Upper Back Pain
Upper back pain is less common than lower back pain, because the anatomy of the upper back is more stable and has limited movement compared to the bending action of the lumbar region (lower back). However, patients who suffer from upper back pain may experience significant discomfort and inability to perform daily activities.
The causes of upper back pain include:
- Injury to the muscles, tendons or ligaments of the vertebrae.
- Arthritis, marked by deterioration of the bony structures and cushioning discs between bone.
- Fibromyalgia, a form of rheumatism affecting soft tissues and muscles.
- Spinal disc herniation.
- Referred pain from internal organs such as the heart.
- Bone cancer.
Upper back pain affects the thoracic region of the spine, which includes the posterior chest and abdomen, and terminates at the lumbar area, where the back bends. The pain may be short-lived or chronic, lasting more than three months. It may be characterized as a dull ache or a sharp, stabbing sensation. Stiffness may accompany back pain. Pain may be constant or occur only during certain movements. Individuals experiencing upper back pain with chest pain or difficulty breathing may be having a heart attack and should be seen in an emergency medical center.
The spine is composed of 33 interlocking vertebrae, which are connected by ligaments and supported by muscles. Cervical, thoracic, lumbar, sacral and coccygeal are the five regions of the spine, beginning at the neck and ending at the tailbone. Intervertebral discs provide cushioning between the vertebral bones and make the spine flexible for movement. The upper back refers to the thoracic area, starting at the base of the neck and ending at the lower back, six inches from the base of the shoulder blades. There are 12 thoracic vertebrae, which serve as attachment points for the ribs, forming a bony cage to protect the vital organs.
The two most common causes of upper back pain are muscular irritation and joint dysfunction. Myofascial injury, damage to the muscles and ligaments, is the most common cause of upper back pain.
Strained muscles may be the result of:
- Poor posture.
- A traumatic accident, such as a car accident or other physical trauma.
- Sudden movement during a sporting activity.
- An overuse injury.
Joint dysfunction may be related to arthritis, and the accompanying damage to the cartilage and loss of lubricating fluid in the spine. This disease process causes degradation of the tissues and results in bone rubbing against bone, which is painful and limits movement of the spine. Another case of joint dysfunction is bulging discs, which occurs when pressure on the spinal disc causes it to bulge out of place. A herniated disc is caused by weakness and internal damage to the disc. Both bulging and herniated discs may cause upper back pain. Spinal stenosis, a narrowing of the spinal canal caused by arthritis, herniated discs, Paget’s disease or congenital defects, is a condition that places pressure on the spinal cord and causes upper back pain.
Other causes of upper back pain are tumors in the bone, referred organ pain, or pulmonary disease.
Individuals experiencing severe upper back pain or those whose pain fails to resolve after a few days should consult a physician. The exam will begin with questions regarding the history and onset of pain. During a physical exam the doctor will look for areas of redness, tenderness and swelling as well as assessing the patient’s range of motion and how movement affects the pain. Imaging studies, such as X-rays, CT scans, or MRIs (Magnetic Resonance Imaging) may be ordered to visualize the muscles, bones and tissues of the spine. Discography is an imaging study, which uses contrast dye to visualize the details of the intervertebral discs.
If the upper back pain is a result of muscular irritation, manual treatments may be ordered:
- Exercises to strengthen the muscles and provide better support to the spine
- Physical therapy
- Massage therapy
- Chiropractic or osteopathic manipulation
Large muscles in the upper back may benefit from stretching and strengthening exercises. Anti-inflammatory medications such as COX-2 inhibitors, NSAIDs, Tylenol or Ibuprofen act to decrease inflammation and reduce pain. Muscle relaxants reduce pain by treating muscle spasms.
Local injections are also used to treat upper back pain, including:
- Medical Branch Blocks (MBBs) for arthritis related pain.
- Epidural Steroid Injections for degenerative disc disease.
- Facet Injections to reduce inflammation in the facet joints of the vertebrae.
Selective nerve blocks are useful in identifying the nerves responsible for transmitting pain signals and inhibiting the sensation of upper back pain.
Treatment for upper back pain is minimally invasive and seeks to relieve pain and get the patient back to normal daily activities.
- Arizona Pain. Upper Back Pain. Retrieved from http://arizonapain.com/pain-center/pain-conditions/upper-back-pain/
- J. Talbot Sellers, DO. (April 17, 2002) All About Upper Back Pain. Retrieved from http://www.spine-health.com/conditions/upper-back-pain/all-about-upper-back-pain
- Robert Williams M.D. (December 20, 2010) Upper Back Pain: Causes. Retrieved from http://www.localhealth.com/article/upper-back-pain/causes