Middle Back Pain: Medical Causes and When It Is an Emergency
What is middle back pain?
Middle back pain is any type of pain or discomfort in the area between your upper and lower back. Healthcare professionals refer to this area as the lower thoracic area or lower thoracic spine. The upper thoracic area or upper thoracic spine makes up part of the upper back. The lumbar spine makes up part of the lower back.
The middle back consists of the spine (spinal column), spinal cord, nerves, discs, muscles, blood vessels, ligaments, and tendons. Any of the structures in the spine or back area can become irritated or inflamed in response to a variety of mild to serious conditions. Middle back pain causes include sports injuries, poor posture, arthritis, muscle strain, and car accident injuries. Middle back pain is not as common as lower back pain because the thoracic spine does not move as much as the spine in the lower back and neck.
Pain in the middle of the back may be either short lived or chronic, which is defined as lasting more than three months. Middle back pain may be described as a dull, annoying ache or a sharp, acute pain. The pain can radiate, or spread, to other areas of your body. The converse is also true; pain that is caused by a problem somewhere else in your body can radiate to your middle back.
In some cases, acute back pain can resolve with basic self-care measures within a few weeks, but it can also persist and lead to more serious problems over time.
Prompt diagnosis and treatment of middle back pain can help control symptoms and reduce the risk of complications, such as disability. Seek prompt medical care if your pain is severe, is persistent, or causes you concern. In some cases, the underlying cause of middle back pain can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have middle back pain accompanied by chest pain, difficulty breathing, loss of bladder or bowel control, or numbness or paralysis in the arms or legs.
What causes middle back pain?
The middle back consists of the thoracic spine (bony structures called vertebrae surrounding the nerves of the spinal cord). Between the vertebrae are spongy sacs of cartilage called discs that act as cushions 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 thoracic spine is a sudden movement during sports activities or home improvement projects. People who normally lead a relatively sedentary lifestyle are at increased risk of these types of strains and sprains.
Middle back pain can also be due to more serious conditions, such as fibromyalgia, spondylitis (infection or inflammation of the spinal joints), or a herniated disc. A bulging disc can put pressure on the nerve roots coming out from the spine, resulting in middle back pain.
In addition, a problem in another part of the body, such as the heart or digestive organs, can radiate to the middle back. This is called referred middle back pain.
Diseases and disorders that can cause middle back pain
Middle back pain can be due to diseases and disorders of the bones and tissues in the back including:
- Osteomyelitis (infection or inflammation of the bones)
- Osteoporosis (thinning and weakening of the bones)
- Paget’s disease (abnormal bone tissue loss and reformation)
- Spinal degeneration (degenerative disc disease, also called spondylosis)
- Spinal stenosis (narrowing of the spinal canal, creating pressure on the spinal cord or nerves)
- Spondylitis (infection or inflammation of the spinal joints)
Structural causes of middle back pain
Middle back pain can be due to injury or misalignment of the bones and tissues in the back including:
- Herniated disc
- Kyphosis (abnormal curving of the upper spine and humpback)
- Muscle spasm
- Scoliosis (sideways curve of the spine)
- Spinal tumor or cancer (the tumor can be noncancerous, also known as benign)
- Spine fracture
- Sprains and strains due to overuse or injury
Other possible causes of middle back pain
Middle back pain can also be due to systemic problems or problems affecting other body systems, which can be serious or life threatening in some cases. These include:
- Aortic aneurysm (life-threatening bulging and weakening of the wall of the aortic artery that can burst and cause severe hemorrhage)
- Gastric ulcer (with or without perforation)
- Heart attack
- Kidney stones (pain is usually below the rib cage in the flank area)
- Multiple myeloma (bone marrow cancer)
- Abdominal malignancy
What other symptoms might occur with middle back pain?
Middle back pain symptoms depend on the underlying disease, disorder or condition. For instance, if your back pain is due to arthritis, you may experience pain in other joints of your body. Back pain due to a pinched nerve can cause loss of bladder control. Back pain is often a major symptom of fibromyalgia, which is characterized by fatigue and sleep problems.
Other symptoms that may accompany middle back pain include:
Morning back stiffness
Redness, warmth or swelling of the back
Shoulder, neck or hip pain
Serious symptoms that might indicate a life-threatening condition
In some cases, middle back pain may occur with other symptoms that might indicate a serious or life-threatening condition, such as heart attack or cauda equina syndrome (a syndrome in which nerves in the spinal cord of the lower back are compressed or paralyzed, cutting off sensation and movement). Seek immediate medical care (call 911) if pain in your middle back occurs with any of the following symptoms:
Chest pain, tightness or pressure
Difficulty breathing or shortness of breath
Loss of bladder or bowel control
Severe abdominal pain
What are the risk factors for middle back pain?
Although anyone can experience middle back pain, there are certain risk factors that make you more likely to experience it. Middle back pain can occur at any age, but it most often begins between 30 and 50 years of age. The activities associated with this age group, along with the increasing age of the spine and associated tissues, are the most influential factors in back pain. Risk factors include:
- Advanced age
Congenital (present at birth) or acquired back deformities (such as kyphosis, an abnormal curving of the upper spine and humpback)
Family history of back pain or disease (such as degenerative disc disease)
Stress and anxiety
- Weak abdominal (core) muscles
What are potential complications of middle back pain?
The complications associated with middle back pain depend on the underlying disease, disorder or condition. For example, middle back pain resulting from a degenerative condition, such as spondylosis, can lead to inactivity and its associated complications.
You can best treat middle back pain and minimize the risk of complications by following the treatment plan you and your health care professional design specifically for you. In many cases, this may include physical therapy and basic self-care measures, such as rest and nonprescription pain relievers.
In some cases the degree and duration of your pain may become overwhelming and affect your everyday living. Treatment and pain management for all types of back pain is an area of ongoing research. Contact your doctor to learn about your treatment options.
Over time, middle back pain can lead to complications including:
- Absenteeism from work or school
Permanent nerve damage (due to a pinched nerve) including paralysis
- Poor quality of life