Upper and Middle Back Pain

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Topic Overview

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This topic provides an overview of upper and middle back pain. Ifyou have low back pain or neck pain, see the topicLow Back Pain orNeckPain.

What is upper and middle backpain?

Upper and middle back pain can occur anywhere from the base ofyour neck to the bottom of your ribcage.

Your ribs attach to a long, flat bone in the centerof the chest called the sternum and attach to and wrap around your back. If anerve in this area is pinched, irritated, or injured, you may also feel pain inother places where the nerve travels, such as your arms, legs, chest, andbelly.

The upper and middle back (called the thoracic spine) has:

  • 12 vertebrae. Thesebones attach to your rib cage. They make up the longest part of your back.
  • Discs that separateeach vertebra and absorb shock as you move.
  • Muscles andligaments that hold thespine together.

See a picture of thespine.

Upper andmiddle back pain is not as common as low back pain or neck pain, because thebones in this area of the back don't flex or move as much as the bones in yourlower back or neck. Instead, they work with the ribs to keep the back stableand help protect vital organs, such as the heart andlungs.

What causes upper and middleback pain?

Upper and middle back pain may be caused by:

  • Overuse, muscle strain, or injury to the muscles, ligaments, anddiscs that support your spine.
  • Poor posture.
  • Pressureon the spinalnerves from certain problems, such as aherniated disc.
  • A fracture of one of the vertebrae.
  • Osteoarthritis caused by thebreakdown of cartilagethat cushions the small facetjoints in the spine.
  • Myofascial pain that affects theconnective tissue of a muscle or group of muscles.

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

What are the symptoms?

Common symptoms of upper and middle back pain are:

  • A dull,burning, or sharp pain.
  • Muscle tightness or stiffness.

Moreserious 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 orbladdercontrol.

How is upper and middleback pain diagnosed?

Your doctor will first ask you about your pasthealth, your symptoms, and your work and physical activities. Then he or shewill do a physical exam.Your doctor may also order an imaging test, such as anX-ray or anMRI, to find out ifsomething such as a broken bone or a herniated disc is causing yourpain.

You may need more tests to check for otherpossible causes for your pain.

How isit treated?

In most cases, people with mild to moderate back pain canmanage their symptoms with:

  • Over-the-counter painmedicines , such as acetaminophen (for example, Tylenol) andnonsteroidal anti-inflammatory drugs (for example, Advil, Aleve, aspirin, andMotrin).
  • Heat or ice.
  • Exercise.
  • Manual therapy ,such as massage, mobilization, or spinal manipulation.

But if yourpain gets worse and you're having a hard time doing your daily activities, youmay need to take a prescription pain medicine. Surgery is seldom used to treatupper and middle back pain.

How can youcare for yourself at home?

There are several things you can do at hometo help reduce your pain. For example:

  • Rest. If your backhurts a lot, take a break. But try not to let too much time pass before you getmoving again. Instead, return to your activities slowly.
  • Useover-the-counter pain medicines, such as acetaminophen (for example,Tylenol) and nonsteroidal anti-inflammatory drugs (for example, Advil, Aleve,aspirin, and Motrin). These can reduce pain and swelling. Be safe withmedicines. Read and follow all instructions on the label.
  • Use aheating pad or ice pack. Heat can reduce pain and stiffness. Ice can helpreduce pain and swelling.
  • Exercise. Exercises that stretch andstrengthen the muscles in your back, shoulders, and stomach can help improveyour posture, decrease your chance of injury, and reduce pain.
  • Practice good posture. Be sure to stand or sit tall. Don't slump orslouch.
  • Learn ways to reduce stress. You might try deepbreathing and relaxation exercises or meditation.

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Cause

In most cases, upper and middle backpain is caused by:

  • Overuse, muscle strain, or injury to themuscles, ligaments, and discs that support your spine.
  • Poorposture.
  • Myofascialpain that affects the connective tissue of a muscle or groupof muscles.

For example, some people hurt their backs whenthey:

  • Slump or slouch when they sit or stand.
  • Play sportsor do yard work.
  • Get jolted in a car accident.
  • Get hit hard inthe back.
  • Lift something too heavy.

