What intercostal neuralgia is
Hull University Teaching Hospitals NHS Trust explains that all the ribs have nerves, called intercostal nerves, that run just underneath them from the spine at the back to the breastbone at the front. The 2026 review in the Journal of Thoracic Disease describes intercostal neuralgia as a neuropathic (nerve) pain syndrome along the path of these nerves, which supply the chest wall and upper abdomen.
The review notes that intercostal neuralgia is a poorly defined condition with many causes, better understood as a group of related problems that share the same nerves and type of pain. It is different from a muscle injury between the ribs; see our guide to intercostal muscle strain.
Symptoms
The review describes pain that is persistent or comes in attacks, felt as shooting, burning or aching, in one or more spaces between the ribs. It is often made worse by movements of the chest, such as deep breathing, coughing or twisting the trunk.
Sensory changes are common: numbness, increased sensitivity of the skin, or pain from a light touch that would not normally hurt. Hull NHS explains that it usually affects a localised area of the chest wall. The review notes that chronic pain can disturb sleep, work and daily activities.
Causes: shingles, surgery and injury
Hull NHS notes that localised chest wall nerve pain can occur after shingles or around a scar from chest surgery. The review lists the most common causes as pain after chest surgery and nerve pain after shingles (postherpetic neuralgia).
Other causes include rib fractures and other injuries, chest tubes, breast surgery, osteoporotic fractures of the spine in older adults, nerve compression, pregnancy, inflammation, infection and, rarely, tumours. The review reports that it is more common in middle-aged and older adults.
When chest pain is an emergency
Chest pain can come from the heart, lungs or other organs, which can be life-threatening. Sudden, severe or crushing chest pain, pain with breathlessness, sweating, nausea or feeling faint, or chest pain after an injury needs emergency care before anything else.
Hull NHS also warns that a sharp, severe pain that is worse on breathing in, with breathlessness, after a nerve block may mean a punctured lung (pneumothorax) and needs immediate medical help. Tenderness when pressing the chest does not on its own rule out a serious cause.
Other causes of rib pain to rule out
Several conditions cause pain around the ribs. Muscle injuries, inflammation of the cartilage joining the ribs to the breastbone and problems where the ribs meet the spine can all cause chest wall pain. The review notes that pain on the opposite side when bending sideways may suggest a problem in the lining of the lungs rather than the nerve.
Our guides to costochondritis, intercostal muscle strain and back rib pain describe these alternatives. Only a doctor can tell them apart after examination and, if needed, tests.
Diagnosis
The review explains that intercostal neuralgia is mainly a clinical diagnosis, based on a history of nerve-type pain along one or more intercostal nerves and an examination. The doctor looks for tenderness along the space between the ribs, changes in sensation, scars from surgery or injury and, after shingles, skin marks.
There are no universally accepted diagnostic criteria. A targeted nerve block, in which temporary pain relief after the injection suggests the nerve is the source, is a key test. Hull NHS explains that a block may be a test to find the source of pain and to relieve it. The review adds that specialised MRI of the nerves and nerve conduction studies may help in some cases.
Medicines for nerve pain
The review describes a stepwise approach based on the treatment of nerve pain. The first step is usually a medicine from one of the classes used for neuropathic pain, such as certain anticonvulsants or antidepressants used at pain-relieving doses, started low and increased slowly according to other conditions and tolerance.
Medicated skin patches may be used alongside or, for older people or those taking many medicines, as a first option. The review notes that all medicines can cause side effects, such as drowsiness, dizziness or constipation. Medicines are chosen and adjusted by your doctor; do not start or stop them on your own.
Nerve blocks and other procedures
If medicines do not control the pain, the review describes interventional treatments as the next step. Hull NHS explains that an intercostal nerve block is an injection of local anaesthetic, with or without steroid, around the nerve, guided by X-ray or ultrasound. Some people get relief that wears off after a couple of months, others get complete relief, and for some the pain does not improve or gets worse.
Risks are usually minor, such as bruising, but include a small chance of puncturing the lung, rare infection and very rare nerve injury. The review describes other options for selected people, such as freezing the nerve (cryoneurolysis) or longer-lasting nerve blocks, and notes that manual therapy may help when the joints between ribs and spine contribute.
Where the sources differ
Hull NHS (February 2026) focuses on the nerve block procedure: what it involves, its risks and what to expect. The 2026 review, written from a plastic surgery perspective, covers diagnosis and the full range of treatments, and argues that surgery may give more lasting relief in cases that do not respond to other treatment. However, it acknowledges that the evidence comes from small studies without direct comparisons, and that surgery can cause loss of sensation and other complications. This guide presents surgery only as a rare option for selected cases, decided by specialists.
Treatment of intercostal neuralgia is medical. Once a doctor has made the diagnosis, our physiotherapy practice in Bilbao can support adults with mobility and posture as part of the plan (consultations are in Spanish).
In summary
Intercostal neuralgia is nerve pain along the ribs, usually after chest surgery, shingles or injury. It causes sharp, burning or shooting pain, often worse with breathing or twisting, and is diagnosed clinically, sometimes with a test nerve block. Treatment moves step by step from medicines to procedures, with surgery reserved for rare cases. New chest pain always needs medical assessment first.
Hull NHS asks patients to keep a pain diary after a nerve block. A diary before your appointment is also useful: note where the pain is, what it feels like, what triggers it (breathing, coughing, twisting, touch), its intensity from 0 to 10, any surgery, shingles or injury beforehand, the medicines you have tried and their effects. Bring it to your doctor.
Frequently asked questions about intercostal neuralgia
These answers are general information and do not replace an examination or individual medical advice.
What is intercostal neuralgia?
Nerve pain along the intercostal nerves, which run under the ribs from the spine to the breastbone.
What does intercostal neuralgia feel like?
Sharp, burning or shooting pain along one or more ribs, often worse with deep breaths, coughing or twisting, sometimes with numbness or skin sensitivity.
What causes intercostal neuralgia?
Most often chest surgery or shingles. Rib fractures, chest tubes, breast surgery, spinal fractures and nerve compression are other causes.
How is it diagnosed?
By a doctor, from your history and examination after ruling out other causes. A nerve block may be used as a test.
How is intercostal neuralgia treated?
Step by step: medicines for nerve pain, then procedures such as nerve blocks, and surgery only in rare cases that do not respond.
How long does it last?
It varies. Some people improve over time, while others develop chronic pain that needs ongoing treatment.
Sources
- Hull University Teaching Hospitals NHS Trust · Intercostal nerve block for pain relief
- Shamoun V, et al. When all else fails: a narrative review of surgical options for intercostal neuralgia. Journal of Thoracic Disease, 2026 (doi:10.21037/jtd-2026-1171)
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.