Intercostal neuritis in pregnancy is a rare condition, but its presence causes significant discomfort in women. Find out what its causes are and what can be done to improve the pain.
Some women have chest pain similar to intercostal neuritis during pregnancy. It is a rare condition It usually appears in advanced stages of pregnancy. However, the main cause of this disorder has not been established, making accurate treatment difficult.
In this article we will focus on investigating what information is available so far and what are the possible sources that may be involved in the development of this neuropathy. In the same way, we will try to review what treatment options exist for intercostal neuritis in pregnancy and what their risks are.
Intercostal neuritis of pregnancy as its own entity
There is a dilemma regarding the name of the condition. In intercostal neuritis there is an inflammatory process that compromises a thoracic nerve that triggers pain. However, in pregnancy, the mechanism involved is not inflammation.
That is why some authors have proposed that the name that should be used for this disorder is “gravidic thoracic neuralgia”. The reasons are two:
- First of all, a difference is established with traditional neuritis, the cause of which is well known.
- On the other hand, it is highlighted that it is a condition that occurs in pregnant women.
What is known about the origin of chest pain in pregnancy?
As it is a rare condition, studies on it are scarce. Until now, the real cause of chest pain in pregnancy has not been established.
However, there are various hypotheses that try to explain the predisposition that exists in pregnant women to develop intercostal neuritis. We analyze them.
Pain due to elongation of the fibers
One of these theories is that the growing uterus produces progressive elongation of nerve fibers. This results in the activation of pain receptors, generating the condition. The acceptance of this hypothesis is based on the fact that intercostal neuritis associated with pregnancy disappears a few hours after delivery.
On the other hand, this could explain why pain is more frequent in advanced stages of pregnancy. In the same way, it is a valid argument to justify why neuropathy affects the levels closest to the growing abdomen more than those nerves in the upper thoracic region.
Root compression without a hernia
Another reason why thoracic neuralgia is believed to appear in some pregnant women is mechanical understanding of the nerve, when it emerges from the spinal column. This entrapment is the result of the additive action of several factors that are typical of pregnancy.
Among them are the following:
- Accentuation of lumbar lordosis to counteract the increase in weight in the abdominal region and, thus, to be able to modify the center of gravity of the body.
- Fluid retention due to increased blood volumewhich predisposes the soft tissues surrounding the spine to present a slight swelling.
The result is that the stretching caused by hyperlordosis and the increase in size of the paravertebral structures leave less space for the nerves to have a free path. However, the fact that intercostal neuritis does not affect the majority of pregnant women suggests that there are other factors involved.
Laxity of the ligaments due to the action of relaxin
Lastly, the increase in relaxin, a molecule associated with increased flexibility of the hip joints and ligaments to promote childbirth, could be involved in the origin of pain. For some authors, relaxin It also has an effect on the intervertebral discsmaking them more vulnerable to stress.
However, this hypothesis is controversial.
What symptoms does intercostal neuritis cause in pregnant women?
The gravidic neuralgia causes pain of moderate to severe intensity on one side of the chest. This usually follows the path of one or two intercostal nerves and a numb sensation may appear in the area.
Most frequently, it becomes noticeable in the lower levels of the thoracic region. That is, those closest to the abdomen.
A distinctive feature of intercostal neuritis in pregnancy is that palpation of the back muscles increases the painful sensation. Similarly, position changes can make the symptom worse. The pain could even make it difficult for the woman to move.
Generally speaking, intercostal neuritis most often affects the right side of the chest. In addition, some women report that the pain radiates to the abdomen.
It is important to highlight that symptoms subside after delivery. However, it is common for this condition to recur in future pregnancies.
Diagnosis of intercostal neuritis in pregnancy
The symptoms are enough to establish the diagnosis.
The doctor may may consider it necessary to perform an electromyography. Not in order to confirm any finding, but to rule out a more complex cause.
Differential diagnoses to consider
It is important to rule out pathologies in which there is an underlying nerve lesion. Let us remember that in intercostal neuritis of pregnancy there does not appear to be nerve damagebut the condition is secondary to a mechanical effect.
However, assuming this condition at first, without resorting to an adequate review, could mask other more serious disorders:
Options to reduce gravid thoracic neuralgia
In general, It is considered that the best therapy for neuromuscular pain associated with pregnancy is its prevention, through physical conditioning prior to becoming pregnant. However, this recommendation is of little use to a patient who already has the condition and to those who are predisposed to developing it.
Within the literature, the treatment is reduced to the indication of acetaminophen and the topical use of lidocaine patches in the affected area, as a last resort to reduce symptoms. However, this analgesic management must have strict medical supervision, due to the possible risks.
The use of amitriptyline is also suggested in those cases in which the pain is intense. But it is necessary to individualize each case. The risk/benefit ratio must be weighed when faced with drugs such as this, which have not been shown to be safe in the pregnancy of human beings.
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