After a rib fracture
The nerve can be caught in healing bone (callus), pinched between displaced fragments, or scarred into a fracture that has not knitted. Rib fractures →
Intercostal neuralgia · rib nerve painIntercostal neuralgia is pain from one of the nerves that run beneath each rib, wrapping from the spine round to the front of the chest. It needs a different kind of treatment, because ordinary painkillers were never designed for nerve pain.
Page last updated September 2026
Nerve pain has a recognisable pattern. Any of the following is worth a proper look:
“Nerve pain that has been present for many months becomes harder to switch off, because the spinal cord and brain learn to amplify it. The earlier a fixable cause is found, the better the result.”
Mr Marco Scarci, Consultant Thoracic Surgeon
It is neuropathic pain — pain generated by the nerve itself rather than by injured tissue around it. That is why it feels burning or electric, not like a bruise, and why ordinary painkillers were never designed for it.
A new blistering rash along the painful band is shingles — it is treated with antiviral tablets, ideally within 72 hours of the rash appearing. See a doctor without delay.
Between each pair of ribs runs an intercostal nerve, in a groove along the underside of the rib alongside an artery and a vein. There are eleven pairs, plus one below the twelfth rib. Together they supply feeling to the skin of the chest and upper abdomen and power to the muscles between the ribs.
When one of these nerves is bruised, stretched, compressed, scarred or inflamed anywhere along its course, it can start to fire abnormally. The result is neuropathic pain: pain generated by the nerve itself rather than by injured tissue around it. That is intercostal neuralgia.
The nerve can be caught in healing bone (callus), pinched between displaced fragments, or scarred into a fracture that has not knitted. Rib fractures →
Post-thoracotomy pain is the best-known example, but keyhole surgery and chest drain sites can also leave a nerve irritated.
The shingles virus lives in nerve roots; pain that persists after the rash has healed is called post-herpetic neuralgia and commonly affects a chest nerve.
Where a loose cartilage catches the nerve — slipping rib syndrome. Slipping rib syndrome →
A tumour, an infection or a spinal problem. This is uncommon, but it is the reason imaging matters.
For example from diabetes, where the nerves themselves become damaged.
Sometimes no cause is ever found.
The pattern of the pain usually gives the diagnosis away, and a careful examination confirms which nerve is involved by mapping the area of altered sensation. The harder and more important question is what is irritating the nerve, because that is what determines the treatment.
That may mean a CT scan to look at old fractures and callus, an MRI to look at the nerve and the spine, or an ultrasound of the chest wall.
A small injection of local anaesthetic around the suspected nerve, under ultrasound guidance. If the pain disappears for the duration of the anaesthetic, the nerve is confirmed as the source — and the likely response to treatment can be predicted.
Nerve pain responds poorly to paracetamol and anti-inflammatories. The treatments that do work are used in roughly this order, matched to the cause.
Amitriptyline, gabapentin, pregabalin or duloxetine, started low and adjusted, usually by your GP or a pain specialist. They take a few weeks to judge and they are not for everyone.
Lidocaine patches over the painful area, or capsaicin cream — local relief without systemic side effects.
Retraining the over-sensitive skin and freeing up guarded movement, alongside the medical treatment.
Local anaesthetic and steroid around the affected nerve, which can give weeks or months of relief and can be repeated.
For pain that responds to blocks but keeps returning — the nerve is interrupted for longer, and recovers gradually so it can be repeated.
Releasing a nerve trapped in callus, stabilising a fracture that has not healed, removing a slipping cartilage, or, in selected cases, removing the damaged segment of nerve (neurectomy).
Timing matters. Nerve pain that has been present for many months becomes harder to switch off, because the spinal cord and brain learn to amplify it. The earlier a fixable cause is found, the better the result.
new weakness in an arm or leg, or changes in bladder or bowel control; fever, night sweats or unexplained weight loss; pain that wakes you every night and is steadily worsening; or a new blistering rash along the painful band.
you are struggling to breathe, or breathing is getting worse; you are coughing up blood; you have crushing or tight chest pain, or pain spreading to your arm, jaw or back, with sweating or faintness; or you feel dizzy or faint, or have severe abdominal pain after a chest injury. Call 999 or go to A&E. If you are unsure, call 111.
