Causes of upper back pain

Medically Reviewed By : Dr Sravya, MBBS, MS

Introduction

Are you feeling uneasy due to your achy back? It can cause mild to severe discomfort
depending upon the degree of pain you are suffering from. It affects people from all
age groups and people from various lifestyles. However, women are mostly affected
by back pain.

Back pain

Back pain may have different causes and it is important to learn about the underlying
causes and manage them. The causes of upper back pain may range from something
as basic as poor posture to as severe as spondylitis. It is essential to rule out the
cause to make a proper treatment plan.

Let us discuss in detail various causes of upper back pain:

In This Article

Causes of Upper Back Pain

Pain caused by trauma, muscle strains, or injury in the area located between the neck region and the base of the ribcage is referred to as upper back pain. One can manage symptoms at home that are mild to moderate. But if the pain is severe, it needs a proper diagnosis and a well-crafted treatment plan.

Your upper and middle back is situated in the area between the neck and bottom of the ribcage. The region of your upper and middle back is called the thoracic spine which consists of 12 small bones called vertebrae. These vertebrae form the backbone. Each of your vertebrae consists of a disk that separates the vertebrae from one another. These disks act as a shock absorber as you move. Your upper back has many muscles and ligaments that hold all the vertebrae together.

Upper back pain does not commonly occur as other pains, because the bones in the upper back play a crucial role in protecting vital organs such as the heart and lungs. Their movement is not like the bones in the neck and lower back.

Few conditions cause upper back pain which includes certain medical conditions and injuries.

Back sprains: This involves injury to the band of tissues connecting two bones. Sudden back pain causes include back sprains.
Back strains: Here, the band of tissues that connect a muscle to the bones are injured causing pain. One can injure muscles, and ligaments but lifting something heavy is one of the sudden back pain causes.
Bad posture: People with a bad posture have problems standing straight. They often stand in a slouching position which puts extra load on the spine causing strain in the upper back leading to upper back pain.
Bulging disks: Our vertebrae are small disks that are made up of jelly-like substances that act as a cushion for your spines. There are instances when the disks bulge i.e. they come out through the spine, putting pressure on the nerves or the spinal cord causing a sudden and sharp back pain.
Fractured bones: Bones in the spine may break during accidents like car accidents, sports injuries, or falling off from a height.
Arthritis: A form of arthritis called osteoarthritis, causes severe upper back pain. This is one of the most common back pain causes in females due to the decreasing level of estrogen which is a post-menopausal effect.
Pregnancy: Pregnancy is one of the leading back pain causes in females. But for most of the women, lower back pain is a very common problem. However, there are few cases wherein there are instances of upper back pain in females during pregnancy.
Pneumonia and other lung infections: People suffering from pneumonia and other lung infections may experience upper back pain.
Heart attack: A heart attack may start with a sharp sudden upper back pain associated with other symptoms like shortness of breath and chest pain.
Tuberculosis: Tuberculosis is a serious bacterial infection that may spread from lungs to other parts including the spine. Upper back pain is one of the symptoms of spinal tuberculosis and needs immediate diagnosis and medical attention.

As we discussed the causes of upper back pain, let us now delve into the details of upper back pain and the diagnosis.

Upper back pain can be described as;

Diagnosis of upper back pain

Diagnosis of the causes of upper back pain may start with a simple physical exam like lifting or bending of the legs to see the severity of the pain you have. This physical examination lets your doctor know your muscle strength. After assessing your symptoms, if your doctor is unable to diagnose the cause of your upper back pain, he or she may advise you to do some imaging tests. These tests include;

X-ray: This test is done to take the image of the bones using radiation, to check for any issues in the spine that are causing upper back pain. A chest X- ray also diagnoses pneumonia.
Magnetic Resonance Imaging (MRI): Radiations are used in this imaging test to produce images of the bones in the spine to assess the causes of upper back pain.
Computed Tomography (CT Scan): Here, 3 dimensional images of the bones and soft tissues in the spine.
Electrocardiogram (EKG): This is carried out to diagnose a heart attack.
Electromyography (EMG): This test is carried out to check the nerves and spines to see if there is any nerve damage that causes tingling or numbness.
Blood Test: This test detects the genetic markers, if any, that result in some medical conditions that are responsible for causing upper back pain. Blood and sputum tests are done to check the infection of Mycobacterium tuberculosis.

Once the cause of the upper back pain is ruled out by the doctor, an appropriate treatment plan is made. Let us study how to manage and treat the upper back pain caused by any of the above reasons.

Treatment of the upper back pain

Your treatment depends upon the causes, and symptoms (severity of the pain) that you present at the time of assessment.

Many types of pains that can be managed with some home remedies and lifestyle changes do not need any medicines. One can apply heat bags or ice packs and back massage in some cases. These techniques relieve the pain caused by pain, stiffness, and swelling.

However, some types of pain that are caused due to certain medical conditions need medical intervention. Your doctor may prescribe you the following medications.

Medications like painkillers are mostly prescribed medicines while treating upper back pain. E.g.: Advil and non-steroidal anti-inflammatory drugs (NSAIDs).
If your pain is not relieved after taking over-the-counter medicines, you may be given antidepressants that block the pain senses in the brain. These medicines help increase the endorphins which is a natural painkiller.
A muscle relaxant may be given to you if your doctor rules out muscle spasms as the cause of your upper back pain. These stop the muscle spasms.
In rare serious cases, you may be prescribed narcotics only under the supervision of your doctor. Narcotics also known as opioids make you capable of bearing even the unbearable pain. Your doctor may first give you short-acting narcotics like oxycodone or hydrocodone for the initial opioid therapy. Later he/she may prescribe you long-acting narcotics such as morphine or Oxycontin.
A thoracic epidural injection may be administered in the space that covers the spine and nerve roots. Nerves travel through the body and spread throughout the body. If at all, a nerve is compressed near your chest, it can cause pain in your arm or chest.
Treatment of spinal tuberculosis includes medications and surgery to treat spinal damage.
Antibiotics and breathing exercises are recommended to treat back pain from pneumonia.
In addition to the physical exams, you may be administered with spinal injections that provide long-lasting relief.

Highlights

An achy back can leave you in discomfort. Unlike lower back pain, upper back is not a common type of back pain. It is caused due to reasons like muscle spasms, strains, or sprains (the most common causes of sudden back pain, bad postures, bulging disks, fractured bones, and osteoarthritis. The upper back is prevalent in women as they have decreased levels of estrogen hormone post-menopause. Additionally, some
pregnancies are expected to have upper back pain. Hence, pregnancy is one of the leading back pain causes in females. Some of the serious causes of upper back pain include pneumonia and lung infections, heart attack, and spinal tuberculosis. All the three causes need a proper diagnosis and immediate medical attention.

You may be assessed based on the symptoms you present at the doctor’s office. The doctor may first go for the physical examination wherein, he/she may ask you to bend your leg to see the effect of pain on bending. Any of the imaging tests including X-ray, MRI, CT Scan, or EMG may be advised based on the symptoms you have. You may be sometimes advised to do your blood workup to check for the genetic markers that are present due to certain medical conditions that cause upper back pain.

Once the assessment is done, based on the reports, your doctor may prescribe you medications that include over-the-counter medicines or NSAIDs. In some serious cases, your doctor may advise you to take narcotics under strict medical supervision. Spinal or epidural shots may be administered if the reports and the severity of the symptoms demand so.