Why Am I Experiencing Pain on Both Sides of My Lumbar Ribs?

Causes and Symptoms of Intercostal Neuralgia

The phenomenon of pain proximal to the ribs is infrequent, typically manifesting during sudden physical exertion, such as running. This discomfort, often referred to as a "side stitch," is transient, offering swift relief. The pain is predominantly unilateral, though some individuals may experience bilateral rib pain. If the pain persists, prompt medical attention is warranted to determine its underlying cause and initiate appropriate treatment. Below, we delve into the reasons behind bilateral rib pain.

Causes of Pain on Both Sides of the Ribs

Disregarding external trauma, bilateral rib pain is frequently attributed to intercostal neuralgia. This is a subjective symptom experienced by patients where the intercostal nerves, originating from the thoracic spinal cord and traversing the intercostal spaces to innervate thoracic muscles, the back, and the chest wall, become irritated or inflamed. Consequently, intercostal neuralgia presents as pain radiating obliquely downwards from the thoracodorsal region along the intercostal spaces to the anterior chest and abdominal wall's midline.

Degenerative protrusion of thoracic intervertebral discs, thickening and ossification of joint capsules and ligaments can narrow and deform the neural canal, leading to inflammation of the intercostal nerves and resultant pain. Additionally, conditions such as tuberculous infection of the thoracic vertebrae, thoracic vertebral fractures or dislocations, spinal or spinal cord tumors, ankylosing spondylitis, as well as lesions of the ribs, mediastinum, and pleura can also affect the intercostal nerves. Notably, herpes zoster-related intercostal neuralgia tends to be severe.

Symptoms of Intercostal Neuralgia

Intercostal neuralgia is characterized by pain radiating from the back along the intercostal spaces to the anterior chest and abdominal wall, exhibiting a semi-circular distribution. Although it is more commonly unilateral, it can affect both sides simultaneously. Activities like coughing, deep breathing, or sneezing often intensify the pain. Physical examination may reveal tenderness and percussion pain at the thoracic spinous processes, interspinous spaces, or paravertebral areas. Some patients may experience tenderness along the intercostal spaces, accompanied by sensory abnormalities in the areas innervated by the affected nerves. The pain is often described as stabbing or burning, with a characteristic radiation pattern along the intercostal nerves. In cases of herpes zoster, localized lesions may be visible.

The diagnosis of intercostal neuralgia relies primarily on the characteristic distribution of pain. Identifying the underlying cause is crucial, especially considering the possibility of tuberculosis, tumors, osteoporotic compression fractures in the elderly, and early stages of herpes zoster, which are conditions that can easily go unnoticed. Treatment should address the root cause of intercostal neuralgia, with a tailored plan based on the established etiology.