Intercostal Neuralgia/Chest wall pain

Pain can come from the rib cage be coming from several sources. When pain arises from the nerves in the chest, it typically comes from the intercostal nerves. The intercostal nerves arise from the spinal cord and lie under the rib, along with the vein and artery. These nerves innervate the muscles of the rib cage and the skin and chest cavity. The intercostals nerves can be injured in from surgery or trauma, viral infections such as shingles, or idiopathic (no identifiable cause).


The appropriate location in the rib cage is located under fluoroscopy (real time x-ray). An IV is usually placed pre procedure and a light anesthetic (twilight) is optional for the procedure.

A small needle (25g) is advanced carefully to the inferior border of the rib. The needle is then walked off the rib to lie immediately below the rib. A small amount of contast material is then injected and the nerve should be outlined. A small amount of local anesthetic and steroid is then injected to block and treat the nerve. If the pain recurs, there are other procedures that can be considered for longer term relief such as a pulsed radiofrequency ablation of the nerve root or spinal cord stimulation to control the pain.

The procedure is not very painful. There is a small risk of pneumothorax (puncture of the lung) with this procedure and systemic absorption of the local anesthetic, which is real and must be taken into consideration when deciding whether or not to proceed with the injection.

If you suffer from chronic chest wall pain or know someone that does please feel free to consult our physicians at the The Spine and Pain Institute of New York. Our offices are located at 860 Fifth Ave., New York, NY and 2348 Richmond Road, Staten Island, NY 10306