Intercostal neuralgia is a group of symptoms in which the thoracic nerve root (i.e., intercostal nerve) is damaged due to different causes, such as: thoracic spine degeneration, thoracic spine tuberculosis, thoracic spine injury, thoracic spine duralgia, tumor, ankylosing spondylitis and other diseases or rib, mediastinal and pleural lesions, and the intercostal nerve is compressed and stimulated by the above diseases, and an inflammatory response occurs, resulting in a syndrome of band-like pain in the chest intercostal space or abdomen.
Basic overview
Intercostal neuralgia is a frequent pain in one or several intercostal areas with episodes of exacerbation. Primary intercostal neuralgia is rare, and secondary cases are usually associated with viral infection, toxin stimulation, mechanical injury, and foreign body compression. The pain is mostly stabbing or burning in nature and is distributed along the intercostal nerves. Intercostal neuralgia is a frequent pain in the area innervated by one or several intercostal nerves. It is one of the common causes of chest pain in the elderly.
We know that there are 12 pairs of intercostal nerves, which emanate from the thoracic medulla and then unite through the anterior and posterior roots. The thoracic nerve is divided into anterior, posterior, spinal and communicating branches. The anterior branch is located between the medial and lateral intercostal muscles and is called the intercostal nerve and travels beneath the intercostal artery. Secondary intercostal neuralgia is usually seen clinically, while primary intercostal neuralgia is less common.
Secondary intercostal neuralgia is caused by lesions of adjacent organs and tissues, such as lesions of thoracic organs (pleurisy, chronic lung inflammation, aortic aneurysm, etc.), injuries to the spine and ribs, age-related spinal osteoarthritis, deformities of the spine in thoracic vertebral segments, and spinal cord tumors in thoracic vertebral segments, especially extramedullary tumors, which often compress nerve roots and have symptoms of intercostal neuralgia. There is also an intercostal neuritis caused by the herpes zoster virus, which can also present with intercostal neuralgia.
Intercostal neuralgia is mainly a frequent pain in one or several intercostal areas, which is sometimes exacerbated by episodes, sometimes provoked by breathing movements, and worsened by coughing and sneezing. When the pain is severe, it may radiate to the ipsilateral shoulder or back, sometimes in a band-like distribution. On examination, sensory hypersensitivity in the corresponding skin area and pressure pain at the corresponding rib margins can be found, especially in the back, lateral thoracic wall, and anterior thoracic penetration after the intercostal nerve penetrates the intervertebral foramen. In some patients, signs and symptoms of various primary lesions may be observed.
In addition, intercostal neuralgia due to herpes zoster viral neuritis refers to the invasion of the skin and dorsal root ganglia by the herpes virus, producing clusters of blisters and papules on the skin in its innervation zone, with blisters being the most common, arranged in a band according to the distribution of the intercostal nerves, and accompanied by neuralgia in one or several adjacent intercostal nerve distribution zones. The onset of the disease is characterized by prodromal symptoms such as low-grade fever, fatigue, and loss of appetite, followed by localized sensory hypersensitivity, burning sensation, or deep pain in the chest and abdominal wall of varying degrees.
The treatment of secondary intercostal neuralgia depends on the cause. Primary intercostal neuralgia can be treated according to the general treatment of neuralgia, such as the use of various analgesics and physical therapy. When this is not effective, intercostal nerve root closure can be considered. For herpes zoster skin damage can be used externally to protect the dry agent, such as camphor puff powder, furnace glycolic lotion or gentian violet solution, 5% andrographis tincture topical also has anti-inflammatory and analgesic effect; appropriate use of vitamin B1, B12 and adrenal corticosteroids often have good results.
Pathogenesis
The intercostal nerves emanate from the thoracic medulla and are formed by the union of anterior and posterior roots. There are 12 pairs, and the thoracic nerve is divided into anterior, posterior, spinal and communicating branches. The anterior branch is located between the medial and lateral intercostal muscles and is called the intercostal nerve, which travels beneath the intercostal artery. Intercostal neuralgia is actually just the name of a symptom that refers to frequent pain in the innervation area of one or several intercostal nerves. It is a common cause of chest pain in middle-aged and elderly people.
The symptoms of intercostal neuralgia arise in both primary and secondary forms, and secondary intercostal neuralgia is usually seen clinically, while primary intercostal neuralgia is less common. Secondary intercostal neuralgia is caused by lesions of adjacent organs and tissues, such as lesions of thoracic organs (pleurisy, chronic lung inflammation, aortic aneurysm, etc.), injuries to the spine and ribs, age-related spinal osteoarthritis, deformities of the spine in thoracic vertebral segments, and spinal cord tumors in thoracic vertebral segments, especially extramedullary tumors, which often compress nerve roots and have symptoms of intercostal neuralgia. There is also an intercostal neuritis caused by the herpes zoster virus, which can also present with intercostal neuralgia.
Intercostal neuralgia is mainly a frequent pain in one or several intercostal areas, which is sometimes exacerbated by episodes, sometimes provoked by breathing movements, and worsened by coughing or sneezing. When the pain is severe, it may radiate to the ipsilateral shoulder or back, sometimes in a band-like distribution. On examination, sensory hypersensitivity in the corresponding skin area and pressure pain at the corresponding rib margins can be found, especially in the back, lateral thoracic wall, and anterior thoracic penetration after the intercostal nerve penetrates the intervertebral foramen. In some patients, signs and symptoms of various primary lesions may be observed.
