Condition Basics

What is upper and middle back pain?

Upper and middle back pain is pain that occurs anywhere from the base of your neck to the bottom of your rib cage. Your ribs attach to the sternum and attach to and wrap around your back. If a nerve in this area is pinched, irritated, or injured, you may also feel pain in other places where the nerve travels. For example, you may have pain in your arms, legs, chest, and belly.

The upper and middle back is called the thoracic spine. Back pain in this area is less common than low back or neck pain. That's because the bones in the upper and middle back don't move as much as the lower back or neck bones.

What causes it?

Many things can cause upper and middle back pain. These include poor posture; overuse or injury of the muscles, ligaments, or discs that support the spine; a vertebra fracture; pressure on the spinal nerves from problems such as a herniated disc; and osteoarthritis.

What are the symptoms?

Common symptoms of upper and middle back pain are muscle tightness or stiffness or a dull, burning, or sharp pain. More serious symptoms that need to be treated right away include weakness in your arms or legs, loss of bowel or bladder control, and numbness or tingling in your arms, legs, chest, or belly.

How is it diagnosed?

Your doctor will ask you about your past health, symptoms, and work and physical activities. Then your doctor will do a physical examination. Your doctor may also order an imaging test, such as an X-ray or an MRI, to find what is causing your pain. You may also need other tests.

How is upper and middle back pain treated?

Most people with mild to moderate back pain can manage their symptoms with over-the-counter pain medicines such as acetaminophen and NSAIDs, heat or ice, exercise, and manual therapy. If your pain gets worse and limits your daily activities, talk to your doctor.

Cause

Upper and middle back pain may be caused by:

• Overuse, strain, or injury of the muscles, ligaments, or discs that support the spine.
• Poor posture.
• Pressure on the spinal nerves from certain problems, such as a herniated disc or spinal stenosis.
• A fracture of one of the vertebrae.
• An odd-shaped spine. Certain conditions, like scoliosis or kyphosis, can make your back hurt.
• Osteoarthritis caused by the breakdown of cartilage that cushions the small facet joints in the spine.
• Myofascial pain that affects the connective tissue of a muscle or group of muscles.

In rare cases, pain may be caused by other problems, such as gallbladder disease, cancer, or an infection.

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Symptoms

Upper and middle back pain may feel like a dull, burning, or sharp pain or muscle tightness or stiffness. These symptoms may:

• Be felt at a single point or over a broad area.
• Start suddenly or slowly get worse.
• Be constant or come and go.
• Get worse when you do certain activities or move and sit in a certain way.

More serious symptoms that need to be treated right away include:

• Weakness in your arms or legs.
• Numbness or tingling in your arms, legs, chest, or belly.
• Loss of bowel or bladder control.

When to Call a Doctor

Call 9-1-1 or other emergency services immediately if:

• Back pain occurs with chest pain or other symptoms of a heart attack. Symptoms of a heart attack include:
  • Chest pain or pressure, or a strange feeling in your chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in your back, neck, jaw, upper belly, or one or both shoulders or arms.
  • Feeling dizzy or light-headed.
  • A fast or uneven heartbeat.
• A person has signs of damage to the spine after an injury (such as a car crash, fall, or direct blow to the spine). Signs may include:
  • Being unable to move part of the body.
  • Severe back or neck pain.
  • Weakness, tingling, or numbness in the arms, legs, chest, or belly.

Call your doctor now if:

• You have a new loss of bowel or bladder control.
• You have new or worse numbness in your legs.
• You have new or worse weakness in your legs. (This could make it hard to stand up.)
• You have new or increased back pain with fever, painful urination, or other signs of a urinary tract infection.

Watchful waiting

Watchful waiting is a wait-and-see approach. If you get better on your own, you won't need treatment. If you get worse, you and your doctor will decide what to do next. If your back pain is mild to moderate, it probably will get better on its own. You can try home treatment to relieve your symptoms. If you don't feel better in 1 to 2 weeks, call your doctor.

Examinations and Tests

Your doctor will first ask you about your past health, your symptoms, and your work and physical activities. Then your doctor will do a physical examination.

Your doctor may also order an imaging test, such as an X-ray, an MRI, or a CT scan. This test is to find out if something like a broken bone or a herniated disc is causing your pain.

You may need more tests, such as an electromyogram and nerve conduction study, to check for other possible causes for your pain.

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Treatment Overview

There are many treatments for upper and middle back pain. Work with your doctor to find what is best for you.

