Procedure Description
Intercostal nerve blocks and radiofrequency ablation (RFA) are minimally invasive procedures used to treat chronic pain along the chest wall or upper abdomen, especially pain caused by intercostal nerve irritation or injury. The intercostal nerves run along the bottom edge of each rib and transmit pain signals from the chest and upper abdominal regions.
The treatment begins with a diagnostic intercostal nerve block, in which a local anesthetic (and sometimes corticosteroid) is injected to temporarily relieve pain and confirm the nerve source. If significant relief is achieved, RFA may be performed to "burn" or deactivate the affected nerve for longer-lasting pain control.
What It Treats
These procedures are used to manage nerve-related pain from:
Post-thoracotomy or post-surgical pain
Rib fractures
Intercostal neuralgia
Shingles (herpes zoster) or postherpetic neuralgia
Chronic chest wall or flank pain
Nerve entrapment following trauma or surgery
Pain after breast surgery (e.g., mastectomy, lumpectomy)
They are particularly helpful when pain is sharp, burning, or shooting along a rib or wraps around from the back to the chest or abdomen.
How It Is Performed
Intercostal Nerve Block
You will lie on your side or stomach, depending on the pain location.
The skin over the rib area is cleansed and numbed with local anesthetic.
Using ultrasound or fluoroscopic guidance, a thin needle is inserted near the bottom edge of the rib (just above the intercostal nerve).
A small amount of local anesthetic, often with a steroid, is injected.
The procedure typically takes 15–30 minutes.
Radiofrequency Ablation (RFA)
If the nerve block successfully reduces pain, RFA may be scheduled.
The same target nerve is accessed using fluoroscopy or ultrasound.
A specialized probe is inserted, and the nerve is stimulated to confirm correct placement.
A radiofrequency current is then applied to heat and ablate the nerve, reducing its ability to transmit pain.
The procedure usually takes 30–45 minutes.
Pre-Procedure Instructions
You may eat and drink normally, unless sedation is planned (then nothing for 6 hours prior).
Continue most routine medications, but you may need to pause blood thinners—follow your provider’s guidance.
Inform your provider if you:
Are pregnant or breastfeeding
Have allergies to local anesthetics, contrast dye, or steroids
Have an active infection or fever
Arrange transportation if sedation is used or if mobility is affected post-procedure.
Wear loose, comfortable clothing that allows access to the chest or upper back.
What to Expect After the Procedure
You may feel immediate pain relief after the block due to the local anesthetic.
Soreness or bruising at the injection site may occur and usually resolves within 1–2 days.
Pain relief from a nerve block may last hours to days; if effective, RFA may provide longer-lasting relief—typically 6 to 12 months.
Most patients return to light activity the same day but should avoid strenuous activity for 24–48 hours.
You may be referred for follow-up physical therapy to support recovery and mobility.
Call your provider if you experience:
Fever or signs of infection at the injection site
Increased chest pain or shortness of breath
Numbness or weakness that persists or worsens
Lasting Relief for Chest and Rib Pain
At Parkview Spine & Pain, we specialize in precision-guided intercostal nerve blocks and ablations to relieve pain from nerve irritation, trauma, or surgery. These techniques can provide effective, long-term relief when other treatments have failed.
👉 Schedule a consultation today to learn whether an intercostal nerve block or RFA is right for your condition.