Upper Back Pain

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Upper Back Pain 2017-07-05T19:17:48+00:00

What Is Upper Back Pain?

Upper back pain is any type of pain that stretches from the middle of your back, up through and across your shoulders.

With so much focus on lower back pain, those with pain in their upper backs can be left without help or the treatments they need. In this post, we talk about what causes pain in your upper back and how you can find treatments to relieve it.

The upper back is also know as the thoracic region. It spans from the neck to the lower back.

The vertebrae that make up the upper thoracic spine are connected to the ribs and muscles of the back. The upper back is a source of pain for many. While it is not as common as neck or lower back pain, it can still result in severe pain. It can also have a negative impact on an individual’s life.

Upper back pain is either acute or chronic in nature, depending on the length of time it lasts for. Acute cases of pain:

  • Generally last for less than three months
  • Are associated with short-term injuries or inflammation of the thoracic spine

Cases of chronic upper back pain:

  • Last longer than three months
  • Are sometimes indicative of nerve damage or structural damage to the spinal bones

Video: What Causes Upper Back Pain?

Why Does My Upper Back Hurt So Much?

Acute pain may be caused by damage to the muscles of the upper back region. This can occur as the result of:

  • Accidents
  • Sports injuries
  • Poor posture

When damage occurs to these muscles, the immune system releases inflammatory molecules, which cause pain. While these causes can all lead to short-terms of back pain, they can also lead to long-term, chronic, and severe upper back pain.

Chronic upper back pain is associated with:

  • Pre-existing injuries
  • Poor ergonomic set-ups
  • Lack of exercise
  • Improper lifting techniques
  • Obesity
  • Stress
  • Poor posture
  • Smoking
  • Carrying bags that are too heavy
  • Weak core (abdominal) muscles

In the case of an injury or a strain, muscles and ligaments in the upper back may be stretched too far or torn, resulting in pain and inflammation.

Upper Back Pain | PainDoctor.com

Stress and poor posture

Consider your daily desk set-up. When you’re physically or emotionally stressed, you often sit with your whole body slumped forward. Your chin juts out. Your shoulders likely will creep up towards your ears. You may even shorten your abdominal muscles.

This classic office posture offers little support for our muscles. And, it can lead to long-term pain and discomfort. When we finally do get back into alignment, our backs may feel sore or tired as our muscles re-learn their job.

Arthritis 

Muscle inflammation may also be caused by medical conditions such as arthritis. Arthritis may also result in structural damage to the thoracic vertebrae or the ribs.

Additionally, upper back pain can occur when there is damage to the facet joints of the thoracic spine.

Herniated discs 

Intervertebral disc bulging or herniation may cause chronic upper back pain. Intervertebral discs are rings of tissue that are found between each vertebra in the spine. They act as shock absorbers and provide support for the spine.

Intervertebral discs consist of a spongy inner layer and a tough outer layer. When there is deterioration of the outer layer, the inner layer can protrude outwards. This causes irritation and inflammation of the nearby spinal nerves. And, this can result in chronic upper back pain.

Other causes 

The upper thoracic spine and associated nerves control the upper back. Damage to the thoracic nerves can result in chronic pain.

While it’s relatively rare, certain cancers that affect the thoracic cavity or thoracic spine may also lead to chronic upper back pain.

Furthermore, small fractures to the thoracic spine bones can lead to chronic pain. These fractures can be associated with degenerative bone conditions, including:

If you’re experiencing any numbness in your arms, legs, or chest, or loss of bowel control, it could be a sign of a serious problem. Likewise, if you suffer from a lung condition. Always talk to a doctor immediately if you’re experiencing these symptoms or related conditions with upper back pain.

Treatments For Upper Back Pain

If you suffer from pain, there is help. From lifestyle interventions to minimally-invasive procedures, you can find the relief you need.

Talk to your doctor about lifestyle interventions. At-home treatments for upper back pain include:

Working with a physical therapist can also help immensely. They’ll work to strengthen underused muscles and will train you on better ways to sit and move during the day. Further, a chiropractor can also perform spinal adjustments to realign any abnormalities.

If these interventions don’t work, you do have other options. Talk to your pain specialist about the following treatments.

Upper Back Pain | PainDoctor.com

Medications 

First-line pharmacological treatment for this type of pain is oral pain medications. These medications include:

  • Naproxen
  • Ibuprofen
  • Acetaminophen
  • Anticonvulsants, such as carbamazepine

However, the downside to using these medications include the possibility of overuse, addiction, and potential organ damage.

