Intercostal Neuralgia (ICN) Ch 2
Effective Treatments

Intercostal neuralgia can be difficult to treat and successful treatment will depend on exactly what is causing the pain. First line treatments begin with topical preparations and over the counter anti-inflammatory drugs.






Medicine you can apply
directly to the skin 

Medications that are applied directly to the skin, such as capsaicin or lidocaine ointment, can be helpful when the cause of the pain is close to the surface of the skin. 

Stimulates the Skin

Capsaicin is a compound that is extracted from chile peppers. Rubbing it into the painful area stimulates the skin and stimulates the release of endorphins.

Some people will complain of a burning sensation that makes this medicine sometimes difficult to tolerate.

Capsaicin from Chili Peppers
can be used to treat nerve pain.

chili peppers

Image Thanks to Visitor 7,
via Wikimedia Commons


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Numbing Medicine

Lidocaine is a local anesthetic that relieves pain by numbing the nerves. Lidocaine patches are also available. They can be cut to fit your area of pain and they are less messy and more convenient to use.

Oral Medications for Nerve Pain

Medications can be very helpful for relieving intercostal neuralgia. The most commonly used medical treatments for nerve pain are anti-inflammatory preparations, anti seizure drugs, anti depressant medication, and narcotic pain medicine.

Non-Steroidal Anti-Iflammatory Drugs (NSAIDs)

Anti-inflammatory drugs such as ibuprofen or naproxen can help to relieve pain by reducing inflammation and swelling that may be irritating the nerves.

Anti-Seizure Medications

Anti-seizure preparations such as gabapentin or pregabalin can reduce pain by stabilizing nerve membranes and limiting nerve activity.

Talk to Your Doctor

These treatments can be helpful but any medication can have side effects. You should always talk to your doctor who knows your medical history before starting any new treatment.

Intercostal Neuralgia (ICN) Medical Treatments


Image Thanks to raynata, via Wikimedia Commons

Narcotic Pain Treatments

Medications can sometimes be helpful for relieving the pain and other symptoms of intercostal neuralgia. Unfortunately, they do not often cure this type of nerve pain.

Anti-Depressant Treatments 

Certain types of anti-depressant medicines, such as SSRIs and NSRIs, are also sometimes used to treat nerve pain. They relieve pain by suppressing the nerve signal as it travels to your brain.


SSRIs (selective serotonin reuptake inhibitors) and NSRIs (norepinephrine and serotonin reuptake inhibitors) are drugs which help to relieve neuralgia or nerve pain by changing the balance of neurotransmitters at the synapse or connections between nerves.

 Narcotics really are not the best treatment for nerve pain because they have their effect at the pain receptors rather than within the nerve where neuralgia begins. 

Narcotics may also cause side effects such as constipation, sedation, and respiratory depression. They also present a significant risk of addiction and other complications.

but they are sometimes used when other treatments have failed

Nevertheless, in spite of these potential problems, drugs such as oxycodone, hydrocodone, and hydromorphone are often used when other treatments have failed.

When their use is closely monitored by a physician trained in the management of narcotic medicines they can be used safely and many people do find them helpful.

During Pregnancy

Intercostal neuralgia during pregnancy is best treated by delivering the baby. Other options for treatment are limited because of the risk to the unborn child. 

Topical treatments such as lidocaine ointment, Lidoderm Patches, and capsaicin are thought to be safe and may provide some relief. 

When medications and other treatments for Intercostal Neuralgia (ICN) have not been helpful your doctor may refer you to a pain management specialist for consideration more aggressive treatments that may be helpful.

Injections for (ICN) 

When you are experiencing pain from an injury to one or more of the intercostal nerves your pain management doctor may give you some relief with a nerve block.

Numbing Medicine

Injections of local anesthetic can be placed along the nerve to make it numb.

Some doctors will also inject a steroid medication, similar to cortisone, along with the local anesthetic.

Steroid Medicine

The steroid medication will reduce swelling and inflammation along the nerve and may provide longer lasting relief.

Injection for Intercostal Neuralgia


Image thanks to Johannes Jansson,
via Wikimedia Commons

Success will depend on a few Variables

How successful these injections are will depend on exactly what is causing the pain and other variables. If you do receive some relief you can monitor your symptoms to see how long the relief will last. Your pain may be gone permanently, or it may be began to gradually return after a day, a week, or several months. Every case will be different.

If you do have even temporary relief other procedures may be considered.

If nerve blocks with local anesthetic are helpful your doctor may consider Radio Frequency Ablation (RFA) as a more permanent way to block the nerve.

The RFA procedure uses high frequency radio waves to generate heat that will burn a small section out of the nerve. This will completely block the pain that is coming from that nerve.

This may not be 100% permanent because the nerve may grow back and the pain may return. However, these treatments will often last for several months or years.

What are the Risks

Anytime you are having an injection there is always a risk of bleeding, infection, and damage to nerves. But, when these procedures are performed by trained doctors using real time xrays for visualization the risk is very very low.

What You Need to do 

If you are having pain that you think he is caused by an injury to the intercostal nerves you can talk to your doctor about trying some of these treatments.

He may prescribe some of the medications or he may refer you to a pain management specialist for further evaluation and treatment.

Return to:
What is Intercostal Neuralgia? Ch 1



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