Upper Back Pain

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Introduction

What is upper back pain?

Upper back pain is any type of pain or discomfort throughout the back side of the chest and upper abdominal area. The upper back area includes the shoulder blades and where the rib cage connects to the thoracic (chest region)  spine. The upper back is also referred to as the middle back or the thoracic spine.

Most people will experience back pain at some point in their lives. However, pain in the upper back is not as common as lower back pain. Upper back pain is not as common because the thoracic spine does not move as much as the spine in the lower back and neck.

Upper back pain may either be acute, lasting briefly or it may be chronic, lasting longer than three months. Your pain may be dull and throbbing or sharp and stabbing. You may be in constant pain, or perhaps the pain occurs only during a particular activity, such as lifting grocery bags or after working at your desk for a prolonged period of time.

In addition to the thoracic spine and shoulder blades, there are numerous nerves, muscles, tendons, and ligaments in the upper back. Any of these structures can become irritated or inflamed in response to a variety of different factors and conditions, such as poor posture, overuse, trauma, arthritis, and bone cancer. However, most upper back pain causes involve muscle irritation or joint problems and are usually not a cause for concern.

Upper back pain occurring with other symptoms, such as chest pain or difficulty breathing, may be a sign of a heart attack and should be immediately evaluated in an emergency setting. In addition, if your pain is extreme, persistent, or causes you concern, contact a medical professional.

Symptoms

What other symptoms might occur with upper back pain?

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:

Serious symptoms that might indicate a life-threatening condition

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. Back pain occurring with any of the following symptoms may indicate a serious or life-threatening condition:

Causes

What causes upper back pain?

The upper 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 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.

Structural causes of upper back pain

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

Life-threatening causes of upper back pain

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 noncancerous, also known as benign)

What are the risk factors for upper back pain?

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

What are the potential complications of upper back pain?

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

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 30
  1. Lower back pain fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
  2. Warning signs of heart attack, stroke & cardiac arrest. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4595
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