“ ★★★★★“Shingles at 68, and three years of pregabalin fog afterwards. My GP was kind but the answer was always another dose adjustment. Mr Scarci mapped the band, found the nerve with one injection — the pain vanished for the first time in three years, right there in clinic — and cryoablation a few weeks later gave me months of peace. I have my head back as well as my chest.”
“ ★★★★★“Four years after my lung operation I still had burning along the scar line. Everyone said it was normal after that kind of surgery. Mr Scarci disagreed — politely and with evidence. The diagnostic block proved which nerve it was, the cryoablation switched it off, and this spring was the first since 2022 I haven’t dreaded wearing a seatbelt.”
“ ★★★★★“I broke two ribs on a job site and they healed — but every twist sent an electric shock around my side. Eighteen months of being told the X-rays looked fine. Mr Scarci explained the nerve was caught in the healed bone, proved it with a block, and freed it with keyhole surgery. Back on the tools six weeks later, no shocks since.”
MD(Hons) · FRCS(Eng) · FCCP · FACS · FEBTS · Consultant Thoracic Surgeon, Imperial College Healthcare NHS Trust
Intercostal nerves are Mr Scarci’s daily terrain — the structures a thoracic surgeon works beside in every chest operation, protects during rib fixation, and freezes with cryoablation to keep surgical patients comfortable. That anatomy-first fluency is exactly what chronic chest nerve pain needs: the ability to read the band, name the nerve, prove it with a block, and deliver every rung of the treatment ladder personally — from injection to keyhole nerve release.
He also treats the causes behind the neuralgia — fracture nonunions, slipping ribs, surgical scarring — so the source is fixed, not just silenced.
No GP referral required. Bring your medication list and any old letters or scans — the history of how it started matters.
St John’s Wood, NW8 9LE
11:00am–1:00pm Monday PMMarylebone, W1G 6BW
5:30–7:30pm Tuesday PMBorehamwood, WD6 3BS
5:30–7:30pm Wednesday AMHammersmith, W12 0HS
9:00–11:00am Thursday AMSouth Kensington, SW5 0TU
9:30am–12:30pmNot in London? Remote video consultations are available to review your history and plan the diagnostic visit before you travel.
Nerve pain is burning, shooting or electric, follows a band along one rib space, and often comes with numbness or skin that hurts to touch. Rib and cartilage injuries tend to be sharp with movement, tender to press at one point, and worse with breathing. Many people have both, particularly after a fracture, and it takes an examination to separate them.
Often, yes. Post-shingles and post-surgical nerve pain usually improves over months. Pain that is still there beyond three months, or that is worsening, deserves assessment for a treatable cause rather than more waiting.
It is done with a fine needle under ultrasound guidance and takes a few minutes. Most people describe a brief sting and some pressure. Serious complications are rare. It is both a treatment and a test.
When the nerve is trapped by callus from an old fracture, pinched by a slipping cartilage, or tethered in a fracture that has not healed, freeing or removing the cause resolves the pain in most people. When there is no structural cause, surgery is rarely the answer and the focus is on blocks, ablation and medicines.
Keep moving and stretching gently rather than guarding the area. Wear loose clothing and avoid straps that press on the band of pain. Protect your sleep. Desensitisation, meaning regular gentle touch to the sensitive skin with a soft cloth, retrains the nerve over weeks.
Including non-union and chronic pain, where the nerve is caught in healed or unhealed bone.
MechanicalA loose lower cartilage catching the nerve beneath it.
UnexplainedRib and chest wall pain that other tests have failed to explain.
JointInflammation of the rib–cartilage joints — joint pain rather than nerve pain.
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A consultation with Mr Scarci is a hands-on examination by a surgeon who treats the chest wall every week, with imaging arranged on the same visit where it will change the plan.