Intercostal neuralgia

For a lay person:

Intercostal neuralgia is nerve pain along one of the nerves that run between the ribs. It causes sharp, burning or stabbing pain that wraps around the chest or upper abdomen, often worse with deep breaths, coughing or movement. It can follow shingles, chest surgery or rib injury, or occur without a clear cause.

For a trained medical person:

Neuropathic pain in the distribution of an intercostal nerve, caused by herpes zoster, thoracotomy or other surgery, trauma, rib or spinal pathology, or tumour. Diagnosis is clinical, after excluding cardiac, pulmonary and abdominal causes of chest pain, with imaging if a structural cause is suspected. Management treats the cause and uses neuropathic agents such as gabapentinoids or tricyclics, topical treatments, and intercostal nerve block for refractory pain.

In Chinese medicine:

Liu and Tseng's textbook differentiates this condition into these patterns: Liver Qi Stagnation; Blood Stasis Leading to Stagnation; Qi Stagnation and Blood Stasis; Liver and Gallbladder Damp-Heat; Liver and Kidney Yin Deficiency. Treatment follows the pattern a patient presents with, not the Western diagnosis alone.

When to get help: Chest pain can be a heart attack: call emergency services for chest pain with breathlessness, sweating, nausea or pain spreading to the arm, jaw or back. See a doctor for a new rash with band-like pain, which may be shingles and benefits from early antiviral treatment.