343 posters, 5 videos, 2 audios, 18 topics, 33 sessions, 263 authors, 202 institutions

24th Annual Pain Medicine Meeting 2025

November 13-15, 2025| JW Marriott Austin, Austin, Texas

2177731

Intercostal Neuralgia in Severe Thoracolumbar Scoliosis: A Therapeutic Role for Radiofrequency Ablation

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Poster Presenter

Joseph Nalbone

Authors

Joseph Nalbone

Affiliations

Emory University

Part of Topic

Medically Challenging Cases

Intercostal Neuralgia in Thoracolumbar Scoliosis: A Therapeutic Role for Radiofrequency Ablation

Introduction

Intercostal neuralgia due to severe thoracolumbar scoliosis is rare and often resistant to medications and physical therapy.
Chronic rib compression and nerve irritation from spinal deformity drive persistent neuropathic pain.
Radiofrequency Ablation (RFA) has documented efficacy in post-thoracotomy and post-herpetic neuralgia, but evidence in scoliosis-related neuralgia is lacking.
This case highlights the therapeutic potential of intercostal RFA for scoliosis-related pain, demonstrating functional improvement and durable analgesia.

Case Presentation

52-year-old woman with severe scoliosis (thoracic 74°, lumbar 39°) presented with refractory neuropathic chest wall pain.
Constant burning and aching pain radiating across the left T8-T11 dermatomes; pain intensity significantly interfered with activities of daily living.
Sleep limited to 4 hours with frequent nocturnal awakenings, daytime fatigue and impaired mobility contributed to reduced quality of life,
Pain persisted despite treatment with pregabalin, tizanidine, and structured physical therapy; patient declines spinal corrective surgery due to recovery concerns.
Physical exam was significant for restricted spinal range of motion, pain exacerbated by flexion and rotation; no tenderness on palpation over ribs or paraspinal muscles, suggesting neuropathic rather than musculoskeletal origin.
Radiographs confirmed marked scoliosis with rib compression corresponding to the symptomatic dermatomes.
Fluoroscopically guided intercostal nerve blocks at T8-T11 provided significant temporary relief, confirming intercostal neuralgia as the pain generator.
Radiofrequency ablation was performed on left T8-T11 intercostal nerves using a 16-gauge, 10cm RF needle with 10 mm active tip. Thermal lesioning at 80° for 90 seconds per level.
At 1-month follow-up, patient reported 85% pain reduction, decreased pain score to 2/10, and sustained functional improvement, including uninterrupted sleep and improved daytime activity.

Discussion

Severe thoracolumbar scoliosis alters rib alignment and creates chronic mechanical compression of intercostal nerves.
This leads to peripheral nerve irritation, ectopic discharges, and neuropathic pain that is often refractory to medications or rehabilitation alone.
Agents such as gabapentinoids and muscle relaxants may reduce central sensitization but fail to address the ongoing mechanical nociceptive input from rib deformity.
Physical therapy improves mobility but often does not relieve neuropathic pain once intercostal nerve compression is established.
Diagnostic intercostal blocks are critical to localize the pain generator and predict response to ablative procedures.
RFA provides longer-lasting analgesia compared to local anesthetic/steroid injections by creating thermal lesions that interrupt nociceptive signaling.
Robust evidence supports intercostal RFA for post-thoracotomy pain and post-herpetic neuralgia with months to years of benefit in select patients.
Application in structural spine deformity–related pain is rarely described, making this case novel and clinically significant.
Minimally invasive outpatient procedure with low morbidity.
Provides durable relief in patients unwilling or unsuitable for corrective spinal surgery.
Improves functional capacity and sleep quality, key outcomes often overlooked in chronic pain management.
Potential complications include pneumothorax, neuritis, infection, and incomplete pain relief.
Durability of benefit in scoliosis patients is not well established; repeat procedures may be necessary.
Intercostal RFA should be considered in the multidisciplinary pain management approach for scoliosis patients with intractable neuralgia.
Larger series or prospective studies are needed to define safety, efficacy, and durability in this population.

Conclusion

Intercostal RFA for intractable intercostal neuralgia due to severe thoracic scoliosis has meaningful therapeutic value

References

Kapural L, Mekhail N. Radiofrequency ablation for intercostal neuralgia: a case series. Pain Pract.2013;13(1):59-63.
Davis TT, Delaney D. Chronic intercostal neuralgia: diagnosis and treatment. Curr Pain Headache Rep.2018;22(10):70.
Gofeld M, Restrepo-Garces CE, Theodore BR, Faclier G. Radiofrequency denervation of intercostal nerves for chronic post-thoracotomy pain. Pain Physician. 2010;13(6):507-512.
American Society of Regional Anesthesia and Pain Medicine (ASRA). Guidelines on neurolytic procedures. Reg Anesth Pain Med. Latest edition.
Chua NH, Vissers KC. Use of intercostal nerve RFA in refractory chest wall pain: a review. Pain Med.2020;21(5):989-995.