Epidural steroid injections

If first line pharmacological medications fail to provide relief of upper back pain, epidural corticosteroid injections may help.

Corticosteroids can reduce inflammation in the body. They are often used to treat pain that is associated with conditions such as arthritis. Your pain doctor will use a small needle to deliver the corticosteroids to the affected nerve. Often, they’ll combine the corticosteroid with a local anesthetic, such as lidocaine. The local anesthetic helps to reduce pain by numbing the area.

You can watch an epidural steroid injection procedure take place in the following video.

 

Facet joint injections 

Corticosteroid injections can also be given into the area of the facet joint if this is the source of a patient’s pain. Additionally, medial branch blocks can be used to help control upper back pain. However, injection procedures have the potential for certain side effects.

For example, the anesthetic may cause severe discomfort in the chest. It could also cause numbness. Nerve blocks in the upper back region can lead to cardiac damage in severe cases. Furthermore, corticosteroids are associated with side effects such as:

  • Mood swings
  • Weight gain
  • Future risk of arthritis

Talk to your doctor to understand your risks.

Discectomy

Though rare, if your upper back pain is caused by a disc herniation, your pain doctor can perform a discectomy. This is a minimally invasive treatment. It involves removing the bulging part of the intervertebral disc, or the entire disc itself.

Discectomy is sometimes referred to as percutaneous disc decompression. It can provide significant pain relief for up to two years after the procedure. The risks associated with discectomy include infection, bleeding, and nerve damage.

Vertebroplasty or kyphoplasty

If a spinal fracture is the cause of your pain, a vertebroplasty could help. A vertebroplasty procedure involves anesthetizing the area above the fractured vertebrae, followed by the insertion of acrylic cement, which helps to seal the fracture.

A kyphoplasty is a variation of this procedure. It involves inserting and inflating a small balloon to help support the bone. That way, the needle is able to reach the fractured area.

Both vertebroplasty and kyphoplasty are effective treatment options for thoracic fractures. Risks include bleeding and infection at the injection site. There is also the potential for the acrylic cement to leak from the bone. This can result in inflammation of nerves and surrounding soft tissues.

Conclusion

Pain in the upper back is not as common as lower back or neck pain. However, it can still result in significant pain. This can have a detrimental impact on your everyday life.

Your pain doctor will first prescribe lifestyle changes or medication for acute, or short-term, pain. However, if these fail to provide pain relief, your pain doctor may recommend epidural injections, facet joint injections, or medial branch blocks. In cases of chronic upper back pain, treatment is dependent on the cause of the pain.

Working with a highly-skilled pain specialist can help you find a diagnosis for your pain. They’ll also identify treatments that could work for you. Then, they’ll coordinate with your full healthcare team to help you find the relief you need.

To find a pain specialist in your area, click the button below.

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References

  1. Lim JB, Sharma H, MacDuff E, Reece AT. Primary osteosarcoma of the spine a review of 10 cases. Acta orthopaedica Belgica. Aug 2013;79(4):457-462.
  2. Reynolds J, Belvadi Y, Kane A, Poulopoulos M. Thoracic Disc Herniation leads to Anterior Spinal Artery Syndrome. Demonstrated by Diffusion.Weighted Magnetic Resonance Imaging (DWI): A Case Report and Literature Review. The spine journal : official journal of the North American Spine Society. Nov 16 2013.
  3. Aydin AL, Sasani M, Erhan B, Sasani H, Ozcan S, Ozer AF. Idiopathic spinal cord herniation at two separate zones of the thoracic spine: the first reported case and literature review. The spine journal : official journal of the North American Spine Society. Aug 2011;11(8):e9-e14.
  4. Soultanis KC, Mavrogenis AF, Starantzis KA, et al. When and how to operate on thoracic and lumbar spine fractures? European journal of orthopaedic surgery & traumatology : orthopedie traumatologie. Oct 25 2013.
  5. Buy X, Gangi A. Percutaneous treatment of intervertebral disc herniation. Seminars in interventional radiology. Jun 2010;27(2):148-159.
  6. Manchikanti L, Manchikanti KN, Manchukonda R, Pampati V, Cash KA. Evaluation of therapeutic thoracic medial branch block effectiveness in chronic thoracic pain: a prospective outcome study with minimum 1-year follow up. Pain physician. Apr 2006;9(2):97-105.

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