Upper Back Pain

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Upper Back Pain 2017-08-23T13:05:34+00:00

What Is Upper Back Pain?

Are you suffering from pain in your upper back? Upper back pain is any type of pain that stretches from the middle of your back, up through and across your shoulders. Upper back pain can be caused by:

  • Fracture in one of the vertebrae
  • Sports or overuse injuries
  • Poor posture or ergonomic set-up during work
  • Neck or shoulder strain
  • Arthritis, especially osteoarthritis
  • Spinal disorders, like scoliosis or kyphosis
  • Herniated discs
  • Degenerative disc disease
  • Spinal stenosis
  • Osteopenia
  • Osteoporosis
  • Cancer or infection, in severe cases

With so much focus on lower back pain, people with pain in their upper backs can be left without the help they need. In this post, we give information about what causes pain in your upper back and what treatments can help.

Video: What Causes Upper Back Pain?

The upper back is also known 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. This thoracic back pain is a source of discomfort 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. This video talks about some of its causes.

Why Does My Upper Back Hurt So Much?

The most common causes of upper back pain occur from:

  • Accidents
  • Sports injuries, both recent and old ones that haven’t healed correctly
  • Poor posture
  • Overuse, at work or during exercise

When damage occurs to the muscles in the upper back, the immune system releases inflammatory molecules that lead to pain. Accidents or injuries can lead to pain that resolves with rest. But sometimes, this pain becomes worse. If you’re experiencing pain for three months or more, it could be considered chronic pain.

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 creep up towards your ears. And, your head inches forward, putting pounds of pressure on your upper back and shoulders.

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. With enough time, it could significantly damage the muscles and vertebrae in the upper back.

Other habits that can lead to stress in the upper back include:

  • Poor ergonomic set-ups at work that lead to ongoing neck and shoulder strain
  • Lack of exercise
  • Improper lifting techniques
  • Obesity
  • Smoking
  • Carrying bags that are too heavy
  • Weak core (abdominal) muscles

Arthritis 

Upper back pain may also be caused by medical conditions like arthritis. Arthritis is an inflammatory condition in our joints. It can lead to chronic pain and stiffness. Arthritis can cause structural damage to the facet joints of the thoracic vertebrae in the upper back or the ribs.

The most common type of arthritis is osteoarthritis. The effects of daily living and wear-and-tear on the body can lead to inflammation in our joints.

Spinal disorders

Spinal disorders, like scoliosis or kyphosis, put unnatural strain on the vertebrae of the back. This can lead to pain that worsens over time as the condition progresses. If you suffer from spinal disorders, it’s important to work closely with your doctor. They can suggest braces, therapies, or surgeries that can help.

Herniated discs 

Intervertebral disc bulging or herniation may also cause chronic upper back pain.

Intervertebral discs are rings of tissue that are found between each vertebra in your spine. They act as shock absorbers and provide support for the spine. These 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.

Degenerative disc disease

Degenerative disc disease refers to damage that occurs in the intervertebral discs due to aging. This condition can be associated with a wide variety of specific pain symptoms. Patients may experience:

  • A localized stabbing pain
  • General and widespread pain
  • A lack of feeling
  • Prickly sensations
  • Pain that extends into the extremities

The following video gives information about this condition.

 

Spinal stenosis

Some people suffer from spinal stenosis. With this condition, the spinal canal itself narrows. This happens from age-related wear-and-tear, especially if you work in a physical job. The symptoms of this condition are pretty obvious. You’ll feel pain in the neck and back, especially when you stand straight. It’s often relieved when you bend over. Other more serious symptoms include:

  • Numbness
  • Muscle weakness
  • Impaired bladder or bowel control

Other causes 

Small fractures to the thoracic spine bones can also lead to chronic pain. These fractures can be associated with degenerative bone conditions, including osteopenia and osteoporosis.

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

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.

How Can I Stop My Upper Back Pain?

Your first step should be to 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 upper back pain treatments:

  • Medications
  • Epidural steroid injections
  • Facet joint injections
  • Discectomy
  • Vertebroplasty or kyphoplasty
  • Surgery

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 help with conditions like arthritis. Your pain doctor will use a small needle to deliver the corticosteroids to the affected area. 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 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

These are relatively safe procedures for most patients, however. They can also help you avoid surgery and the risks associated with that. Talk to your doctor to learn more about this option.

Discectomy

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 quality of 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.

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References

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  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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