A 23 year old lady was seen in the Pain Clinic. She had a fall down some stairs whilst wearing a rucksack and bruised the left side of her chest- rib fractures were excluded on X-ray. She had stabbing pains in the left side of the lower chest which started off intermittently but became continuous. There was some associated soreness.
Approximately 6 months later, she presented to the Pain Clinic was found to have tenderness on deep palpation of the T12 rib. There was also some reduction to pin prick sensation and some increase to light touch. Of note, she had improved with occasional doses of Tramadol.
A diagnosis of intercostal neuralgia was made. The lady was commenced on Pregabalin 75 mg twice a day which was slowly titrated to 150mg twice per day. At 3 months, her pain had greatly improved and the tenderness had decreased. The dose was 150 mg twice a day. The plan was to reduce the Pregabalin to a lower dose for another 3 months and then try and stop it after that.