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

2185752

Case Report: Successful use of Intercostal Nerve Radiofrequency Ablation in a Patient with Slipping Rib Syndrome

Medically Challenging Cases

Case Report: Successful use of Intercostal Nerve Radiofrequency Ablation in a Patient with Slipping Rib Syndrome

ASRA Fall 2025

Greta Niemela, MD; Tiffany Lin, MD | November 2025

Introduction:

Slipping rib syndrome (SRS) is an underdiagnosed condition causing chronic debilitating thoracic wall pain due to hypermobility of costal cartilage and irritation of intercostal nerves
Conservative management includes analgesics and intercostal nerve blocks
When conservative management fails, surgical rib fixation is considered

Case Description:

25-year-old woman with hypermobile Ehlers Danlos Syndrome and SRS who developed recurrent rib fractures and chronic chest wall pain
Limited relief with conservative treatment, scheduled for bilateral rib fixation
Underwent bilateral T7–T10 RFA preoperatively, which resulted in complete pain resolution and opioid tapering
Patient remained pain-free postoperatively

Discussion:

This case demonstrates first reported successful use of intercostal nerve RFA resulting in significant and durable pain relief for SRS
RFA provided meaningful preoperative symptom control, enabled opioid tapering

Conclusion:

Intercostal RFA may serve as an effective, durable, and less invasive treatment for SRS-related pain
Useful to consider in patients with connective tissue disorders like hypermobile EDS who are at increased surgical risk
Further studies are warranted to assess the long-term efficacy of RFA as a standalone treatment for SRS