Upper Back Pain
Upper back pain regularly sends patients to seek pain care. Upper back pain is less common than low back pain or neck pain. The spine, which is made of 33 interlocking vertebrae – connected by ligaments – is divided into five regions: cervical, thoracic, lumbar, sacral and coccygeal. The spinal column gives the upper body support and gives attachment points for the ribs and muscles in the back. Between these vertebrae are attachment points for the ribs and muscles of the back. Between the vertebrae are elastic intervertebral discs; these are critical to provide cushioning for each of these bones, and promote flexibility. When these discs begin to deteriorate, or are deformed, severe pain and impaired movement are possible.
Of the five regions of the spine, the thoracic area begins at the base of the neck, continuing to the low back – six inches below the bottom of the shoulder blades. This region is made of 12 vertebrae that are medium sized. (The neck is made of fine vertebrae, while the low back is thick.) The thoracic vertebrae are responsible for connecting the ribs, which attach to the breastbone. This bony (thoracic) cage surrounds the vital organs, protecting the heart, lungs and liver.
The thoracic region of the spin provides general structural stability. The most common cause of pain in this region is myofascial injury – muscle and ligament damage from accidents, poor posture, exercise, etc. When muscles in this region become strained, nerves can become inflamed causing pain. Another cause of discomfort in the upper back is thoracic facet joint pain. This can be caused by arthritis – a deterioration of the cartilage and lubricating fluid between joints. When this tissue degrades, bones rub against each other – limiting movement and causing pain. And yet two other causes of pain in the upper back are a bulging disc – when excess pressure is put on a disc and it bulges out of place causing nerve irritation, and herniated discs – when the inner material of the disc is weakened. Both bulging and herniated discs cause nerve pain. This nerve pain may send shooting pain into the limbs, and other areas of the body as well. This radiculitis – radiating, or shooting, nerve pain – can cause a variety of other issues if untreated. A final cause of upper back pain is spinal stenosis. This is a narrowing of the spinal canal that puts pressure on the spinal cord, which is typically caused by arthritis, herniated discs, congenital defects or Paget’s disease.
There are two types of general pain: acute and chronic. Acute upper back pain can be an emergency situation because the thoracic section is responsible for protecting vital organs. If the pain is sudden, intense and unexplainable, it is wise to seek immediate emergent care.
Chronic upper back pain is long-term pain, which could be caused from any of the aforementioned conditions, heart disease, gastroesophageal reflux disease or even pulmonary illnesses. Your pain physician should be able to determine the cause of pain with appropriate diagnostics. This may include an MRI, CT scan,or X-ray.
Treatment options for upper back pain may include:
- Medial Branch Blocks (MBBs) – Medial Branch Blocks are a minimally invasive non-surgical treatment used for arthritis-related neck and back pain.
- Pharmacotherapy – Administration of non-steroidal anti-inflammatory drugs (NSAIDs, or Ibuprofen-like drugs), Acetaminophen (Tylenol), muscle relaxants, and membrane stabilizing medications is often effective in treating upper back pain.
- Epidural Steroid Injections – Epidural injections are often used for degenerative disc disease and other pain syndromes.
- Facet injections – These minimally invasive injections can temporarily relieve neck or back pain caused by inflamed facet joints.
- Selective Nerve Blocks – These are used to help your practitioner identify which nerves are causing your pain.
- Discography – Discography involves the use of contrast dyes to obtain a detailed image of intervertebral discs.
Our physicians will be able to determine the most appropriate manner of treatment and cause of upper back pain.
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