Conditions that putpressure on the spinalnerves also can cause pain. These include:

  • Osteoarthritis . This occurs whenthe cartilage thatcushions the small facetjoints in the spine breaks down. When this happens, the backbones rub together and cause damage and pain. Osteoarthritis is caused by thenormal wear and tear of the cartilage as you age.
  • A fracture of thevertebrae, which can occur when a lot of force is put on the spine. Thisforce can be from a car or bike accident or a direct blow to the spine. Acompression fractureoccurs when an injury to the bones in the spine causes them to break andcollapse (compress) on each other, such as from a fall. In people who haveosteoporosis, whichmakes the bones brittle and weak, a spinal bone can also break and collapsefrom only a minor injury or simply moving the wrong way.
  • Anodd-shaped spine, such as with scoliosis orkyphosis. This can makeyour back hurt. When you look at a normal spine from the back, it is usuallystraight. But when a person has scoliosis, the spine curves from side to side,often in an S or C shape. It may also be twisted. When a person has kyphosis,the upper spine is rounded and looks like a hump. In bad cases of scoliosis orkyphosis, a person may have a hard time breathing.
  • A herniated disc . This occurswhen one of the small, spongy discs that cushion your spine bulges or breaksopen and presses on the nerves in the spine. A herniated disc may be caused bynormal wear and tear of the disc as you age. Or it may be brought on byactivities that you do over and over again that cause a lot of vibration ormotion (such as using a jackhammer) or by a sudden heavy strain or increasedforce to your back. In most cases, a herniated disc occurs in the lower back orneck. It can occur in the upper or middle back, but this is rare. See a pictureof a herniated disc.
  • Spinalstenosis . The spinal cord runs through an opening in thebones called the spinal canal. Spinal stenosis occurs when that openingnarrows. In some cases, bone, ligament, and disc tissue grows into the spinalcanal and presses on the nerves that branch out from the spinal cord. Thetissue can also squeeze and irritate or injure the spinal cord itself. In mostcases, spinal stenosis occurs in the lower back and neck. It can occur in yourupper or middle back, but this is rare.
  • Degenerative disc disease .This is not really a disease but a term used to describe the normal changesthat occur in your spinal discs as you age. Over time, the discs in your spinebreak down, or degenerate. A loss of fluid in the discs or tiny tears or cracksin the outer layer of the discs can occur over time. The breakdown of the discscan cause back or neck pain, arthritis, spinal stenosis, or a herniated disc. Asudden injury to your back, such as from a fall or a car accident, may alsostart this process. This problem can occur anywhere on your spine. But in mostcases, it occurs in the discs in the lower back and neck.

In rarecases, upper and middle back pain may be caused by other problems, such asgallbladder disease,cancer, or an infection.

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Symptoms

In general, symptoms of upper and middleback pain may:

  • Feel like a dull, burning, or sharp pain.
  • Befelt at a single point or over a broad area.
  • Start suddenly or slowlyget worse.
  • Be constant or come and go.
  • Occur with muscletightness or stiffness.
  • Get worse when you do certain activities ormove and sit in a certain way.

More serious symptoms that need tobe treated right away include:

  • Weakness in your arms or legs.
  • Numbness or tingling in your arms, legs, chest, or belly.
  • Loss ofbowel or bladdercontrol.

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When to Call a Doctor

In most cases, back pain gets better withhome treatment. So unless you have signs of a severe illness, injury, or heartattack, you can give your back pain some time to work itself out before youcall your doctor.

Call 911 or other emergency servicesimmediately if:

  • Back pain occurs with chest pain or othersymptoms of a heart attack. Symptoms of a heart attack include:
    • Chestpain or pressure, or a strange feeling in your chest.
    • Sweating.
    • Shortness of breath.
    • Nausea or vomiting.
    • Pain, pressure, ora strange feeling in your back, neck, jaw, upper belly, or one or bothshoulders or arms. See a picture of areaswhere symptoms may be felt.
    • Feeling dizzy orlightheaded.
    • Afast or uneven heartbeat.
  • A person has signs of damage to thespine after an injury (such as a car accident, fall, or direct blow to thespine). Signs may include:
    • Being unable to move part of the body.
    • Severe back or neck pain.
    • Weakness, tingling, or numbness in thearms, legs, chest, or belly.

