Intercostal neuralgia is a rare yet debilitating condition that can be caused by thoracotomy, herpes zoster infection, or traumatic rib fractures. This case report describes a 48-year-old woman who developed persistent intercostal neuralgia after sustaining bilateral multiple rib fractures from a violent coughing episode. Initial surgical decompression and subsequent neurectomy of the affected intercostal nerve temporarily alleviated her symptoms. A third surgical intervention involving targeted muscle reinnervation with intercostal to thoracodorsal nerve transfer provided long-lasting pain relief. This case highlights the importance of considering nerve entrapment as a cause of posttraumatic intercostal neuralgia and suggests the targeted muscle reinnervation as a reliable procedure for obtaining persistent pain relief.