What is Upper Back Pain?
Upper back pain explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors
The upper back is the area of the spine in the thorax, between the neck and lower back. It contains the vertebrae (spinal bones) attached to the bones and muscles of the ribs. A significant number of people experience pain in this region. Upper back pain can be either acute or chronic. Acute upper back pain can be associated with temporary injury or inflammation in the region. Chronic pain may indicate nerve or vertebral damage. Upper back pain is not as common as that in the neck or lower back, but can be as discomforting and cause as much decline in function or motion.
Causes of Upper Back Pain
Acute upper back pain may be associated with damage to muscle tissue. This can be a result of sporting or athletic activity, accidental injury, or posture defects. Muscle damage causes the release of inflammatory molecules by the immune system, which is also associated with pain. Inflammation is also a symptom of some disorders, such as arthritis, that may affect thoracic vertebrae or ribs. Damage to the facet joints can also cause pain. Chronic upper back pain may be caused by herniation or bulging of the protective discs (rings of tissue) between each thoracic vertebra. Bulging occurs if the discs degenerate and bulge away from the spine.
Thoracic spinal nerve damage is also associated with chronic upper back pain. This can be caused by certain types of tumors that develop in the thorax. These are rare, however. Minor fractures, associated with motor vehicle accidents, osteoporosis, or bone cancers in the spine can also result in chronic pain.
Treatment for Upper Back Pain
Conventional over-the-counter medications are often the first-line treatment for upper back pain. These include acetaminophen, naproxen, ibuprofen, and anticonvulsants such as carbamezapine. If these drugs fail to relieve pain, the patient may then consider minimally invasive surgical procedures. For example, epidural steroid injections, a direct delivery of steroids to thoracic spinal nerves via a catheter or needle may be effective. As steroids prevent inflammation, they are often used to treat pain associated with conditions, such as arthritis.
Nerve blocks are similar procedures, injecting a combination of local anesthetics, such as bupivacaine, and steroids to inhibit pain and inflammation in thoracic spinal nerves. These combinations can also be injected directly into facet joints, or the nerves that serve them. Injection procedures have some risks. Injection of local anesthetics may cause severe chest numbness and discomfort. In serious cases, cardiac events such as arrythmias and tachycardia may occur as a result of nerve blocks. Steroids are associated with adverse effects, such as stomach ulcers, immune system depression, and irritability.
Bulging discs can be addressed with discectomy. This is a slightly invasive surgery to remove parts of the disc that have become herniated. This procedure, also known as percutaneous disc decompression, is reported to effectively reduce chronic pain for up to two years after surgery. Nerve damage, infection, and bleeding can occur as a result of discectomy.
Vertebroplasty is another option for vertebral fractures that may be causing upper back pain. A needle is inserted through the skin into the broken vertebra, and medical cement is injected. Kyphoplasty is a variation on this, in which a small balloon is inserted through the needle, and then inflated to restore the height of the vertebra. These surgeries are associated with a significant reduction in chronic pain. Both may cause bleeding and infection at the needle insertion site. There is a low incidence of “cement leak” that may cause damage and inflammation of the surrounding tissue.
Upper back pain is less prevalent than lower back or neck pain, but can cause similar distress and debility. Upper back pain can be acute or chronic, and have a variety of causes. Acute pain may be treated by over-the-counter drugs, such as ibuprofen and acetaminophen. If these are ineffective, direct facet joint or nerve injections are an option. If chronic pain is caused by vertebral fracture, this can be treated with kyphoplasty or vertebroplasty. These treatments are effective in treating chronic upper back pain.
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