Call your doctornow if:

  • You have a new loss ofbowel or bladder control.
  • You have new numbnessin your legs or numbness in your legs that is getting worse.
  • You havenew weakness in your legs or weakness in your legs that is getting worse. (Thiscould make it hard to stand up.)
  • You have new or increased back painwith fever, painful urination, or other signs of a urinary tractinfection.

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 decidewhat to do next. If your back pain is mild to moderate, it probably will getbetter on its own. You can try home treatment to relieve your symptoms. If youdon't feel better in 1 to 2 weeks, call your doctor.

Be sure to callyour doctor right away if you start to have other symptoms or you have:

  • Numbness.
  • Weakness.
  • Fever.
  • Urinary symptoms,such as pain when you urinate.
  • Pain that is getting worse.
  • Painthat you can't manage at home.

Who to see

Health care professionals who often diagnose the cause ofback pain include:

If your back pain is severe orlong-lasting, health professionals who can treat you include:

You can alsoget care from:

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Exams and Tests

Your doctor will first ask you about yourpast health, your symptoms, and your work and physical activities. Then he orshe will do a physicalexam. Your doctor may also order an imaging test to find out ifsomething such as a broken bone or a herniated disc is causing your pain.

The type of imaging test you have depends on what kind of problem yourdoctor suspects. You may have one or more tests, such as:

  • AnX-ray to look forinjuries or diseases that affect the discs and joints of the spine.
  • AnMRI to look forinjuries and diseases that affect the discs and nerves of the spine, such as aherniated disc, apinched nerve, or a tumor. It can also show whether any part of thespinal canal hasnarrowed.
  • A CTscan to look for a tumor, a fracture, a herniated disc,narrowing of the spinal canal, or an infection. It can also show whetherosteoporosis is thecause of a compressionfracture.
  • A bone scan to look for damage tothe bones, a tumor, or infection, or to find the cause of unexplained backpain.
  • An electromyogram andnerve conduction study to check how well the spinal cord,nerve roots, and nervesand muscles that control your arms and legs are working. It can help find outwhat is causing pain, numbness, or weakness in the arms or legs.

More tests may be done to check for other possible causes for yourpain.

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Treatment Overview

There are many treatments for upper andmiddle back pain. What works for someone else may not help you. Work with yourdoctor to find what is best for you.

Treatment for upper and middle backpain is based on:

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

Treatment for mild tomoderate pain

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

  • Over-the-counter painmedicines , such as acetaminophen (for example, Tylenol) andnonsteroidal anti-inflammatory drugs (for example, Advil, Aleve, aspirin, andMotrin), to reduce pain. But if these don't get rid of your pain, you may needa prescription pain medicine that is stronger.
  • Heat or ice toreduce pain and stiffness.
  • Exercise to stretch and strengthenthe muscles of your back, shoulders, and stomach.
  • Physical therapy to help increaseyour flexibility, strength, and balance. Yourphysical therapist mayteach you an exercise program so you can do it at home.
  • Massage to help reduce muscletension and pain and improve blood flow.
  • Spinal manipulation to helprelieve pain and improve function. It can range from massage and slow pressingto a quick thrust.
  • Acupuncture . It involvesputting tiny needles into your skin at certain points on the body to promotehealing and pain relief.

Treatment if back paingets worse

If your back pain doesn't get better or it gets worse, yourdoctor may recommend:

  • Prescriptionmedicines, such as opioids, to help reduce pain.
  • Musclerelaxants to help reduce pain and muscle tension and improve mobility.
  • Antidepressants, such as amitriptyline andduloxetine, to help treatlong-lasting (chronic) back pain.
  • Steroid shots to help reduceswelling and relieve pressure on nerves and nerve roots. But there is littleevidence showing that these shots can help control back pain.

Insome cases, a back brace may be used to support the bones in the spine after afracture.

