along the rib cage or just experience persistent pain along the incision site. The description of the pain is similar, and it may be severe and debilitating.


The cause of intercostal neuralgia is related to irritation to the intercostal nerves. This can be related to compression of the nerves, muscles and ligaments via trauma or scar tissue, or a direct injury to the area from surgery. Other causes include inflammation of the intercostal nerves associated with an outbreak of shingles, tumor, or radiation for the treatment of some cancers.

Which patients go on to develop persistent pain following a thoracotomy is unclear. Research is being done to look at different surgical approaches and different pain treatment plans prior to, during, and after a thoracotomy to see whether it will help reduce the incidence of PTPS.


Sometimes the pain associated with intercostal neuralgia or post-thoracotomy pain syndrome will prompt your physician to refer you to a pain specialist. On your initial visit to Center for Pain Management, you and your doctor will carefully craft a treatment plan. This plan will depend on your specific symptoms and a complete examination. On initial examination, a thorough history and physical exam will allow us to tailor a plan of care unique to your symptoms. Your customized treatment plan may involve a combination of medications and injection therapy.

You may be prescribed a combination of medications to include nerve-stabilizing medications (anti-convulsants), anti-depressants which also work to stabilize the nerve, nonsteroidal anti-inflammatories, and topical patches and creams. Your doctor may also suggest administration of a nerve block to help alleviate some of the pain. If the pain persists, despite the initial treatment options, your provider may suggest a spinal cord stimulator trial or a peripheral nerve stimulator trial.