Upper Back Pain
Treated by Top Pain Doctors in San Antonio, Austin, Houston, Dallas, Texas
Upper back pain is less common than lower back pain but still results in significant discomfort and the inability to enjoy an active lifestyle. The upper back is also known as the thoracic region, and it includes the spine as well as surrounding muscles, tendons and ligaments. Beginning at the base of the neck and continuing to the lumbar area where the back bends, the thoracic region is where the ribs attach and the ribcage houses vital organs. Anatomy of the thoracic area is more stable than the lower back, functioning to provide support and strength to the torso and protect internal organs, rather than movement (such as bending).
Upper back pain may be caused by muscle injury, joint dysfunction in the spine or referred organ pain. It may manifest as a sharp, stabbing pain or a constant dull ache. Stiffness or muscle spasm may also be present. Upper back pain accompanied by chest pain or difficulty breathing may be signaling a heart attack, and warrants emergency attention.
Possible causes of upper back pain:
- Arthritis, resulting in deterioration of the bony structures and loss of cushioning discs between bone
- Physical trauma to the muscles, tendons or ligaments of the vertebrae
- Fibromyalgia, an auto-immune disease affecting the soft tissues and muscles
- Herniated disc
- Referred organ pain from the heart or lungs
- Bone cancer
The spine is a chain of 33 interlocking vertebrae supported by muscles and ligaments. It’s divided into cervical, thoracic, lumbar, sacral and coccygeal regions, originating in the neck and terminating at the tailbone. Intervertebral discs provide cushioning between the bones of the vertebrae and make flexible movement possible. The thoracic region originates at the base of the neck and continues to the lower back, six inches from the base of the shoulder blades. It refers to 12 vertebrae, each with attachment points for the ribs. Myofascial injury and joint dysfunction are the two most common causes of upper back pain.
Myofascial injury refers to damage to muscles and ligaments, and may be caused by one of several events:
- Physical trauma, such as a car accident
- Sporting activity, especially sudden or extreme movements
- Overuse injury, performing a repetitive task puts strain on muscles, tendons and ligaments
- Incorrect posture, especially while sitting at a desk with a computer
Joint dysfunction may be the result of a disease process or physical injury, such as:
- Arthritis, causing degradation of the bones and cartilage, as well as loss of lubricating fluid between bones of the spine
- Bulging discs, occurring when excessive pressure on the vertebrae forces spinal discs out of place
- Herniated disc, the result of weakness and internal damage to the spinal disc
- Spinal stenosis, a narrowing of the spinal canal due to arthritis, herniated discs, Paget’s disease or congenital defects
Joint dysfunction can cause pinching of the nerves, inflammation, friction of bone against bone and impaired movement, all of which manifest as upper back pain.
Other causes of upper back pain include:
- Bone cancer
- Pulmonary disease
- Referred organ pain
If upper back pain is severe or lasts more than a few days, a physician should examine the individual. To begin, the patient will be interviewed regarding the history and onset of pain. The physician will ask the patient to describe the character of their pain and how movement affects the pain. During a physical exam, the physician will assess the upper back for signs of inflammation (redness and swelling) as well as physical deformity. The patient will demonstrate range of motion so the physician can see how the pain inhibits movement. Imaging studies such as X-rays, CT scans, or MRIs (Magnetic Resonance Imaging) may be ordered to visualize the spine and supporting tissues. Discography uses contrast dye to visualize the intervertebral discs and diagnose problems with the spine.
Treatment of upper back pain is focused on healing the underlying problem. Noninvasive interventions are effective at treating myofascial injury by strengthening the muscles, improving flexibility, and aligning the spine. The physician may order physical therapy, Chiropractic manipulation, massage therapy or acupuncture.
Inflammation and upper back pain are often treated with medications, both prescription and over-the-counter, including:
- COX-2 inhibitors
- NSAIDs, Nonsteroidal Anti-Inflammatory Drugs
Muscle relaxants may also be prescribed to relieve pain by eliminating muscle spasms.
Upper back pain caused by joint dysfunction may be effectively treated with minimally invasive injections to the site:
- Medical Branch Blocks (MBBs) for arthritis related pain
- Facet Injections to decrease inflammation of the vertebral facet joints
- Epidural Steroid Injections to treat degenerative disc disease
Selective nerve blocks may be administered by the physician to determine the route along which pain signals are being transmitted, locating the origin of upper back pain and making the physician better informed to treat the pain.
Upper back pain is most often resolved with rest and noninvasive interventions. Treating the underlying cause of pain is necessary to obtain long-term relief. The goal of upper back pain treatments is to restore strength and stability of the thoracic region so patients may return to a healthy, active lifestyle.
- Arizona Pain. Upper Back Pain. Retrieved from http://arizonapain.com/pain-center/pain-conditions/upper-back-pain/
- J. Talbot Sellers, DO. (April 17, 2002) All About Upper Back Pain. Retrieved from http://www.spine-health.com/conditions/upper-back-pain/all-about-upper-back-pain
- Robert Williams M.D. (December 20, 2010) Upper Back Pain: Causes. Retrieved from http://www.localhealth.com/article/upper-back-pain/causes