Upper Back Pain

What is upper back pain?

Upper back pain regularly sends patients to the doctor to seek help. Upper back pain is not as common as lower back pain or neck pain, but it can become chronic if left untreated. Understanding what causes it starts with a discussion of your spinal anatomy.

Your spine is made of 33 interlocking vertebrae connected by ligaments. Between the supportive vertebrae are attachment points for the ribs and muscles of your back. Intervertebral discs separate each vertebra and provide critical cushioning between them and promote flexibility.

Your spine is divided into five regions:

• Cervical
• Thoracic
• Lumbar
• Sacral
• Coccygeal

Of the five regions of the spine, the thoracic area (the upper back) begins at the base of the neck, continuing to your lower back, approximately six inches below the bottom of the shoulder blades.

This region is made of 12 vertebrae that are medium-sized, as compared to the fine vertebrae of the neck and the sturdy, thick bones of your lower back. These thoracic vertebrae are responsible for connecting the ribs, which attach to the breastbone. This bony cage surrounds the vital organs, protecting your heart, lungs, and liver.

When any part of the thoracic spine begins to deteriorate or is damaged, severe pain and impaired movement can occur in your upper back.

What are major upper back pain causes?

The thoracic region of your spin provides general structural stability to the core of the body. The most common cause of pain in this region is myofascial injury. This occurs from muscle and ligament damage during accidents or trauma.

Other causes of upper back pain can include the following:

• Chronic poor posture
• Strain during exercise
• Nerve inflammation
• Thoracic facet joint pain
• Arthritis
• Bulging or herniated discs
• Spinal stenosis

Disc issues

Two other less common causes of pain in the upper back are bulging or herniated discs.

You experience excessive pressure on your intervertebral discs, either by trauma or just over time as the discs begin to deteriorate. The discs can then begin to bulge out through the spinal column, placing pressure on the nerves and causing pain.

If this problem becomes chronic, the disc may burst and become herniated. Once disc herniation occurs, the pain may become unbearable and require more interventional treatment.

Both bulging and herniated discs cause nerve pain. This nerve pain may send shooting pain into your limbs and other areas of the body. This radiculitis (radiating or shooting nerve pain) can cause a variety of other issues if you don’t treat it.

Spinal stenosis

A final major cause of upper back pain is spinal stenosis. This is a narrowing of your spinal canal that puts pressure on the spinal cord.

Arthritis, herniated discs, congenital defects, or Paget’s disease are the major causes of this condition.

Diagnosing upper back pain

There are two types of pain: acute and chronic.

Acute upper back pain can be an emergency situation because the thoracic section is responsible for protecting vital organs. If your pain is sudden, intense, and unexplainable, it is best to seek immediate emergency care. Upper back pain is an often-unrecognized symptom of heart attack in women. Don’t ignore it.

Chronic upper back pain is long-term pain that lasts for three months or more. It may be caused from any of the aforementioned conditions, as well as heart disease, gastroesophageal reflux disease, or even pulmonary illnesses.

To determine the cause of your pain, your doctor will take a thorough medical and family history and conduct a physical exam. This may also include an MRI, CT scan, or X-ray to look for damage or visible trauma to the spine or surrounding muscles. Once a diagnosis is made, your doctor will work with you to design a treatment plan. This plain should relieve your symptoms as well as address the underlying cause of your pain.

How to treat upper back pain

Treating upper back pain may start with lifestyle interventions. These often include:

• Physical therapy
• Changes to proper posture
• Changes to the diet to help maintain a healthy weight

Gentle exercises such as yoga and other complementary medical approaches (e.g., acupuncture, chiropractic, and massage) can also help relieve upper back pain.

Other more interventional treatment options for upper back pain may include the following.

Medications

Non-steroidal anti-inflammatory drugs (NSAIDs, or ibuprofen-like drugs), acetaminophen (Tylenol), muscle relaxants, and membrane-stabilizing medications are often effective in treating acute upper back pain.

TENS therapy

A transcutaneous electrical nerve stimulator (TENS) device is a non-invasive way to confuse pain signals to the brain.

It replaces pain with a patient-controlled gentle tingling sensation instead.

Medial branch blocks (MBBs)

Medial branch blocks are a minimally-invasive, non-surgical treatment used for arthritis-related neck and back pain.

These block pain signals from being transmitted to the brain and can also be used as a diagnostic tool.

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 from inflamed facet joints.

These are placed directly into the facet joint of the affected vertebrae and can help with pain and range of motion.

Surgery

Surgery is a treatment of last resort for upper back pain. It’s best only considered when other more conservative treatments have been unsuccessful.

References

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2. Lu, W, Li, YH, & He, XF. (2010). Treatment of large lumbar disc herniation with percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint. World J Radiol, 28(2), Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21160944
3. Siemienow et al (2008). Identifying serious causes of back pain: cancer, infection, fracture. Cleveland Clinic Journal of Medicine, 75(8) 557-566 http://www.ccjm.org/content/75/8/557.full.pdf+html
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