The intercostal nerves are located in the intercostal groove that spans the length of the interior of each rib bone. There are 11 intercostal nerves, and each nerve branches out from the spinal cord and wraps around the front of the ribcage. These nerves are responsible for supplying sensation to the skin above the rib cage and part of the abdomen. Inflammation or compression of these nerves can cause severe chest pain over time.
Treatment for irritated intercostal nerves often begins with simple at-home remedies. A cold pack placed over the painful area in 15 minute intervals may numb the pain and reduce inflammation in the nerves and surrounding tissues. An over-the-counter pain reliever can be taken to reduce some painful sensations. Severe pain that has not responded to any home treatment may need to be evaluated and treated by a physician.
Intercostal nerve syndrome occurs when the nerves that are normally wedged in between the ribs are somehow compressed by the abdominal muscles. This condition may be caused by trauma to the thoracic cage or be due to pregnancy-related body changes. The pain may spontaneously subside or eventually require medical treatment.
A nerve block may be recommended after a person has experienced persistent pain in the chest wall. A mixture of an anesthetic and a steroid are injected into the area closest to the painful nerve. The anesthetic prevents pain signals from being transmitted to the brain. Administering a steroid with the anesthetic decreases the inflammation present in the surrounding tissue in addition to numbing the nerves. A reduction in inflammation can result in less pain over time.
A procedure to destroy the intercostal nerve fibers may be necessary if the nerve block is not relieving the pain. The doctor may recommend intercostal nerve cryoablation after other less invasive treatment methods have failed. Nerve cryoablation is usually an outpatient process, and most people are able to return to light activity the following day.
During the cryoablation procedure, a needle is inserted through the skin into the space between the ribs near the painful nerve. A small amount of gas is released and forms tiny ice balls, exposing the nerve fibers to the extremely cold temperature causing rapid cell death. The doctor may use an ultrasound image to pinpoint the exact location of the nerve behind the intercostal groove. Using ultrasound imaging during the cryoablation produces more accurate results and lasting pain relief.