Surgery is seldom used to treat upper and middle back pain. Ifyour doctor recommends surgery, the type will depend on the problem you have.Before you decide to have surgery, it's a good idea to get a second opinionfrom a different doctor. Surgery choices may include:

  • Kyphoplasty or vertebroplasty .Bone cement is injected through a needle into the broken vertebrae to try tostabilize the bone. These surgeries are not done very often, because mostfractures heal on their own. And there is no evidence that kyphoplasty orvertebroplasty are better than nonsurgical treatment.1
  • Herniateddisc removal . It removes the portion of the disc that isherniated and pushing into the spinal canal. In most cases, herniated discsthat occur in the upper and middle back are small and don't need surgery. Butyou may need surgery for a large herniated disc that presses on the spinalcord.
  • Spinal decompression for stenosis. It widens the spinalcanal that has narrowed, and it relieves pressure on the spinal cord or nerves.This procedure is not done very often, because spinal stenosis in the upper andmiddle back is rare.

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Home Treatment

There are several things you can do athome to help reduce your pain. For example:

  • Rest. If yourback hurts a lot, take a break. But try not to let too much time pass beforeyou get moving again. Instead, return to your activities slowly, and avoidthings that make your pain worse. Studies show that bed rest doesn't relieveback pain better than staying active. And bed rest of more than a couple ofdays can make your back pain worse and lead to other problems, such as stiffjoints and muscle weakness.2
  • Use over-the-counter painmedicines , such as acetaminophen (for example, Tylenol) andnonsteroidal anti-inflammatory drugs (for example, Advil, Aleve, aspirin, andMotrin). These can reduce pain and swelling. Be safe with medicines. Read andfollow all instructions on the label.
  • Use a heating pad or icepack. Heat can reduce pain and stiffness. Ice can help reduce pain andswelling. You might want to switch back and forth between heat and cold untilyou find what helps you the most.
  • Exercise. Ask your doctor or aphysical therapist aboutwhat kinds of exercises you can do to stretch and strengthen the muscles inyour 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 . Poorposture puts stress on your back. Be sure to stand or sit tall, with yourshoulders and your stomach pulled in to support your back. Don't slump orslouch.

Here are some other things you can do to feel better:

  • See a counselor. Cognitive-behavioral therapy can showyou how to change certain thoughts and behaviors to control your pain. For moreinformation, see the topic Stop NegativeThoughts: Choosing a Healthier Way of Thinking.
  • Learnways to reduce stress . Stress can make your painfeel worse. You might try deep breathing and relaxation exercises ormeditation.
    Click here to view an Actionset. Stress Management: Breathing Exercisesfor Relaxation
  • Eat nutritious foods.Getting plenty of calcium and vitamin D may help prevent osteoporosis, whichcan lead to compression fractures and back pain. For more information, see thetopic Healthy Eating.
  • Don't smoke. Smoking decreases blood flow and slows healing. If youneed help quitting, see the topic QuittingSmoking.
  • Take extra care when you lift. When youmust lift, bend your knees and keep your back straight. Avoid twisting. Keepthe load close to your body.
  • Use apaindiary (What is a PDF document?). Write down how your moods, thoughts, sleep patterns,activities, and medicines affect your pain. Having a record of your pain canhelp you and your doctor find the best ways to treat yourpain.

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Other Places To Get Help

Organizations

American Academy of Orthopaedic Surgeons : OrthoInfo
www.orthoinfo.aaos.org
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (U.S.)
www.niams.nih.gov

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References

Citations

  1. Esses SI, et al. (2011). The treatment of symptomatic osteoporotic spinal compression fractures. Journal of the American Academy of Orthopaedic Surgeons, 19(3): 176–182. Also available online: http://www.aaos.org/research/guidelines/guide.asp.
  2. McIntosh G, Hall H (2011). Low back pain (acute), search date December 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.

Other Works Consulted

  • Hanson TJ (2008). Thoracic compression fracture. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 2nd ed., pp. 213–217. Philadelphia: Saunders Elsevier.
  • Mercier LR (2008). The back. In Practical Orthopedics, 6th ed., pp. 143–184. Philadelphia: Mosby Elsevier.

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Credits

ByHealthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer Robert B. Keller, MD - Orthopedics

Current as ofSeptember 30, 2014