Platelet Rich Plasma Injection as A Treatment for Intercostal Neuralgia: A Case Report

Intercostal neuralgia is a neuropathic pain condition that may persist following rib fractures, adversely affecting sleep quality and daily functioning. Conventional pharmacological and interventional treatments may provide insufficient pain relief, prompting interest in regenerative therapeutic approaches. This case report aimed to describe the clinical outcomes of ultrasound-guided perineural platelet-rich plasma (PRP) injections in a patient with refractory posttraumatic intercostal neuralgia. A 52-year-old woman presented with persistent pain along the distribution of the left tenth intercostal nerve following a rib fracture sustained 10 months earlier. Previous conservative treatment, cryoablation, and prolotherapy had failed to provide meaningful symptom relief. Autologous PRP was prepared using a double-spin centrifugation technique and administered perineurally under ultrasound guidance. Two injections were performed at a two-week interval. Pain intensity and symptom improvement were assessed using the Numeric Rating Scale (NRS) and clinical symptom evaluation. At baseline, the patient reported a pain intensity of 3–4 on the NRS, with breakthrough pain episodes reaching 6 and occurring three to five times daily, accompanied by sleep disturbances and limitations in daily activities. Following the first injection, the patient reported approximately 50% pain relief, followed by complete pain relief after the second injection. These clinical observations may be consistent with the proposed anti-inflammatory and neuroregenerative effects of PRP, although the underlying mechanisms were not directly investigated. Ultrasound-guided perineural PRP injections may represent a potential therapeutic option for refractory posttraumatic intercostal neuralgia. However, controlled clinical studies using standardized treatment protocols, objective outcome measures, and longer follow-up periods are necessary to establish their efficacy and safety.