If the chest pain episodes are short and sting like lightning, most are not angina and are probably intercostal neuralgia. So what is the cause of chest lightning pain? Intercostal neuralgia is divided into secondary and primary, and can be secondary to radicular intercostal neuralgia from diseases such as thoracic spine degeneration, thoracic spine tuberculosis, thoracic spine injury, thoracic spine duralgia, tumor, ankylosing spondylitis, etc.; dry intercostal neuralgia can be secondary to rib, mediastinal or pleural lesions. Primary intercostal neuralgia is rare.