Thoracic Back Pain

While you might not think that your daily activities, such as staring at your phone or computer screen, sitting for extended periods of time, driving long distances, or doing physically intense activities can cause upper back pain, the activities do add up and the pain is definitely felt. If you’re tired of experiencing upper back pain and not sure how to best treat your source of it, or even what caused it in the first place, the California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, Chula Vista areas is here to help. 

What is Upper Back Pain? 

While not as common as lower back pain or neck pain, upper back pain (also known as thoracic back pain) is quite common and can become chronic if left untreated. Of the five regions of the spine, the thoracic (upper back) region begins at the base of the neck and ends in the lumbar area where the back bends, about 6” below the shoulder blades. The 12 vertebrae of the thoracic region make up the part of the backbone to which the ribs are attached. This area of the ribcage houses vital organs like the heart, lungs, small intestine and liver. These particular vertebrae are medium-sized, allowing for the main purpose to be support and strength, protecting the internal organs, versus mobility, such as bending or twisting, like the cervical region of the spine. When any of the various parts of the thoracic back begin to deteriorate or are damaged, both impaired movement and severe pain can occur. 

There are numerous reasons why a person might experience upper back pain. The main causes can include trauma, medical condition or lifestyle. Most patients report upper back pain with feelings such as:

• Sharp, stabbing pain
• Constant dull ache
• Possible stiffness or muscle spasm
• Headaches
• Localized tightness or aching
• Radiating pain the arms, including numbness, tingling or weakness
• Pain the jaw or occipital area

Due to the fact that there are a host of reasons why a person might experience upper back pain, it’s imperative to partner with a pain management specialist who can properly diagnose and recommend a treatment plan that not only helps to get you out of pain, but that also fits within your lifestyle and your goals for an active and productive life. 

What Causes Upper Back Pain? 

Because the thoracic region provides great structure and support for the body, it’s often the brunt of physical upsets. There are many causes of upper back pain, but the main cause is myofascial injury, which refers to damage to the muscles and ligaments during instances or repeated trauma. Examples include: 

• Physical trauma: car accident, slip and fall 
• Sporting activity: if a person moves suddenly or in an extreme motion
• Overuse injury: lifting or pulling more than the body is capable of, causing sprains and strains
• Incorrect posture: sitting poorly for too long, repeatedly  

Other, non-myofascial injury causes of back pain include those stemming from joint issues, such as: 

• Arthritis: osteoarthritis is the most common type of arthritis that causes upper back pain
• Bulging or herniated discs: when excess wear and tear, as well as age, cause the discs to slip out of place or deteriorate, which puts pressure on the nearby nerves
• Spinal stenosis: the narrowing of the spinal canal that pinches and puts pressure on the nerves in the spinal column
• Nerve inflammation
• Thoracic facet syndrome: when the facet joints deteriorate over time and become painful and stuff 

Joint dysfunction generally leads to inflammation, pinching of the nerves in the spinal column, and bone-on-bone friction that causes not only pain but also limited range of motion. 

Disc issues, most often bulging or herniated discs, can also cause upper back pain. When discs located in between the vertebrae begin to break down, either by overuse, trauma or years of wear and tear, they can slip out of place and bulge outward into the spinal column. This causes pressure on the surrounding nerves, causing pain. If this problem isn’t treated and eventually becomes chronic, the discs themselves can burst and become herniated, which causes severe pain and requires more in depth treatment. Both bulging and herniated discs can cause pain, even causing shooting pain that is felt in other parts of the body including the limbs. 

Another cause of upper back pain is spinal stenosis, which is the narrowing of the spinal canal that puts pressure on the spinal cord and the nerves located within the spinal cord. Arthritis, herniated discs and physical defects are main causes of spinal stenosis. 

Less often, but still possible, causes of upper back pain include bone cancer, pulmonary disease (chronic inflammatory lung disease) and referred organ pain. 

How is Upper Back Pain Diagnosed? 

The best way to address upper back pain is to partner with a pain management specialist who is expertly trained in diagnosing and treating the cause of pain. They might ask questions such as: 

• When did the pain begin? 
• When during the day, or during what type of movement, do you feel the pain the most? 
• Does the pain come and go, or is it constant?
• What has helped you to feel less pain? 
• What have you done that has caused you to feel more pain? 
• Do you live an active or sedentary lifestyle?
• Did you have a recent accident, or an accident within the past year or so that was particularly bad?
• Do any relatives or family members have issues with upper back pain?

Additionally, your provider will perform a comprehensive physical exam, including having the patient demonstrate range of motion and when/if pain occurs. They will also evaluate the upper back for signs of inflammation, including redness and swelling, as well as any noticeable physical deformity. An in-depth review of your medical, health and family history will be discussed to determine if there are any notable causes of your upper back pain. 

Your provider will also rely on X-rays, MRIs and CT scans to get a better picture of what the naked eye cannot see, as well as determine if any trauma has occurred in the upper back or spine area. 

