Pain in the Upper Back: Causes and When to See a Doctor

Upper back pain symptoms vary depending on the underlying disease, disorder or condition. Upper back pain due to infection or inflammation may be accompanied by a fever. Back pain due to a more complex condition, such as fibromyalgia, may involve insomnia and fatigue. The range of symptoms include:

• Fatigue

• Fever

• Headache

• Mood changes, including anxiety and depression

• Morning back stiffness

• Neck pain

• Redness, warmth, or swelling of the back

• Shoulder pain

• Sleep disturbance

• Stress

In some cases, upper back pain may occur with other symptoms that might indicate a heart attack or other life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) for upper back pain that occurs along with any of the following symptoms:

• Abdominal pain

• Chest pain

• Difficulty breathing

• Indigestion

• Jaw pain

• Nausea or vomiting

• Sweating

The upper back consists of the thoracic spine (bony structures called vertebrae surrounding the nerves of the spinal cord), shoulder blades, and the back (posterior) side of the rib cage. Between the vertebrae are spongy sacs of cartilage called discs that act as a cushion and provide a range of motion to the back. Muscles, tendons and ligaments provide additional support. Any of these structures in the back can become irritated or inflamed in response to a variety of mild to serious conditions.

A common cause of mild to severe pain in the upper back is a sudden movement during sports activities or home improvement projects. Upper back pain can also be due to more serious conditions, such as fibromyalgia, spondylitis (a type of arthritis of the spine), or disc herniation. A bulging disc can put pressure on the nerve roots coming out from the spine, resulting in upper back pain. Although the lower back is a “hot spot” for bulging, or herniated, discs, the discs in the upper back can also deteriorate and rupture.

In addition, a problem in another part of the body, such as the heart, can radiate to the upper back. This is called referred upper back pain. It can also occur with a problem in the lungs that causes referred upper back pain when breathing. However, this can also occur with muscle strains in the area.

Thoracic back pain can be due to injury, inflammation or infection of the bones and tissues including:

• Herniated disc

• Muscle spasm

• Osteoarthritis

• Osteomyelitis (infection or inflammation of the spinal bones)

• Osteoporosis (metabolic bone disease)

• Paget’s disease of the bone

• Spinal degeneration (degenerative disc disease, also called spondylosis)

• Spinal stenosis (a narrowing of the spinal canal that presses on the spinal cord or nerves)

• Spine fracture

• Spondylitis (infection or inflammation of the spinal joints)

• Sprains and strains due to overuse or injury

In some cases, back pain may be due to a serious or life-threatening condition that should be evaluated as soon as possible or in an emergency setting. Possible life-threatening conditions that involve upper back pain include:

• Heart attack

• Kidney stones and disease (although this pain is usually below the rib cage)

• Multiple myeloma

• Spinal tumor or cancer (the tumor can be malignant, metastatic or noncancerous, also known as benign)

Although anyone can experience upper back pain, certain risk factors make it more likely to develop. Being older than 30 years of age and leading a sedentary lifestyle are the most common risk factors. These and other risk factors for upper back pain include:

• Congenital (present at birth) or acquired back deformities (such as scoliosis)

• Family history of back pain or spine disease

• Increasing age

• Obesity

• Poor posture

• Sedentary lifestyle

• Smoking

• Stress and anxiety

• Weak abdominal (core) muscles

Sudden pain in the upper back can be a sign of a heart attack. Call 911 or go to your nearest emergency room for upper back pain when:

• The pain radiates from your chest or also involves the jaw, neck, shoulder or arm.

• You have other symptoms, including cold sweat, anxiety, shortness of breath, dizziness, lightheadedness, weakness, nausea or vomiting.

• You have sudden crushing pain or pressure in the left upper back or shoulder.

You should also seek emergency medical care for upper back pain when:

• You have new bowel or bladder problems.

• You have a fever or chest or abdominal pain.

• You have sustained a back injury, such as a blow to the upper back or a car accident, fall, or sports injury.

Most cases of mild upper back pain will resolve with home treatment. However, there are times when seeing a doctor is the safest option to make sure nothing serious is causing the pain. See your doctor when upper back pain:

• Interferes with your sleep, work, or daily activities

• Is constant or severe, does not respond to rest, or is worse when you lie down

• Persists for more than two weeks despite home management

• Occurs with unexplained weight loss, redness and swelling on the back, or weakness, numbness or tingling in the arms, chest or legs

• Radiates or spreads to the arms or legs

To diagnose the cause of your upper back pain, your doctor will ask you several questions about your pain including:

• When did your upper back pain start?

• Can you describe your pain? Is it sharp, dull, achy or burning?

• On a scale of 1 to 10 with 10 being the worst pain ever, how would you rate your pain?

• Is your upper back pain on the left side, right side, or both sides?

• Is your upper back pain constant or does it come and go?

• What, if anything, makes your upper back pain better or worse?

• Are you experiencing any other symptoms, such as weakness or numbness?

• Does your upper back pain wake you at night or limit your activities during the day?

• Have you ever injured your back?

• What do you do for work?

• Do you exercise?

Your doctor will also perform a physical exam, feeling your back for areas of tenderness or abnormalities. You may need to move your arms, reach in different directions, bend and change positions. Your doctor will want to know if movement affects your pain or if pain limits your movements. Your doctor may also test your muscle strength and reflexes.

In some cases, testing may be necessary including:

• Blood tests to check your blood cell counts and electrolytes

• Bone scans if osteoporosis or a bone tumor is a possibility

• Imaging exams, including X-rays, CT (computed tomography) scans, and MRIs (magnetic resonance imaging)

• Nerve studies to evaluate how well your nerves and muscles are working

It is not always possible to diagnose an underlying cause or condition. If the problem persists and your provider is unable to determine a cause, seeking a second opinion may give you more information and answers.

The complications associated with any kind of back pain depend on the underlying disease, disorder or condition. Most cases of upper back pain are not due to serious diseases and do not lead to long-term complications. Physical therapy, basic self-care measures, and following the treatment plan outlined by your doctor can help treat many causes of back pain and relieve pain. However, upper back pain may become chronic and overwhelming. If you are struggling, ask your doctor about advances in back pain treatment.

Over time, upper back pain can lead to complications including:

• Absenteeism from work or school

• Permanent nerve damage (due to a pinched nerve) including paralysis

• Physiological and psychological response to chronic pain

• Poor quality of life