Upper back pain occurs in the thoracic region of the spine, and is less common than lower back pain due to the stability, strength and limited movement of the upper back. The pain may be acute or chronic, a dull ache or a sharp stabbing sensation, and may be accompanied by stiffness. Typically the discomfort interferes with the activities of daily living, whether it is a constant pain or brought on only by specific movements. However, if upper back pain is present along with difficulty breathing or chest pain, this may indicate a heart attack and requires immediate emergency treatment.

The causes of upper back pain include:

• Arthritis, a condition causing deterioration of the bony structures and cushioning discs between bones.

• Physical injury to the muscles, tendons, or ligaments of the vertebrae.

• Fibromyalgia, a type of rheumatism, which affects the soft tissues and muscles.

• Herniated disc.

• Referred organ pain from the heart or lungs.

• Bone cancer.

Injury to the muscles and ligaments of the upper back may be caused by:

• Traumatic situation, such as a car accident or other physical trauma

• Incorrect posture, especially while sitting at a desk with a computer

• Sporting activity, particularly sudden or extreme movements

• Overuse injury

Another less common cause of upper back pain is joint dysfunction, which may be a result of any of the following conditions:

• Arthritis, leading to damaged cartilage and decreased lubrication between bony structures of the spine

• Bulging discs, due to pressure on vertebrae forcing spinal discs to bulge out of position

• Herniated disc, marked by weakness and internal damage to the disc

• Spinal stenosis, or narrowing of the spinal canal due to arthritis, herniated discs, Paget’s disease, or congenital defects

All the conditions mentioned above result in pinched nerves, inflammation and impaired movement leading to upper back pain.

Bone cancer, pulmonary disease and referred organ pain may also be the root cause of upper back pain.

Diagnosis

The doctor will need to know how movement affects the pain and how the upper back pain has interfered with activities of daily living. A physical exam will be performed, in which the physician will look for signs of inflammation such as tenderness, redness and swelling and with an assessment of range of motion. Imaging studies, such as X-rays, CT scans or MRIs may be performed to help the physician diagnose joint dysfunction or problems with surrounding muscles, ligaments and tendons. Discography, an imaging tool using contrast dye, may be used to help the physician visualize details of the intervertebral discs.

Treatment

In the case of upper back pain caused my myofascial injury, treatment is based on strengthening muscles, improving alignment of the spine and increasing flexibility.

These noninvasive treatments include:

• Physical therapy

• Massage therapy

• Chiropractic or osteopathic manipulation

• Acupuncture

Medications to reduce inflammation and decrease upper back pain may be prescribed:

• COX-2 inhibitors

• NSAIDs — Nonsteroidal Anti-Inflammatory Drugs

• Acetaminophen

• Ibuprofen

Muscle relaxants reduce pain by treating muscle spasms.

If the pain is severe or if it’s caused by joint dysfunction, local injections to the joint are a minimally invasive treatment:

• Medical Branch Blocks (MBBs) for arthritis related pain

• Facet Injections to reduce inflammation in the facet joints of the vertebrae

• Epidural Steroid Injections for degenerative disc disease

Selective nerve blocks are a procedure performed by physicians to identify which nerves are responsible for transmitting pain signals. Identifying the route of pain signals may help the physician find the cause of pain to assist in treatment determination.

The goal of treating upper back pain is to relieve discomfort by treating the underlying cause. Noninvasive treatments are usually effective in relieving pain and returning the patient to an active lifestyle.

Resources

1. Arizona Pain. Upper Back Pain. Retrieved from

2. Talbot Sellers, DO. (April 17, 2002) All About Upper Back Pain. Retrieved from

3. Robert Williams M.D. (December 20, 2010) Upper Back Pain: Causes. Retrieved from