Some women have chest pain similar to intercostal neuritis during pregnancy. It’s a rare condition It usually appears in the advanced stages of pregnancy. However, the root 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 could be involved in the development of this neuropathy. Likewise, we will try to review what treatment options exist for intercostal neuritis in pregnancy and what their risks are.
Intercostal neuritis of pregnancy as an entity in its own right
There is a dilemma regarding the name of the condition. In intercostal neuritis there is an inflammatory process which compromises a thoracic nerve that triggers the pain. However, in pregnancy, the mechanism involved is not inflammation.
And for this some authors have proposed that the name for this disorder be “thoracic neuralgia of pregnancy”.. 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?
Being a rare condition, studies on it are scarce. Until now, the true 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 stretching of the fibers
One such theory is that the growing uterus produces a progressive lengthening of the nerve fibers. This results in the activation of pain receptors, resulting in the condition. 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 may explain why pain is more common in late pregnancy. Likewise, it is a valid argument for why neuropathy affects the levels closest to the growing abdomen more than those nerves in the upper thoracic region.
Root compression without hernia
Another reason why thoracic neuralgia is believed to appear in some pregnant women is mechanical understanding of the nerve as it emerges from the spinal column. This entrapment is the result of the additive action of several factors typical of pregnancy.
Among them are the following:
- Accentuation of lumbar lordosis counteract weight gain in the abdominal region and, therefore, be able to change the body’s center of gravity.
- Fluid retention due to increased blood volumewhich predisposes the soft tissues surrounding the spine to experience a slight swelling.
The result is that the stretching caused by the hyperlordosis and the increase in the size of the paravertebral structures leave less room for the nerves to have a clear path. However, the fact that intercostal neuritis does not affect most pregnant women suggests that there are other factors involved.
Laxity of the ligaments due to the action of relaxin
Finally, the increase in relaxin, a molecule associated with greater flexibility of the hip joints and ligaments to facilitate childbirth, could be involved in the origin of the pain. For some authorstake it easy It also has an effect on the intervertebral discsmaking them more vulnerable to stress.
What symptoms does intercostal neuritis cause in pregnant women?
pregnancy neuralgia causes moderate to severe pain on one side of the chest. This usually follows the path of one or two intercostal nerves and there may be a feeling of numbness in the area.
Most frequently, it becomes evident 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. Likewise, changes in position can make the symptom worse. The pain may even make it difficult for the woman to move.
In general, intercostal neuritis most often affects the right side of the chest. Also, some women report that the pain radiates to the abdomen.
It is important to underline this symptoms subside after delivery. However, it is common for this condition to recur in future pregnancies.
Diagnosis of intercostal neuritis in pregnancy
The doctor can may deem it necessary to perform an electromyography. Not to confirm any findings, but to rule out a more complex cause.
Differential diagnosis to consider
It is important to rule out disorders in which there is an underlying nerve lesion. Let us remember this in the intercostal neuritis of pregnancy there appears to be no nerve damagebut the condition is secondary to a mechanical effect.
However, hypothesizing this condition at first, without resorting to adequate review, could mask other more serious disorders:
- Slipped disc.
- Shingles infection.
- Diabetic polyradiculopathy.
Options to reduce thoracic neuralgia in pregnancy
Generally, It is believed that the best therapy for neuromuscular pain associated with pregnancy is its prevention, through physical conditioning before becoming pregnant. However, this recommendation is of little use to a patient who already has the condition and to those predisposed to developing it.
Within the literature, the treatment is reduced to the indication of paracetamol 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 cases where the pain is intense. But it is necessary to single out each case. The risk/benefit ratio must be weighed against drugs like this, which have not been shown to be safe in human pregnancy.
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