What is Upper Back Pain
Because the upper back/thoracic spine area of the spinal column has a great deal of stability and limited movement, upper back pain is far less common. When it does occur, it can cause significant discomfort. Muscular irritation (myofascial pain) and joint dysfunction are often the cause of upper back pain. Upper back pain responds best to manual treatments such as exercise, massage therapy, or acupuncture. Although upper back pain is not a very common spinal disorder, it can cause significant discomfort and pain when it does occur. The most common causes of upper back pain are muscular irritation (myofascial pain) and joint dysfunction. There can be an injury to a disc in the upper back (such as a thoracic herniated disc or degenerated disc) that causes upper back pain, but such injuries are very rare. It is important to note that the thoracic spine (also called upper back, middle back, or mid-back) is very different in form and function than the cervical spine (neck) or the lumbar spine (lower back). While the neck and lower back are designed to provide us with mobility, the thoracic spine is designed to be very strong and stable to allow us to stand upright and to protect the vital internal organs in the chest. Because this section of the spinal column has a great deal of stability and only limited movement, there is generally little risk of injury or degeneration over time in the upper back.Anatomy of the Upper Back The word "thoracic" means pertaining to the chest, and the thoracic spine (also called the upper back or mid-back) is the portion of the spinal column that corresponds to the chest area. Twelve vertebrae in the middle of the spine with ribs attached make up the thoracic spine. When viewed from the side, this section of the spine is slightly concave. Each vertebra in the thoracic spine is connected to a rib on both sides at every level and these in turn meet in the front and attach to the sternum (the breastbone). This creates a cage (the thoracic cage) that provides structural protection for the vital organs of the heart, lungs, and liver, and also creates a cavity for the lungs to expand and contract. The upper nine ribs start at the spine, curve around and are joined at the front of the chest. Because the ribs are firmly attached at the back (the spine) and the front (the sternum), they allow for very limited motion in the spine. The lower three ribs do not join together at the front, but do function to protect the vital organs while allowing for slightly more motion. The joints between the bottom thoracic vertebra (T12) and the top lumber vertebra (L1 in the lower back) allow twisting movement from side to side.
The upper back is the region between the spine and the lower back. It is often the site of pain in a large number of people. The upper back is also connected to the ribs and muscles of the back. Upper back pain can be divided into acute and chronic cases. Acute cases can be related to short-term injury or inflammation to the thoracic spine. Chronic or long-term cases of pain in the upper back may be indicative of damage to nerves or the bones of the spine. Upper back pain is not as common as neck or lower back pain, but can be as distressing and debilitating.
Causes of Upper Back Pain
Acute cases of upper back pain may be caused by muscle damage. This can be associated with accidents, playing sports, or poor posture. When muscles are damaged, inflammatory molecules are released by the immune system, which cause pain. Inflammation is also caused by conditions such as arthritis, which may also cause damage to thoracic vertebrae (spinal bones), or the ribs. Pain is also associated with damage to the joints between vertebrae in the upper back (known as facet joints). More long-term sources of upper back pain may be disc herniation or bulging. Discs are rings of tissue located between each bone of the spine for support and shock absorption. Bulging occurs if the discs break down and bulges outwards, causing constant pain.
The upper back is controlled by the thoracic region of the spinal cord, and by the thoracic spinal nerves leading to it. Damage to these nerves can also cause chronic pain. This can be caused by some cancers in the chest (thoracic cavity) or thoracic spine. Though relatively rare, this can cause chronic upper back pain. Minor fractures in the bones of the thoracic spine can also result in chronic pain. Fractures are associated with degenerative bone conditions such as bone cancer or osteoporosis. These conditions are associated with advanced age.
Treatment for Upper Back Pain
The first-line treatment for upper back pain is conventional oral painkillers. These include ibuprofen, naproxen, anticonvulsants such as carbamezapine and acetaminophen. The drawbacks of drug use to manage pain are the possibilities of overuse, addiction, and the organ damage associated with prolonged and regular intake.
If these prove ineffective, epidural steroid injections may be an option. Steroids inhibit inflammation, so they are often used in treating pain associated with arthritis and other similar conditions. The steroids are delivered through a needle to the spinal nerves that are the source of pain. Chronic upper back pain can also be treated by nerve blocks. These are epidural injections of steroids combined with local anesthetics such as lidocaine. Targeting nerves in thoracic regions, which control pain transmission from the upper back, may be useful in controlling chronic pain.
Anesthetic and steroid injections can also be given to the facet joints, or the medial branch nerves that serve them. These procedures have drawbacks; for example, anesthetic injection may cause severe chest discomfort and numbness. In serious cases, cardiac damage may result from nerve blocks in the upper back region. Steroids may also cause side effects, such as mood swings, weight gain, and further risk of arthritis.
If disc herniation is the source of upper back pain, it can be treated by discectomy. This is a minimally-invasive procedure in which the bulging parts of the disc or discs are removed completely.
Discectomy, or percutaneous disc decompression, has shown significant pain relief for up to two years after the procedure. The risks of the procedure are mainly bleeding, infection, and nerve damage after the procedure.
Spinal fractures can be repaired by a technique called vertebroplasty. In this procedure, the area of the back above the broken vertebra is anesthetized. A needle is then inserted into the affected vertebra and acrylic cement is injected. This seals the fracture(s). A variation on this procedure is kyphoplasty, in which a small balloon is inserted and inflated to support the bone so that the needle can adequately reach the fracture to be treated. Both are very effective in treating thoracic fractures. They have minimal risks, such as infection and bleeding at the site of needle insertion. There is also a possibility that the cement may “leak” out of the bone, which causes inflammation in the nerves and other surrounding tissue, and thus further pain.
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Upper back pain is not as common as lower back or neck pain, but can still cause discomfort, reduction in movement and function, and have an impact on quality of life. Acute upper back pain is associated with muscle strain or injury, and is often caused by poor posture, sports, accidents, and inflammation. Chronic pain is associated with conditions such as arthritis, cancer, vertebral fracture, and disc herniation.
Acute pain may be treated with oral medications such as acetominaphen and carbamezapine. If the pain persists, a patient can consider procedures such as epidural steroid injections, nerve blocks, or facet joint injections. If chronic pain is a result of fracture(s), this can be corrected by vertebroplasty or kyphoplasty. These are effective treatments for sources of upper back pain in the medium- or long-term.