In case of intercostal pain it is necessary to analyze its characteristics, such as duration and intensity, to identify the cause.
Although often used as a diagnostic definition, the term “intercostal pain” is somewhat vague. A bit like talking about a cold, a condition characterized by numerous symptoms, not all necessarily limited to the nasal district.
Intercostal pain, in fact, is a chest pain that, in addition to lending itself to errors or inaccuracies of localization, can affect multiple structures (bones, muscles, ligaments, nerves), be caused by various causes and occur at different times: at rest, during breathing or with movement.
How to find out the cause
First of all, it is good to evaluate the patient’s clinical history (previous surgery, cardiopulmonary diseases, trauma), in particular the recent one, paying attention to acute events and the rapidity of onset of pain itself. For example, the appearance after a fall or as a result of intense sports or motor activity (including physical efforts made in the home or professional) leads respectively towards a possible fracture / crack / rib contusion or towards a muscle stretch.
An easily diagnosable sudden episode is pneumothorax, which can occur not only as a result of trauma piercing the pleura (often the rupture of a vesicle or bubble in elderly patients with chronic obstructive pulmonary disease) but also spontaneously in some predisposed individuals (especially young ones). Pneumothorax manifests itself with pain and especially with the failure to expand the affected half of the chest, due to collapse of the lung.
On the other hand, the case of an individual smoker or suffering from a respiratory infection and / or cough is very different, in which an intercostal pain suggests a possible complication of the lower airways. An example of these complications is pneumonia, or the infection of the cavities (alveoli) and lung tissues that occurs with wheezing, chills, fever and cold, and pleurisy, an inflammation (mostly of viral origin) of the membrane that covers the lungs (the pleura), which causes pain during breathing and coughing.
It must also be remembered that osteoarthritis (a degenerative joint disease) can also affect the joints between the ribs and sternum and that the costal cartilages can undergo inflammation (in this case we speak of costochondritis).
Other causes of intercostal pain can be a herpetic neuralgia (a viral infection), confirmed by the varicelliform rash typical of herpes zoster, or a herniated disc, which with its compressive effect on the spinal root can evoke a pain that radiates horizontally, associating with back pain.
Not to be confused with intercostal pain
A necessary clarification concerns two situations that should not be confused with intercostal pain: angina pectoris and gastroesophageal reflux.
Let’s see, then, what they are due to and how they manifest themselves.
The first is a clinical syndrome, typically triggered by physical effort or psychological stress, which manifests itself with a slightly annoying pain, but capable of evolving, in a short time, into a serious sense of tightness of the ribcage. Once onset, then, the pain radiates to the left shoulder, arm and fingers, and goes up along the back until it reaches the throat, jaw and teeth. Often, people who suffer from it provide an inaccurate description, which can be misleading for the specialist who is responsible for making the diagnosis. For this reason, the doctor, after evaluating the symptoms, prescribes an electrocardiogram, sometimes associated with a stress test, or diagnostic imaging tests (echocardiography, scintigraphy or magnetic resonance imaging).
The second, however, is a pathological condition that manifests itself with a pain localized in the central part of the chest or in the upper back, sometimes associated with burning under the sternum (described as heartburn), sore throat, cough or hoarseness. Unlike in the case of cardiovascular disease, however, the diagnosis is simpler if complete symptoms are found. If in doubt, specific tests may be necessary, such as endoscopic examination of the esophagus and biopsy of a sample of parietal tissue (taken during exploration).
| Causes | Events | |
|---|---|---|
| Angina | Sudden reduction of cardiac circulation which, although not causing a heart attack, is an important warning light | Pain similar to a stylized, occurs during physical activity intense and leads the individual to stop instinctively, waiting for the its resolution |
| Gastroesophageal reflux | Ascent of acidic material from the stomach into the esophagus | Burning behind the sternum, usually in the digestive phase and more frequently in the evening hours |
How to alleviate it
Rest and anti-inflammatories are indicated in acute forms of mild or uncomplicated, while the suspicion or presence of other diseases may require the execution of targeted diagnostic investigations (for example blood tests, radiography, tomography or magnetic resonance imaging) and the consequent use of analgesics and specific treatments.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
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