Intercostal neuralgia is a painful problem that involves the nerves that run underneath the ribs.  The pain can be on the side of the chest or upper abdomen.  It usually radiates around from the back towards the front and may mimic the pain of a heart attack or gall bladder disease.  The pain is constant and can be described as burning.  There may be subtle neurologic signs in the area such as loss of sensation.  Patients with shingles will have the characteristic rash overlying the area of discomfort.  Plain X-Rays are useful to check for tumor or fractures.  CT scan or MRI scan is used to check for intrathoracic pathology.  Gall Bladder and Coronary Artery Disease will be in the differential diagnosis and need to be excluded as well.  The treatment of intercostal neuralgia includes non-steroidal anti-inflammatory disease (NSAIDs) and other analgesics.  Tricyclic anti-depressants can be useful as an adjunctive medication.  Gabapentin is a medication in a different class than the anti-depressants and may also help.  The injection of the intercostal nerves with a combination of local anesthetic and steroid is extremely helpful in those patients suffering with this problems.  Pneumothorax is a known complication of this procedure and it should only be done by those experienced with its performance.