Paravertebral and Chest Wall Intercostal Nerve Blocks and Neurolysis

Chronic persistent thoracic and chest wall pain is prevalent. Thoracic discs, facet joints, nerve root dura, and intercostal nerve blocks have been shown to be potential sources of thoracic and chest wall pain. While high-quality studies utilizing dual diagnostic blocks with 80% pain relief as the criterion standard have shown the prevalence of facet joint pain ranging from 34% to 48%, the prevalence of discogenic pain, nerve root dura pain, and chest wall pain secondary to various causes including intercostal nerve irritation has not been determined. Intercostal nerve blocks have been utilized frequently in interventional pain management settings to manage acute and chronic pain in the thoracic and chest wall area, intercostal neuritis, intercostal neuromas, and multiple other causes. Intercostal nerve blocks are performed either utilizing a paravertebral approach or an intercostal approach in managing chronic pain. There is paucity of a literature showing the effectiveness related to intercostal nerve blocks in managing chronic pain, specifically with application of the paravertebral approach.