Utilizing every possible outlet to best diagnose the cause of upper back pain is crucial in determining the best treatment option, which is on a case by case basis and individual to each patient. Once the diagnosis has been made, the specialist will recommend treatment, always beginning with the most minimally-invasive option first before resulting in surgical treatments

There are two main types of upper back pain: acute and chronic. Acute pain is pain that is felt suddenly and the patient isn’t sure why. Because the thoracic region is responsible for protecting the body’s vital organs, it’s important to seek immediate medical care. For instance, upper back pain that is accompanied by chest pain or difficulty breathing could be the sign of a heart attack, requiring emergency attention. Chronic back pain, on the other hand, can last for months or longer, and could be caused by any of the above causes. While pain in other parts of the back could be due to trauma and get better with rest and over-the-counter medications, it’s important to note that pain in the thoracic region is generally due to medical conditions that call for professional intervention. 

The California Pain Consultants team is dedicated not only to their patients’ overall health and wellbeing, but also their livelihood. The team of pain management specialists will use only the best, comprehensive and state-of-the-art diagnostic tools to determine the cause of pain and the best course of action for getting each individual patient out of pain as safely and as efficiently as possible.

How Does Upper Back Pain Start?

There are a few ways that a person could begin to experience upper back pain, including: 

• Sudden: pain could begin instantly due to an injury, or really even out of the blue for no reason that the patient can define
• Delayed: sometimes pain from a traumatic event can take a few hours or days before it’s felt, usually because the inflammation process could not be immediate or the pain is felt in another part of the body other than where the trauma occurred
• Gradual: pain could first be hardly noticeable but then gradually worsen until it’s unbearable
• Upper back pain can also be intermittent, meaning that it comes and goes. Even if it does not constantly get worse over time, it can still cause enough sensation of pain where the person’s quality of life is hindered. Pain can also vary depending on the time of the day or the level of activity. 

What Treatments are There for Upper Back Pain?

Upper back pain symptoms can differ from person to person. Upper back pain symptoms and treatment plans can vary greatly depending on the problem’s underlying cause. Treatment options for non-emergency related thoracic pain include lifestyle changes and physical therapy, with a goal to strengthen the muscles, improve flexibility, and align the spine. Low impact exercises like yoga might also be recommended, as well as alternative medicine, such as chiropractic, massage and acupuncture. If these options don’t yield the results the doctor and patient are hoping for, the next steps could include: 

• Medications: both prescription and over-the-counter medications, such as ibuprofen, NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) and Tylenol can help to relieve pain
• Transcutaneous electrical nerve stimulator: also known as TENS, this non-invasive option helps to relieve pain caused by joint dysfunction, and works by replacing pain with a tingling feeling that the patient controls
• Medial Branch Blocks: also known as MBB, this is a minimally-invasive and non-surgical options for patients who are experiencing arthritis-related pain, and works by blocking the pain signals that are being transmitted to the brain
• Epidural Steroid Injections: a minimally-invasive option that is most often used to provide relief from degenerative disc disease and work by injecting a steroid and an anesthetic into the epidural space with the goal to reduce inflammation and immediately relieve pain
• Facet injections: used to reduce inflammation, control painful symptoms and increase range of motion in the upper back by delivering an anesthetic and/or steroid medication directly into the facet joint of the infected vertebrae
• Surgery: recommended with other less-invasive methods have been exhausted and the patient is still experiencing pain

It’s important to note that because of the thoracic spine’s rigidity and close location to the heart, lungs and other vital organs, pain management specialists will be less likely to suggest surgery when compared with cervical or lumbar spines. Unless medically necessary, it’s best to always try to relieve chronic pain with the most minimally-invasive options as possible before resorting to surgical therapies. 

The good news is that most non-emergency upper back pain (also those not related to trauma) is best resolved with rest, physical therapy and medication. However, it is essential that if pain is still being felt that a medical professional is involved. The goal is always to help the patient experience a pain-free life and enjoy his/her intended quality of life, with as few invasive options used as possible. 

When is Upper Back Pain an Emergency? 

Most upper back pain resolves with at-home care. However, there are cases when it’s imperative that a healthcare professional is involved because there might be a sign that a more serious medical condition has developed. This includes: 

• Upper back pain that doesn’t improve at all after a week
• There is a tingling sensation in the upper legs or buttock area
• Severe pain or spasms are felt
• Sudden fever, weight loss or bladder/bowel problems occur
• Radiating pain or pins-and-needles tingling in the chest or abdomen
• Issues walking
• Severe headache

How Can I Prevent Upper Back Pain? 

While a significant amount of upper back pain is caused by medical conditions, there are some at-home remedies and lifestyle changes you can make that can help you thwart the effects of upper back pain. These include:

• Exercise: stretching and strengthening your upper back muscles will help to provide greater support for potential injuries
• Good posture: helps to keep the neck and upper back in better alignment with the spine 
• Reducing stress: breathing, relaxation techniques and meditation help to reduce the feeling of pain, as well as helping to reduce the feeling of pain from compounding

If you are experiencing upper back pain that is causing you to worry, or you feel that the pain should have been resolved by now, please reach out to the California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, Chula Vista areas. We are here to help properly and expertly diagnose the source of pain as well as provide the best treatment option for you so that your upper back pain is resolved as quickly and as comfortably as possible. Call or click to schedule an appointment today.