• Thoracic Back Pain

    (Middle Back Pain; Mid Back Pain; Upper Back Pain)

    Definition

    Thoracic back pain is a common ache or discomfort in the area of the middle and upper back. The thoracic region of the spine runs from the base of the neck to the bottom of the chest area, just below the breastbone.

    Causes

    The back has many small bones, muscles, and soft tissues that surround and protect the spinal cord. Nerves also leave the spinal cord in the back. Pain may be caused by stress, strain, or injury to any of these structures, such as:
    • Muscle strains
    • Ligament sprains
    • Gradual wear and tear of tissue
    • Fractures of vertebra (spinal bones)
    • Nerve compression—pressure on nerves that exit the spine may be caused by problems with muscles, bones, or disc between vertebra
    • Herniated disc—damage to cushions that sit between the vertebra
    • Imbalance of muscles that support the spine
    Rarely, thoracic back pain is associated with more serious problems like an infection in the spine, heart or lung problems, or cancer.
    Herniated Thoracic Disc
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    Risk Factors

    Damage to the tissue of the back can occur with:
    • Trauma
    • Activities or occupations that require prolonged sitting
    • Repetitive motion
    • Poor posture
    • Being deconditioned—lack of exercise
    Pain may start after lifting, bending, or twisting your back, but it is usually caused by a buildup of small injuries or irritation rather than the one time movement.
    Medical conditions that may increase your chance of thoracic back pain include:

    Symptoms

    The intensity and duration of the pain will depend on the cause.
    Irritation or damage of muscle or soft tissue may cause:
    • Sharp pain
    • Spasms
    • Throbbing or aching pain
    • Weakness or fatigue
    Irritation of the nerves may cause:
    • Burning
    • Tingling/numbing sensation
    • Shooting pain
    • Weakness in area affected by nerve
    Your condition may be a combination of any or all of the symptoms above. The symptoms may occur in intensive bursts or be consistent. It may make daily tasks impossible.

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done, which will include an assessment of the spine and muscles. Your strength, flexibility, sensation, and reflexes may be tested. The doctor will likely know if it is a minor issue or if further testing is needed.
    Imaging tests may be done if the pain is severe or is not going away as expected. Images of the spine and surrounding structures may be taken with:

    Treatment

    Pain due to medical conditions, such as a fracture or arthritis, will be treated by managing the conditions.
    In most cases, thoracic back pain will go away after giving the area time to recover. Major treatment, such as surgery, is rarely helpful.
    Treatment options include:

    Adjusting Activity

    For most, absolute rest is not helpful but 1-2 days of rest may be suggested for severe pain.
    Activities that cause pain will be limited or adjusted for a period of time, and then gradually resumed as soon as possible. Recovery time is often shorter for those who stay reasonably active.

    Medications

    Medications may be recommended to help manage discomfort such as:
    • Over-the-counter or prescription pain relievers
    • Muscle relaxants to reduce spasms

    Physical Therapy

    Physical therapy may be recommended for pain that is limiting daily function or pain that is recurring. A therapist can provide stretching and strengthening exercises to help regain muscular and postural balance. Instruction may also be provided on irritating factors like sitting posture or lifting techniques.
    Therapy may also include heat, cold, massage, or ultrasound treatments for more immediate pain relief.

    Alternative Medicine

    Alternative treatments may help ease tension or pain while your back heals. Options that have shown promise for some with back pain include:
    • Acupuncture
    • Chiropractic or osteopathic manipulation
    • Relaxation therapies
    • Massage

    Prevention

    To help reduce your chance of thoracic back pain:
    • Exercise regularly to keep your back strong and flexible.
    • Avoid sitting for long periods of time. Get up, stretch, and move around frequently.
    • Practice good posture to relieve spinal pressure.
    • Use proper technique when playing sports.
    • Use proper form when lifting objects.
    • Follow your treatment plan for chronic health conditions.

    RESOURCES

    American Pain Society http://www.americanpainsociety.org

    Ortho Info—American Academy of Orthopaedic Surgeons http://www.orthoinfo.org

    CANADIAN RESOURCES

    Back Care Canada—Canadian Spine Society http://backcarecanada.ca

    Canadian Pain Society http://www.canadianpainsociety.ca

    References

    Acute thoracic spinal pain. National Health and Medical Research Council website. Available at: http://www.nhmrc.gov.au/%5Ffiles%5Fnhmrc/publications/attachments/cp94b.pdf. Published February 2004. Accessed January 26, 2015.

    Alternative treatments for upper back pain. Spine Universe website. Available at: http://www.spineuniverse.com/conditions/back-pain/upper-back-pain/alternative-treatments-upper-back-pain. Updated October 12, 2015. Accessed February 29, 2016.

    Evaluation of neck and back pain. The Merck Manual Professional Edition website. Available at: http://www.merckmanuals.com/professional/musculoskeletal%5Fand%5Fconnective%5Ftissue%5Fdisorders/neck%5Fand%5Fback%5Fpain/evaluation%5Fof%5Fneck%5Fand%5Fback%5Fpain.html. Updated March 2013. Accessed February 29, 2016.

    Examination of the spine. Patient UK website. Available at: http://www.patient.co.uk/doctor/examination-of-the-spine. Updated August 21, 2014. Accessed February 29, 2016.

    Peh W; Image-guided facet joint injection. Biomed Imaging Interv J. 2011;7(1):e4.

    Thoracic back pain. Patient UK website. Available at: http://www.patient.co.uk/doctor/thoracic-back-pain. Updated May 29, 2013. Accessed February 29, 2016.

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