Treatment is based on:

• How bad your symptoms are.
• How much your symptoms prevent you from doing your daily tasks.
• How well other treatments have worked.

Treatment for mild to moderate pain

In most cases, people with mild to moderate upper and middle back pain can manage their symptoms with:

• Over-the-counter pain medicines. These include acetaminophen (such as Tylenol) and NSAIDs (such as Advil, Aleve, aspirin, or Motrin), to reduce pain.
• Topical pain medicines. These are medicines that you put on your skin.
  • Non-steroidal anti-inflammatory drugs (NSAIDS). This is a cream that you can rub over the sore area and may help relieve pain.
  • Capsaicin cream. This may help relieve pain.^{footnote 1} It's a substance found in cayenne peppers. Capsaicin cream is applied directly to the skin over the painful area. Do not apply topical products that contain capsaicin to areas of broken skin.
• Heat or ice.
• Exercise to stretch and strengthen the muscles of your back, shoulders, and stomach.
• Physiotherapy to help increase your flexibility, strength, and balance. Your physiotherapist may teach you an exercise program so you can do it at home.
• Massage.
• Spinal manipulation. It can range from massage and slow pressing to a quick thrust.
• Acupuncture. It involves putting tiny needles into your skin at certain points on the body.

Treatment if back pain is severe or lasts a long time

If your back pain doesn't get better or is severe, your doctor may recommend:

Prescription medicines.

These may include:

• Muscle relaxants to help reduce pain and muscle tension and help you move better. These can help with severe muscle spasms that happen when the back pain starts (acute phase).
• Antidepressants, such as duloxetine. They can help treat long-lasting (chronic) back pain.
• Prescription pain medicines.

Steroid shots.

They may help reduce swelling and relieve pressure on nerves and nerve roots. But there is little evidence showing that these shots can help control back pain.

In some cases, a back brace may be used to support the bones in the spine after a fracture.

Surgery

Surgery is seldom used to treat upper and middle back pain. If your doctor recommends surgery, the type will depend on the problem you have.

Surgery choices may include:

Kyphoplasty or vertebroplasty.

Bone cement is injected through a needle into the broken vertebrae to try to stabilize the bone. These surgeries are not done very often, because most fractures heal on their own. And there is no evidence that kyphoplasty or vertebroplasty are better than non-surgical treatment.^{footnote 2}

Herniated disc removal.

This is done to remove the portion of the disc that is herniated and pushing into the spinal canal. In most cases, herniated discs that occur in the upper and middle back are small and don't need surgery. But you may need surgery for a large herniated disc that presses on the spinal cord.

Spinal decompression for stenosis.

This is done to widen the spinal canal that has narrowed. It relieves pressure on the spinal cord or nerves. This procedure is not done very often. That's because spinal stenosis in the upper and middle back is rare.

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Self-Care

There are several things you can do to help reduce back pain. Try these tips.

• Rest, but not too much.

  If your back hurts a lot, take a break. But try not to let too much time pass before you get moving again. Instead, return to your activities slowly, and avoid things that make your pain worse. Studies show that bedrest doesn't relieve back pain better than staying active. And bedrest for more than a couple of days can make your back pain worse. It can also lead to other problems, such as stiff joints and weak muscles.

• Use over-the-counter pain medicines.

  For most back pain, you can take over-the-counter pain medicine. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, seem to work best for back pain. But if you can't take NSAIDs, you can try acetaminophen. Be safe with medicines. Read and follow all instructions on the label.

• Use a heating pad or ice pack.

  You can use either heat or cold, whichever helps you the most. You might want to switch back and forth between heat and cold until you find what helps you the most.

• Exercise.

  Ask your doctor or a physiotherapist about what kinds of exercises you can do to stretch and strengthen the muscles in your back, shoulders, and stomach. These muscles help support your spine. Strong muscles can help improve your posture, keep your body in better balance, decrease your chance of injury, and reduce pain.

• Practice good posture.
  • Poor posture puts stress on your back. Be sure to stand or sit tall, with your shoulders and your stomach pulled in to support your back. Don't slump or slouch.
  • Take extra care when you lift. When you must lift, bend your knees and keep your back straight. Avoid twisting. Keep the load close to your body.
• Keep a pain diary.

  Write down how your moods, thoughts, sleep patterns, activities, and medicines affect your pain. Having a record of your pain can help you and your doctor find the best ways to treat your pain.

• Don't smoke.

  Smoking decreases blood flow and slows healing. If you need help quitting, talk to your doctor.

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