What Is Upper Back Pain?

The upper back is also know as the thoracic region, and spans from the neck to the lower back. The vertebrae that make up the upper back are connected to the ribs and to the muscles of the back. The upper back is a source of pain for many individuals, and while it is not as common as neck or lower back pain, it can still result in severe pain and have a negative impact on an individual’s life. Upper back pain can be categorized as either acute or chronic in nature, depending on the length of time it lasts for. Acute cases of upper back pain generally last for less than three months and are commonly associated with short-term injuries or inflammation of the thoracic spine. Conversely, cases of chronic upper back pain generally last longer than three months and are sometimes indicative of nerve damage or structural damage to the spinal bones.

Causes Of Upper Back Pain

Acute upper back pain may be caused by damage to the muscles of the upper back region. This can occur as the result of accidents, sports injuries, or by poor posture. When damage occurs to muscles, the immune system releases inflammatory molecules, which causes pain.

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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.

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 and cause irritation and inflammation of the nearby spinal nerves, resulting in chronic upper back pain.

The thoracic region of the spinal cord and associated thoracic spinal 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 lead to chronic upper back pain. Furthermore, small fractures to the thoracic spine bones can lead to chronic upper back pain. These fractures can be associated with degenerative bone conditions, including osteopenia, osteoporosis, and cancer. Conditions that lead to chronic upper back pain are associated with increasing age.

Treatments For Upper Back Pain

Spinal CordFirst line pharmacological treatment for upper back pain is oral pain medications. These medications include naproxen, ibuprofen, acetaminophen, and anticonvulsants such as carbamazepine. However, the downside to using these medications include the possibility of overuse, addiction, and potential organ damage that is associated with prolonged use.

If first line pharmacological medications fail to provide relief of upper back pain, epidural corticosteroid injections may be recommended. Corticosteroids help to reduce inflammation so they are often used to treat pain that is associated with conditions such as arthritis. Corticosteroids are delivered to the affected spinal nerve by way of a small needle. Often, the corticosteroid is combined with a local anesthetic, such as lidocaine. The local anesthetic helps to reduce upper back pain by numbing the area.

Corticosteroid injections can also be given into the area of the facet joint if the facet joint is the source of a patient’s upper back 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 that is injected may cause severe discomfort in the chest, as well as numbness. Nerve blocks in the upper back region can lead to cardiac damage in severe cases. Furthermore, the use of corticosteroids is associated with side effects such as mood swings, weight gain, and future risk of arthritis.

If upper back pain is being caused by a disc herniation, a discectomy may be performed. This minimally invasive treatment involves removing the bulging part of the intervertebral disc, or the entire disc itself. Discectomy is sometimes referred to as percutaneous disc decompression and has been shown to provide significant pain relief for up to two years after the procedure. The risks associated with discectomy include infection, bleeding, and nerve damage.

If a spinal fracture is the cause of a patient’s upper back pain, a vertebroplasty may be recommended. 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, which involves inserting and inflating a small balloon to help support the bone so that the needle is able to reach the fractured area. Both a vertebroplasty and a kyphoplasty are effective treatment options for thoracic fractures. There are minimal risks involved, including bleeding, and infection at the injection site. There is also the potential for the acrylic cement to leak from the bone, which can result in inflammation of nerves and surrounding soft tissues, thereby leading to increased pain.

Conclusion

Upper Back PainUpper back pain is not as common as lower back or neck pain but can still result in significant pain, which can have a detrimental impact on an individual’s ability to perform daily activities. Often, acute cases of upper back pain are the result of muscle strain caused by accidents, sports injury, poor posture, or by inflammation. Conversely, chronic cases of upper back pain are often associated with medical conditions including arthritis, spinal fracture, and disc herniation. Acute upper back pain is usually initially treated with oral pain medications. However, if these medications fail to provide pain relief, epidural injections, facet joint injections, or medial branch blocks may be recommended. In cases of chronic upper back pain, treatment is dependent on the cause of the pain. Treatment options for upper back pain can be effective for moderate to long-term relief of pain.

References

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