Written by Staff | 06 July 2011

It’s estimated as many as 25% of adults will experience back pain within the next three months, and that 70% will experience back pain at some point in their lifetime^{1, 2}. Thoracic (upper back) pain is far less common that lumbar (lower back) pain, but it can be much more difficult to diagnose and treat, and the implications can be life-threatening. The differential diagnosis for upper back pain is extensive. Selected causes include²:

• Uncomplicated musculoskeletal back pain, or sprain/inflammation of muscles and ligaments
• Disc herniation resulting in a radiculopathy (pain from compressed spinal nerve roots)
• Tumor or infection of the vertebrae comprising the spinal column; tumors manifest more often in the thoracic spine than other areas
• Vertebral compression fractures, often as a result of osteoporosis
• Vascular problems such as an aortic dissection (rupturing of the primary blood vessel delivering blood from the heart), heart disease, or pulmonary embolism (a blood clot in the lungs)

The most common cause of upper back pain is musculoskeletal injury or inflammation, which can occur due to poor posture, overuse, or from trauma such as a motor vehicle accident or fall⁴. Symptoms include muscle spasms and pain with deep breaths, touch or with shoulder/neck movement. It has been estimated as many as 77% of upper back pain cases will resolve on their own with conservative treatment². Diagnosing the cause of upper back pain is done by a doctor through a comprehensive history and physical exam. Additionally, a full neurological work up is often performed to rule out possible neurological causes. In general, laboratory testing and supplemental imaging are not indicated for uncomplicated upper back pain². A physician may, however, order an x-ray if a bone infection or tumor is suspected or magnetic resonance imaging (MRI) for a suspected thoracic disc herniation that does not improve with conservative management^{2, 3}. Treatment options for upper back pain range from conservative management with medications to surgery depending on the cause and severity of the pain². More conservative treatments include^{2, 4, 5}:

• Pain-relieving medications are the initial treatment of choice for upper back pain. These can include over-the-counter pain medicines such as acetaminophen or ibuprofen, or prescription narcotics
• Temperature regulation can be beneficial for musculoskeletal pain. Icing for the first few days of pain can help control inflammation, and following up with heat can help loosen stiff muscles
• Rehabilitation stretches and exercises can help strengthen muscle groups in the upper back and prevent recurrence. Massage therapy may also prove beneficial

Thoracic disc herniation may require surgical intervention via discectomy, the removal of herniated tissue. Vertebral compression fractures may require vertebroplasty and/or balloon kyphoplasty, in which a balloon and/or cementing material is injected via needle into the fracture to stabilize the bone. Other immediate surgical intervention may be required for the rare, but more serious causes of upper back pain such as a bone tumor, vessel rupture, embolism or heart disease².

References

1. Jones, R.; et al. (2010). Back Pain. First Consult. MD Consult Web site, Core Collection. Retrieved from www.mdconsult.com.ezproxy1.library.arizona.edu/das/pdxmd/.
2. Lin, M. (2009). Upper Back Pain. Marx: Rosen’s Emergency Medicine, 7th Ed. MD Consult Web site, Core Collection. Retrieved from www.mdconsult.com.ezproxy1.library.arizona.edu/books/.
3. Hauser, K. (2008). Pain. Walsh: Palliative Medicine, 1st Ed. MD Consult Web site, Core Collection. Retrieved from www.mdconsult.com.ezproxy1.library.arizona.edu/books/.
4. Clinical Reference Systems. (2011). Upper Back Pain. Patient Handouts. MD Consult Web site, Core Collection. Retrieved from www.mdconsult.com.ezproxy1.library.arizona.edu/das/patient/body/.
5. Clinical Reference Systems. (2011). Upper Back Pain Rehabilitation Exercises. Patient Handouts. MD Consult Web site, Core Collection. Retrieved from www.mdconsult.com.ezproxy1.library.arizona.edu/das/patient/body/.