Intercostal neuralgia is pain in the thoracic region emanating from an intercostal nerve. It occurs commonly after thoracotomy. It can also be seen in elderly debilitated patients without a known precipitating event, other causes include rib trauma, very rarely benign periosteal lipoma and pregnancy. Intercostal neuralgia due to surgical injury of the intercostal nerve has traditionally been difficult to treat. No single treatment modality has been curative. There are several treatment options available, including systemic medications, topical or invasive nerve blocks, cryoablation, and radio ablation. Despite numerous treatment advances, many patients remain refractory to the current therapies and continue to have pain, physical and psychological distress. In this review, we will discuss the pathophysiology of intercostal neuralgia, its clinical manifestations, diagnosis and various pharmacological, non-pharmacological and interventional treatment modalities, as also the insight into the potential complications of the disease and treatment modalities