Using Thoracic Paravertebral Blocks to Treat Intercostal Neuralgia

Incorporating thoracic paravertebral blocks and peripheral nerve stimulation into the treatment algorithm for refractory intercostal neuralgia may offer a more comprehensive approach to pain management, ultimately improving patient outcomes.

 

• Intercostal neuralgia encompasses pain associated with the intercostal nerves
• Standard of care can include pain control with NSAIDs, neuropathic medications, and intercostal nerve blocks (ICNBs)
• This case details an additional strategy to consider when patient fail the typical course of treatment.
• A 36-year old male presented with chronic left-sided thoracic pain, originating from his back and wrapping around his chesPatient reported only partial relief following an ICNB
  • Performing a thoracic paravertebral block (TPVB) provided 100% pain relief for one week
  • Peripheral nerve stimulation (PNS) system was placed in the paravertebral space for 2 months
  • Patient reported complete pain relief while the leads were in place and even after removal
   
  • Sympathetic-mediated pain may explain why patient only had partial relief with an ICNB
  • TPVB affects both intercostal nerve as well as sympathetic ganglion, whereas the ICNB only affects sensory nerves
  • This sympathetic coverage may account for patients experiencing greater postoperative pain control after thoracic surgery when receiving TPVBs compared to ICNB
  • This patient’s pain may have a sympathetic-mediated component resulting in refractory intercostal neuralgia to an ICNB
  • PNS to the paravertebral space can result in neuromodulation of the sympathetic ganglion and may account for the patient’s long-term pain relief even after removal of the PNS system