Evaluation of Intercostal Neuralgia in Patients With Chest Tube Insertion After Traumatic Rib Fracture

Prospective Evaluation of Intercostal Neuralgia Incidence, Risk Factors, and Outcomes in Patients With Chest Tube Insertion After Traumatic Rib Fractures

Traumatic rib fractures are common injuries following blunt chest trauma, often requiring chest tube insertion to manage complications such as pneumothorax or haemothorax. However, chest tube placement can lead to intercostal nerve injury, resulting in intercostal neuralgia-a debilitating condition characterized by chronic, neuropathic pain along the intercostal nerves. Despite its clinical significance, the incidence, risk factors, and long-term outcomes of intercostal neuralgia in this patient population remain poorly understood.

Chronic pain following thoracic trauma, including intercostal neuralgia, has been shown to significantly impair quality of life and functional outcomes, leading to prolonged disability and increased healthcare utilization. Current literature highlights the need for better understanding and management of this condition, particularly in patients undergoing invasive procedures such as chest tube insertion. This study aims to prospectively evaluate the development of intercostal neuralgia in patients with chest tube insertion following traumatic rib fractures.

Study Overview

• Status: Recruiting
• Conditions: Intercostal Nerve Injury
• Intervention / Treatment: Procedure: Chest tube insertion

Detailed Description

Intercostal neuralgia is defined as pain along the intercostal nerve distribution with neuropathic features. Chronic intercostal neuralgia is defined as having intercostal neuralgia symptoms for >3 months.

Intercostal neuralgia pain will be specifically differentiated from persistent rib fracture pain through the presence of neuropathic pain at the level of the chest tube/pigtail that is reproducible with brushing/light touch to the chest tube scar site.

The following data will be collected:

Baseline:

• Demographic information (age, sex, ethnicity, comorbidities).
• Pain assessment using numerical rating scale at rest and with deep inspiration
• Pre-existing chronic pain conditions (e.g., fibromyalgia, chronic regional pain syndrome) and history of prior thoracic surgery or chest tube insertion.
• Injury characteristics (mechanism of injury including presence of foreign bodies and additional penetrating injuries, number and location of rib fractures, associated injuries including vertebral body fractures, sternal fracture, transverse process fracture).
• Neurologic assessment (Glasgow Coma Scale [GCS] on presentation and at time of recruitment)
• Brain imaging findings on presentation (if applicable)
• Chest tube / pigtail details (size, insertion site, duration of placement).
• Spirometry testing including forced vital capacity (FVC) and forced expiratory volume (FEV1) at time of enrolment of study

Additional information to be collected following hospital stay:

• Analgesic use including dose of opioids, use of regional anesthesia techniques, and adjunct analgesic medications while in hospital
• Length of hospital stay
• Presence and duration of mechanical ventilation
• Number of surgeries

Follow ups: 1 (± 3 days) and 3 months (± 1 week) via telephone

• Pain assessment using the numerical rating scale at rest and with deep inspiration
• Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) for neuropathic pain
• EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) for health related quality of life
• Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance 6a for sleep
• Medication use (analgesics, neuropathic pain medications)
• Neurologic assessment at discharge (GCS, diagnosis of traumatic brain injury)
• Brain imaging findings on presentation (if applicable)

Patients who are found to have intercostal neuralgia at 3 month follow up assessment can be referred to the pain clinic and choose to be sent for formal ultrasound to identify and characterize findings to indicate the presence of neuroma (a non-cancerous tumor or growth of nerve tissue), degree of scarring, or any other pain generating causes, if agreed. Participants' preferences regarding the disclosure of neuroma, including their right to know or not to know, will be respected (as described in the consent form).

• Study Type: Observational
• Enrollment (Estimated): 100

Contacts and Locations

• Study Contact: Name: Howard Meng, MD; Phone Number: 416-480-4864; Email: howard.meng@sunnybrook.ca
• Study Contact Backup: Name: Lilia Kauistov, PhD; Phone Number: 416-480-4864; Email: lilia.kaustov@sunnybrook.ca

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada, M4N 3M5
      • Recruiting
      • Sunnybrook Health Sciences Centre
      • Contact: Howard Meng, MD; Phone Number: 416-480-4864; Email: howard.meng@sunnybrook.ca

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Patients with acute traumatic rib fractures requiring chest tube insertion for management.

Description

Inclusion Criteria:

• Adults (≥18 years) with traumatic rib fractures requiring chest tube insertion
• Chest tube or pigtail insertion performed during their initial hospitalization for trauma

Exclusion Criteria:

• Patients with spinal cord injury
• Inability to complete follow-up assessments (e.g., language barriers, lack of telephone access)

Exclusion Criteria:

• Patients with traumatic brain injury
• Patients with spinal cord injury
• Inability to complete follow-up assessments (e.g., language barriers, lack of telephone access)

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Chest tube inserted; Patients with acute traumatic rib fracture/chest injury requiring chest tube insertion	Procedure: Chest tube insertion; Insertion of chest tube

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of intercostal neuralgia	To determine the incidence of intercostal neuralgia in patients undergoing chest tube insertion after traumatic rib fractures. Presence of neuropathic pain to be assessed using S-LANSS (score of 12 or more suggests pain of predominantly neuropathic origin)	1 and 3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assess the impact of intercostal neuralgia on medication use	Determine the impact of intercostal neuralgia on medication use including opioids and anti-neuropathic medications by collection and assessment of quantity of medications taken for pain relief related to intercostal neuralgia.	1 and 3 months
Assess the impact of intercostal neuralgia on quality of life and functional outcomes	Assess the impact of intercostal neuralgia on quality of life using EQ-5D-5L (assesses 5 dimensions, with 1 indicating 'no problems' and 5 indicating 'extreme problems')	1 and 3 months
Assess the impact of intercostal neuralgia on quality of life and functional outcomes	Assess the impact of intercostal neuralgia on quality of life using Promis 6a Sleep questionnaire (scale 1 to 5, with higher numbers indicating poor outcomes and lower numbers indicating good outcomes)	1 and 3 months

Collaborators and Investigators

• Sponsor: Sunnybrook Health Sciences Centre

Publications and helpful links

General Publications

• Blyth FM, March LM, Brnabic AJ, Cousins MJ. Chronic pain and frequent use of health care. Pain. 2004 Sep;111(1-2):51-8. doi: 10.1016/j.pain.2004.05.020.
• Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000 Jun;48(6):1040-6; discussion 1046-7. doi: 10.1097/00005373-200006000-00007.
• Karmakar MK, Ho AM. Acute pain management of patients with multiple fractured ribs. J Trauma. 2003 Mar;54(3):615-25. doi: 10.1097/01.TA.0000053197.40145.62.
• Bailey RC. Complications of tube thoracostomy in trauma. J Accid Emerg Med. 2000 Mar;17(2):111-4. doi: 10.1136/emj.17.2.111.
• Fabricant L, Ham B, Mullins R, Mayberry J. Prolonged pain and disability are common after rib fractures. Am J Surg. 2013 May;205(5):511-5; discusssion 515-6. doi: 10.1016/j.amjsurg.2012.12.007.

Study record dates

Study Major Dates

• Study Start (Actual): January 19, 2026
• Primary Completion (Estimated): December 31, 2027
• Study Completion (Estimated): December 31, 2027

Study Registration Dates

• First Submitted: September 5, 2025
• First Submitted That Met QC Criteria: December 19, 2025
• First Posted (Actual): December 29, 2025

Study Record Updates

• Last Update Posted (Actual): May 15, 2026
• Last Update Submitted That Met QC Criteria: May 13, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: SUN 6775

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No