Upper Back Pain

An extremely common complaint, an estimated 1 in 10 people will experience back pain at some stage in their lives. Lower or lumbar back pain is the most common form of back pain followed by cervical pain originating in the neck. Upper back pain is also known as thoracic or middle back pain and refers to the section of the back from the bottom of the rib cage to the base of the neck.

The Thoracic Spine

The thoracic spine contains 12 vertebrae from T1 – T12 and is more stable than its cervical and lumbar counterparts. Each thoracic vertebra supports a pair of ribs, this means that the range of movement is limited, therefore the risk of developing a degenerative condition is not as great.

The vertebrae also support the weight of the upper body and protect the sensitive spinal cord as it runs through the spinal canal. The ribs are anchored to the vertebrae by facet joints and in between each vertebra is an intervertebral disc. Each disc is formed of an outer layer of tough cartilage and a gel like nucleus substance in the centre. The discs serve as shock absorbers, soaking up any bumps and jolts as well as preventing the vertebrae from grinding against one another.

Causes of Upper Back Pain

Although the thoracic spine is not as susceptible to developing spinal conditions as the cervical spine or the lumbar due to its limited range of movement as previously mentioned, thoracic back pain can occur as a result of mechanical or degenerative issues; it can also be a red flag for a more serious underlying condition.

Mechanical Thoracic Pain

Mechanical upper back pain is felt in the back alone, and is perhaps the most common cause of upper back pain – usually a result of an injury, such as whiplash from a vehicle accident, poor posture and awkward positions, repetitive movement, lifting heavy objects, or wearing a heavy backpack, continuous sitting (driving long distances regularly, or sitting at a desk for prolonged periods), all of which can cause damage to the surrounding soft tissues and joints. Maintaining an active routine, bed rest for periods longer than 2 – 3 days is not recommended, the use of pain relief medication, goal targeted exercises and physiotherapy suffice for the majority.

It is however, important to investigate the cause early and effectively in order to exclude any more serious underlying pathologies such as infection, tumours or spinal instability.

Referred Thoracic Pain

Some patients experience thoracic back pain with referred symptoms, this may be a result of nerve compression caused by prolapsed discs, inflammation in the joints between the bones of the vertebral bodies, arthritis or degeneration in the bones resulting in nerve compression and referred pain. Nerve compression in the thoracic region can cause pain to radiate to the chest wall and cause referred pain felt in the stomach, groin and sternum.

Degenerative Disc Disease

The term degenerative disc disease is used to define a natural process caused by ageing and is actually incorrectly labelled as a disease. The condition is characterised by general wear and tear and a loss of moisture to the spinal discs, and the effect this has on their surrounding spinal structures.

The blood supply to the discs is limited, unlike other tissues in the body only small amounts of healing oxygen and nutrients reach them, making the repair process a lot slower – this means that the disc can deteriorate easily, as well as taking a long time to repair following injuries and tears. The loss of disc height caused by the wear and tear process can in some cases cause the vertebra to come into contact and grind against one another, resulting in pain and irritation, swelling within the bone and in some cases provoking the formation of osteophytes – bone spurs.

Other disc related problems may include trauma to the disc, a bulging or torn disc which can also cause painful symptoms if disc material seeps out of the tear and encroaches on nearby nerves exiting the spinal column.

Some people may have degenerated discs but be completely unaware of it, as there may be no painful symptoms.

Symptoms

Degenerative disc disease is most commonly found in the lumbar and cervical regions, although it can also occur in the upper back. Symptoms may vary in severity, causing anything from mild to severe pain, which may be felt at the source itself or radiate to another part of the body. Pain typically worsens when sitting, bending, twisting or lifting heavy objects.

Diagnosis

An MRI scan will be helpful in illustrating the extent of the damage to the disc as well as highlighting any secondary conditions the damage may be responsible for, such as nerve compression, bone spurs or swelling.

Treatment

Primary treatment is usually in the form of physiotherapy and pain relief medication, in some more severe cases, surgical options may be considered.

Spinal Arthritis

Spinal arthritis primarily affects the joints – healthy joints move easily with little friction, however natural degeneration can cause the cartilage covering the surface of the bones to wear down, it then becomes rougher and thinner, causing friction and making movement painful, this may result in a number of secondary conditions such as osteophytes (bone spurs), nerve compression and spinal stenosis.

Symptoms

Typical symptoms include pain, stiffness, tenderness, swelling and inflammation. It can limit the range of motion and difficulty bending or walking can occur. If nerve compression is involved there may be referred pain as well as tingling and numbness.

Diagnosis

A detailed medical history will be needed with an MRI scan to provide a view of the cartilage and other structures.

Treatment

Spinal arthritis can have a negative impact on quality of life, if left untreated it can lead to severe mobility issues, increased pain and muscle weakness as fear avoidance patterns develop. Traditional conservative treatment methods such as physiotherapy and pain medication are usually the first line of treatment, life style changes such as weight loss, exercise and healthy eating may also be beneficial. In some cases, surgery may be an option.

Other Known Causes

Fractures

Fractured vertebrae usually occur as result of direct impact to the spine such as in an automotive accident or from a direct blow.

Osteoporosis

This describes a condition where the bones become weaker and more brittle, making them more prone to fracturing and in severe cases, collapsing.

Osteomyelitis

A medical condition caused by an infection in the bone resulting in painful symptoms.

Spondylosis

Degenerative spinal conditions can be responsible for back pain, especially in the elderly.

Scoliosis

An abnormal curve of the spine can cause pain in the thoracic region.

Kyphosis (hunchback conditions)

This describes a structural deformity, in which an abnormal curving of the upper part of spine causes it to become rounded, and form a hump like shape.

Red Flag Symptoms

In some rare cases, thoracic back pain can be an indication of an underlying condition of a more serious nature such as cancer, infection or another type of disease.

Red flag symptoms may include:

  • Constant back pain
  • Unexplained continuous fever
  • Swelling or other structural deformity
  • Chest Pain
  • Unexplained weight loss
  • Neurological symptoms
  • A history of cancer

Red flags should be thoroughly investigated to rule out the possibility of a more serious pathology – the thoracic region is the most common area of the body for metastases.

Pain Management Treatment for Upper Back Pain

Regardless of the root cause, living with chronic pain can be extremely debilitating and stressful. Even the simplest daily tasks such as getting dressed and going to work can be painful and distressing, taking its toll on the patient’s general wellbeing and in some cases causing not only physically painful symptoms, but depression and anxiety as well.

The pain management clinic works with a multidisciplinary team of specialist consultants, surgeons, psychologists, physiotherapists and other pain management health specialists. All of which work together to coordinate care and devise an individualised plan to suit the specific needs of each patient.

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