Post Covid Intercostal Neuralgia

So during the first month or so of my acute covid-19 infection I had high fevers, a dry cough and constant burning pain in my lungs (amongst many, many other things!) It was worse in the morning and in the evening. The burning, squeezing compressing pain was on a pain scale of about 8 out of 10 and all I could to was sit in a chair or lie in bed wishing it away. It moved around every part of my lungs sometimes staying for a few hours, sometimes the whole day, before moving onto a new area. It was almost a game with myself "where will the hideous pain be today?" !!

I tried paracetamol and ibuprofen but they didn’t touch it so I resorted a ridiculously hot water bottle for some relief. Does one burning pain cancel out another?! It made it bearable.

So this wandering burning stopped eventually and the pain located itself permanently to my right chest for the next few months.

Now at almost 9 months in I am left with a burning pain on my right chest. It is located over the lateral part of my ribs, round under my armpit towards my back. It isn’t there the whole time but definitely comes on during and after any form of exercise - walking, recumbent cycling and swimming.

Obviously at the beginning of my illness I was diagnosed by a respiratory doctor with costochondritis which was sensible considering I had had a covid-19 pneumonia on this side and had been coughing for months

COSTOCHONDRITIS is an inflammation of the cartilage that connects a rib to the breastbone (sternum)

Symptoms:

• Pain on left side of sternum

• Sharp, aching, pressure like pain

• Affects more than one rib

• Worsens on taking a deep breath or on coughing

Causes:

• Injury

• Physical strain

• Arthritis

• Inflammation from viruses, bacteria and fungi

• Tumours

Risk factors:

• Female

• Over 40 years of age

• Tietze syndrome occurs in Children and young adults affecting both men and women equally. It is the pain but swelling is also present

Treatment:

• Exclude life threatening causes such as a heart attack

• Easing pain as best you can

• Waiting it out- usually improves in a 4- 6 weeks

So for me I really feel I have passed the stage when we can call my persisting pain costocondritis. Plus the fact it never really fit the criteria anyway. So my question was what is this pain?

The answer is INTERCOSTAL NEURALGIA. This is a neuropathic pain involving the intercostal nerves. These are the nerves that come from the spinal cord just below the ribs. It causes chest pain too but anywhere in the chest not just near the sternum.

Symptoms are typically a burning, sharp, or shooting pain which:

• Can be felt around the ribs, in the upper chesand /or the upper back

• May be a squeezing pressure sensation that wraps around the chest from front to back

• May be associated with numbness and tingling

• Can be made worse by deep breathing or stretching

• Can intensify when laughing, coughing, or sneezing

• Can refer to the shoulder or pelvis of that side

More SEVERE symptoms are:

• Involuntary muscle twitching

• Loss of appetite

• Paralysis of the muscles

• Muscle wasting

• Lightening bolt pain

• Itchy, burning, sensitive skin, when caused by shingles, making the wearing of clothes difficult

Causes:

• Trauma to the chest

• Post viral

• Shingles

• Nerve entrapment

• Post surgery

• Idiopathic (spontaneous)

Diagnosis is made from a full history and examination by your doctor.

Treatments:

• OTC topical creams and patches - capsaicin/ lidocaine

• Low dose antidepressants help nerve related pain - amitriptyline, duloxetine, imipramine, nortripyline and venlafaxine

• Anti convulsant medication can also help - Pregabalin and Gabapentin

• Nerve blocks

• Referral to pain management specialist

• CBT, relaxation therapy

• Keeping physically active

• Stretches :

1. Stand tall with back and neck straight and breathe in as deeply as possible. Repeat five times.

2. Raise arms over your head and grasp your hands. Bend to one sided and hold for a count of 10. Relax and repeat bending to the opposite direction.

3. Stand erect with your arms at your sides and elbows bent at 90 degrees. Bring your hand backward, trying to bring shoulder blades together. Hold for a count of 10 and repeat.

So now I have found out my correct diagnosis I am going to try a topical cream and keep on with my exercising despite the fact I know it will bring on the pain. I have managed it for 9 months so far!! And on my Christmas wish list is a new hot water bottle!