What is Thoracic Back Pain?

Thoracic back pain explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Thoracic back pain refers to chronic pain that develops in the upper and middle regions of the back. The thoracic region of the spine consists of twelve vertebrae that extend from the lower portion of the neck to just below the shoulder blades. Unlike the cervical spine in the neck that promotes flexibility (e.g. the turning of the head) or the lumbar region that provides power that is needed to lift heave objects or to bend at the waist, the thoracic region provides stability.

More specifically, the thoracic region of the spine helps protect vital organs in the chest by ensuring that the upper body remains fixed at all times, even when an individual bends. Thoracic back pain may be accompanied by chest or abdominal pain, numbness in the back, a loss of balance, or pain that worsens due to sneezing or coughing.

Causes of Thoracic Back Pain

Common causes of thoracic back pain include:

Vertebral Body Fracture

Tense or damaged muscles, also referred to as myofascial pain, are one of the most common causes of pain in the upper back. Irritation of muscles in the shoulders and upper back or even poor posture may cause this type of pain to arise.

Kyphosis, also known as being hunchback, is a deformity that may develop due to poor posture, arthritis, or other types of medical problems. This type of deformity may lead to pain in the upper and middle back. Similarly, scoliosis is a condition that causes the spine to curve in an abnormal manner and some individuals who have this condition experience thoracic back pain.

Another common cause of thoracic back pain is joint dysfunction, which may develop in the regions where the ribs connect to the spine. A herniated disc in the thoracic region or the development of degenerative disc disease may also cause chronic upper back pain.

Vertebral fractures, also referred to as compression fractures, often develop as a result of osteoporosis and this condition is also among the numerous causes of thoracic pain in older individuals. These types of fractures may develop anywhere along the spine, but they usually occur in the lower portion of the thoracic spine.

Arthritis may also develop in the spine and if it does, it can result in tenderness in the back, reduced mobility, nerve compression, and chronic back pain. With age, gradual wear and tear may cause cartilage in facet joints to become very thin or completely destroyed. As the body tries to repair the damage, bone spurs often begin to form at the joints. Bone spurs are bony projections that grow on top of normal bone and cause the abnormal enlargement of joints and chronic pain. Similarly, osteoarthritis in the thoracic spine may be the source of pain in the upper region of the back.

In rare cases, thoracic back pain may be an indication of a more serious health problem or disease such as a malignant tumor on the spine that is placing pressure on spinal nerves. Diseases that develop in the kidneys, abdominal organs, heart, or lung may also cause pain in the upper back.

In order to treat thoracic back pain, the underlying cause needs to be identified. Once the source of the pain is accurately diagnosed the appropriate form of treatment can be recommended.

Treatments for Thoracic Back Pain

The first line of treatment that is typically recommended for thoracic back pain is pharmacotherapy, which involves over-the-counter pain medication or prescription-strength pain relievers. In certain cases, thoracic back pain gradually decreases or completely stops due to this form of treatment. Commonly recommended pain relievers include: non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen, or ibuprofen; antidepressants; or analgesics such as acetaminophen.

These types of medications have been reported to effectively decrease mild, moderate, and short-term thoracic back pain. In addition, opioids may be prescribed if pain relievers are not effective, but the long-term use of opioids is associated with opioid dependence and in some cases, an overdose. Therefore, individuals who are prescribed opioids are closely monitored.

Another minimally invasive treatment that may be recommended, that is quite effective, is a nerve block. The procedure, which is called a thoracic paravertebral block, involves blocking pain signal transmission from thoracic spinal nerves that may have become compressed due to vertebral fractures or health problems such as a tumor. This form of treatment often provides patients with complete or significant pain relief.

Spinal-Cord-StimulationA thoracic paravertebral block is a short procedure that is relatively safe and non-surgical. After the spinal region that is responsible for the pain has been correctly identified, a local anesthetic is applied to the skin and then anesthesia as well as steroid medication is injected directly into the vertebral space where the affected thoracic spinal nerves are located. The anesthetic provides pain-relief and has a numbing effect, while the steroid medication reduces inflammation that may be present. If a nerve thoracic paravertebral block is effective, rapid pain relief is usually experienced and the procedure can be repeated several times if necessary.

An additional treatment approach that effectively treats thoracic back pain is spinal cord stimulation. This procedure involves the surgical implantation of electronic devices in regions of the spine where affected nerves are located. Electronic signals are transmitted from the devices to the damaged thoracic spinal nerves and this process reduces pain signal transmission.

Another effective approach is radiofrequency ablation, in which damaged nerves are exposed to radio wave-generated heat. The heat causes the destruction of the affected nerves, which, similar to spinal stimulation, hinders the nerves from transmitting pain signals.

An alternative form of treatment that has provided patients with pain relief, in some cases, is called biofeedback training. This form of training teaches patients how to recognize, avoid, and reduce factors that trigger and worsen their back pain.


Thoracic back pain refers to pain in the upper and middle portion of the back. It may develop due to muscle or joint problems in the back, vertebral fractures, arthritis, scoliosis, and tumors along the spine, among other causes. If more serious health problems such as organ disease are responsible for the pain, an individual may also experience numbness, a loss of balance, or chest and abdominal pain.

Pharmacotherapy treatment, nerve blocks, spinal cord stimulation, radiofrequency ablation, and biofeedback training are common approaches that effectively reduce thoracic back pain. However, the type of treatment that is recommended depends on accurately diagnosing the source of the pain.

At Pain Doctor our goal is to relieve your back pain and improve function to increase your quality of life.
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