I was discussing radiation options with my doctor. External focused beam therapy had been discarded as an option because of the close proximity of my lungs to the target lesion in my rib cage. We also discussed Samarium and Strontium therapy and that therapy was a possibility, but those options also had drawbacks. The next thing my doctor mentioned made me think he changed the subject. I thought he’d said something about intercoastal highways and I asked “what? What did you say?” thinking I’d missed something.
Inset shows intercostal nerve following the inside curvature of the rib
“I was saying that we could try an intercostal block. It’s very difficult treatment but it might be our solution to the pain you’re experiencing. That pain is through the intercostal nerve, and also the reason you say the pain seems to appear in front, the side and in your back . The nerves in your ribs follow the arc of the rib’s curvature. It starts at the sternum and follows the rib around from front to back. The idea behind intercostal blocking is to destroy the nerve at its beginning –to block its ability to signal pain. But as I said, it’s a difficult and delicate procedure and one we don’t do here. I’d have to send you to Seattle. I mean, I’m sure there’s someone in town here that could do it, but I’m not sure if the VA has an agreement or …I’ll have to look into that.”
“So,” I said, “there’s a way to make the pain stop but it’s a specialized kind of thing. What can go wrong? What makes it so delicate?”
“Well, a lung puncture is possible and that, especially in your case, would be pretty bad. The procedure involves pressing a needle through bone and cartilage to target this very tiny area. The needle applies alcohol or some other agent that burns the nerve, killing it.”
Lytic lesion in rib shows bone damage
“What happens if they miss? I mean, will I be stuck with immense pain until I finally blow my own brains out?”
“No, no. But it can be problematic. Especially a punctured lung. It’s a really hard procedure.” he said again.
Looking up intercostal blocks turned out to be as vague as my doctor. Side effects listed were rashes, itching, bleeding and even death, although I wonder just what could lead to that consequence. Blocks seem to be fairly common, and in fact acupuncture is a type of nerve blocking in some situations. Blocks can be applied in different ways to different parts of the body. Saddle blocks are a temporary swelling indiced in pregnant women during delivery and it masks some of the painful aspects of childbirth. Blocks are also used in advance of amputation surgery in order to prevent onset of phantom limb pain.
Blocks can’t be used for any pain situation. They only work where the pain path is specific and the nerves involved with the pain are accessible. As common as blocks are, none should be taken lightly. But when a block is indicated, it can be a godsend to pain sufferers. Whether or not we use an intercostal block for me is still under debate.