In addition, intercostal neuralgia due to herpes zoster viral neuritis refers to the invasion of the skin and dorsal root ganglia by the herpes virus, producing clusters of blisters and papules on the skin in its innervation zone, with blisters being the most common, arranged in a band according to the distribution of the intercostal nerves, and accompanied by neuralgia in one or several adjacent intercostal nerve distribution zones. The onset of the disease is characterized by prodromal symptoms such as low-grade fever, fatigue, and loss of appetite, followed by local sensory sensitization, burning sensation, or deep pain in the chest and abdominal wall of varying degrees.
Symptoms
There are two types of intercostal neuralgia, secondary and primary. Radicular intercostal neuralgia can be secondary to diseases such as thoracic spine degeneration, thoracic spine tuberculosis, thoracic spine injury, thoracic duralgia, tumors, and ankylosing spondylitis; dry intercostal neuralgia can be secondary to rib, mediastinal, or pleural lesions. Primary intercostal neuralgia is rare.
At the onset of intercostal neuralgia, the pain is seen to radiate in a semicircular pattern from posterior to anterior along the corresponding intercostal space; the pain is stabbing or burning. The pain increases with coughing, deep breathing or sneezing. The pain mostly occurs in one nerve on one side. Physical examination reveals significant pressure pain next to the spinous process of the thoracic spine and in the intercostal space; typical patients with radicular intercostal neuralgia have a positive flexion test; the distribution area of the affected nerve often shows neurological impairment such as sensory hypersensitivity or hypoesthesia.
Treatment and prevention
Treatment should clarify the primary lesion and use appropriate treatment methods. Drugs, physiotherapy, acupuncture, tui-na, etc. can be used.
I. Body acupuncture
1.Acupuncture points
Main acupoints: Shouhai, Qiuhui, Quchi.
Matching points: Zhigou, Yanglingquan, Hua Tuo (the corresponding segment of the lesion), Ligou.
2. Treatment
Take only one main point at a time, and add supporting points if the effect is not obvious. Shining sea, take both sides, with inspiration into the needle 1 inch to 1.5 inches, repeated twisting combined with lifting and inserting, for 3 minutes to 5 minutes, apply the diarrhea method, retain the needle for 15 minutes. Qiu Hui acupuncture point, should be taken from the left side of the disease, the right side of the disease, the left side of the disease, the same acupuncture method as Shou Hai. Quchi, take the point on the healthy side, after the needle has obtained the qi, twist with a small amplitude and high frequency, while asking the patient to take deep breaths and massage the affected area. Retain the needle for 15 minutes. Huatuo pinch spine, deep stabbing so that the needle sensation radiates along the intercostal nerve, taking only the affected side of the point, applying the method of flattening and flattening the diarrhea, the remaining points are taken bilaterally, with the same acupuncture method as Shiaohai. Daily l-2 times.
3.Efficacy of treatment
Efficacy assessment criteria: cured: pain completely disappeared; effective: pain reduction by two-thirds; improved: pain reduction by one-third to one-half; invalid: pain is not obvious.
II. Skin acupuncture
1. Acupuncture points
Main acupoints: Huatuo Pinnacle Point and the back circulation line of the bladder meridian.
Matching points: the rib space in the lesion area, and the wakefulness circulation of the bile meridian.
2. Treatment method
After routine disinfection, the patient is then treated by repeatedly tapping and stabbing with moderate intensity for 5 times from neck 7 to neck 8 of the Hua Tuo Pinnacle Point and from Da Loom to Guan Yuan Yu of the Bladder Meridian, and then cupping and draining the jar with the flash fire method for 10 minutes. Then the patient was made to lie on his side with the affected part facing upward, and the patient was tapped 5 times along the intercostal space of the lesion area and along the circumferential section of the bile meridian. The patient was then cupped on his side, with the affected area facing upward, and tapped 5 times along the rib space of the lesion area and the wakeful section of the bile meridian. Medium-intensity techniques were used. After tapping, cupping was performed for 10 minutes on the most obvious area of pain. Once a day, 10 times for a course of treatment.
C. Cupping
1.Acupuncture points
Main acupuncture point: A-Yi point.
Supporting points: Neiguan and Yanglingquan.
Location of the A-Yi point: the most obvious place of pain.
2.Treatment
Make the patient lie on his back, first take the supporting points for acupuncture, twist the needle into the method of acupuncture Nei Guan, wait for the sensation and then use the lifting method to increase the amount of stimulation, so that the needle sensation radiates to the upper arm. At the same time, the patient takes a deep breath and deeply stabs Yanglingquan and penetrates straight to Yinlingquan. When there is induction, use the twisting method to increase the amount of stimulation, so that the needle sensation reaches up and down. The needles are left in place for 30 to 50 minutes, with needles performed every 5 minutes. Then, after routine disinfection, take the skin needle at the most obvious point of pain, tap from light to heavy, tap until the skin is red, and absorb it with flash fire or cast fire, or use a vacuum cupping device to suck and cupping. Leave the jar for 10 to 15 minutes, and remove the jar when the skin stasis is purplish red. Treatment every other day, 6 times for a course of treatment, the course of treatment interval of 3 days ~ 5 days.
IV. Electroacupuncture
1.Acupuncture points
Main acupuncture points: Zhimen, Zhigou, Yanglingquan, and Shusanli.
Supporting points: Tai Chong, Zhiyang, Liver Yu, Kidney Yu, Xingma, Qiushu.
2.Treatment
Take two to three main points and one to two supporting points. After obtaining the qi, apply the twisting technique, first tonic and then diarrhea, and run the needle for 10 minutes, then pass the electric needle, with the negative pole connected to the main point and the positive pole connected to the matching point. Use dense or sparse waves, as strong as the patient can tolerate, and energize for 5 to 20 minutes. 1 time daily.