How Long Does Intercostal Neuralgia Last? (+ Recovery Guide)

Have you been diagnosed with intercostal neuralgia, or are you just wondering how long pain between the ribs can last ?

My answers as a physical therapist who has looked at what is said in international scientific studies.

♻️ Last update: January 6, 2025.
👩‍⚖️ Declaration of financial interests: none directly related to the subject. My complete declaration of interest is in the legal notice section.
Written by Nelly Darbois, physiotherapist and scientific editor

What type of intercostal pain am I talking about here?

Intercostal pain is a fairly well-described condition, although we often never hear about it until we’re confronted with it.

I’m talking here about sharp, stabbing, radiating, burning or stabbing pains, sometimes associated with sensations of pins and needles, numbness and tingling.

All in the rib area, but can radiate into the back and thorax.

Sometimes you’ll be diagnosed with“intercostal neuralgia“, which simply means “nerve pain in the ribs”.

Due to inflammation of these nerves, or the after-effects of inflammation that is no longer present.

Not to be confused with other problems that can cause rib pain:
❌ a rib fracture or fracture
❌ torn intercostal muscles
❌ rib metastases.

Your doctor is trained to differentiate between “simple” intercostal pain and one of these other problems.

A few dozen scientific publications are devoted to intercostal pain, which is not very many:

It is often difficult to identify the precise cause of pain.

Here are 3 of the most common:

• in 4/10 cases, tissue or nerve damage following thoracotomy (operation): post-thoracotomy pain syndrome;
• in 3 out of 10 cases, shingles, also known as herpes zoster or varicella zoster virus: post-herpetic or post-zoster neuralgia;
• after a shock to the chest wall: accident, operation.

There are other possible causes: pregnancy, infection, etc.

Source: Fazekas 2023

How long does intercostal pain usually last?

Let’s start by looking at the glass half-full: for some people, intercostal pain disappears within a few weeks or months and never returns. Without any specific treatment.

However, we have no reliable data showing how pain evolves “on average” over time following a diagnosis of intercostal neuralgia.

Here’s what the leading scientific publication on the subject has to say. It’s very vague, but it’s the best we’ve got!

The prognosis for intercostal neuralgia is variable. Some patients experience resolution of symptoms over time, with or without conservative supportive measures, while others develop chronic pain.

Fazekas 2023

Intercostal pain after thoracotomy

Among people who develop neuralgia following thoracotomy, fewer than 5 in 100 will have chronic pain: lasting several months or years. More specifically:

• 6 out of 10 people still have pain 7 to 12 months after the onset of pain,
• 2 out of 10 people still have pain 6 to 7 years later.

This still means that 4 out of 10 people who develop intercostal neuralgia following thoracotomy are pain-free within a few months at most, based on the data available to us.

Source: Fazekas 2023

Intercostal pain after shingles

3 out of 10 people will contract shingles at some point in their lives, which can lead to intercostal neuralgia. Most often after the age of 50, or in immunocompromised individuals.

And in people with shingles, only 1 to 3 out of 10 will experience intercostal pain lasting several months or even years.

Source: Fazekas 2023

Why do intercostal pains sometimes last a long time?

Here are the reasons why, in theory, intercostal pain can last longer than other types of pain.

The trigger.

If your intercostal pain is the result of shingles, it’s well known that this virus can unfortunately cause pain that lasts a long time (even if it’s not systematic).

The neurological origin of pain.

Intercostal pain also belongs to the broad category of neuropathic pain, which is also known to become chronic.

Frequent movements in the region.

The rib area is a region that is often stressed, for example, by breathing. Even the slightest movement caused by breathing can lead to inflammation.

What treatments are available to relieve intercostal pain?

There are few studies evaluating the effectiveness of natural treatments or remedies for intercostal pain.

And when they do exist, they are poorly reproduced, carried out on a small number of people, and of low quality: they often do not compare the evolution of people “with nothing” or “with placebo”.

Nevertheless, here are the suggested treatments for intercostal pain. In addition, of course, to general chronic pain management methods.

Where inciting factors can be identified, it is important to seek to alleviate them. For example, if a patient has a chronic cough that may be contributing to the pain, a cough suppressant may be beneficial.

Fazekas 2024

I’m not going to talk specifically about pain treatments for shingles or thoracotomy, but about “all-cause” treatments for intercostal pain.

The following is a list of proposed treatments, whose specific efficacy on intercostal pain remains poorly evaluated:

• oral medications: NSAIDs, anticonvulsants, antidepressants, opiates;
• topical medications, to be applied to the skin in the area of pain: capsaicin, transdermal lidocaine ;
• TENS;
• intercostal nerve blocks under anesthesia ;
• image-guided radiofrequency ablation of the intercostal nerves and even the corresponding dorsal lymph nodes;
• manual therapy ;
• heavy surgery with potentially irreversible side effects: surgical neurectomy, dorsal rhizotomy or sensory ganglionectomy of the intercostal nerves;
• physical activity ;
• physiotherapy.

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That’s all I wanted to say on the subject! Any questions or comments? See you in comments!