Middle and Upper (Thoracic) Back Pain

Pain in the lower back seems to grab all the headlines – and with good reason, given that 31 million Americans suffer from lower back pain at some time or another. But pain in the upper and middle back, known as the thoracic spine, can be just as debilitating as lower back pain.

The vertebrae of the thoracic spine (T1-T12) connect to the neck’s cervical vertebrae (C1-C7) and to the lower back’s lumbar vertebrae (L1-L5). Given its location in the middle of the back, the thoracic spine provides the body with core stability and protects the vital internal organs of the chest, including the heart and lungs.

There are several reasons people may suffer from thoracic spinal pain. Muscle tension is among the most common causes and is often the result of poor posture. In older adults, arthritis in the thoracic facet joints can cause middle and upper back pain, as can compression fractures of the vertebrae due to osteoporosis. In younger patients, a spine segment or a rib can be out of place and cause pain. Other causes of middle and upper back pain include herniated or degenerated discs or problems with the joints that attach the ribs to the thoracic vertebra.

How is middle and upper back pain treated?

• Because pain in the thoracic region is often caused by muscle tension and poor posture, initial treatment efforts focus on relieving the tension with stretching, massage, and over-the-counter medications such as acetaminophen or ibuprofen.
• Heat and/or ice therapy can help reduce muscle pain and stiffness as well.
• Physical therapy and home exercises that stretch and strengthen the back, shoulder and stomach muscles can increase flexibility and balance.
• Prescription medications, such as oral anti-inflammatories, nerve blockers, and muscle relaxants can help reduce the severity of the pain. There are also patches and creams that can be applied to the skin directly to the area of pain.
• For muscle spasm and tension in the mid and upper back, trigger point injections are used to relax the muscles and get them firing correctly again.
• In some cases, facet joint injections may reduce swelling and relieve pressure on the joints that are causing pain. Using x-ray guidance, we use these injections both as a diagnostic tool to determine the exact source of your pain and as a treatment therapy to administer corticosteroid medication right to the spot to reduce swelling and irritation. If successful in reducing your pain, sometimes radiofrequency of the nerves that go to the thoracic facet joints can be more long-lasting
• Herniation or degeneration of the disc, causing nerve inflammation can be treated with epidural steroid injections. One clue that pain may be coming from the nerve is if there is a tingling or burning sensation the comes from the back and goes forward into the chest or stomach.
• Patients with compression fractures may first try a back brace to stabilize the broken vertebra while it heals, but patients in severe pain may be candidates for kyphoplasty or vertebroplasty. These procedures involve injecting a special bone cement into the compressed bone to return it to its correct vertebral height so it no longer presses on neighboring nerves.
• Alternative therapies, including chiropractic manipulation and acupuncture, may also alleviate muscle tension and pain.

Facet joint injections, trigger point injections, epidural steroid injections, radiofrequency are minimally invasive procedures that can be performed in our offices in less than 15 minutes and often result in dramatic pain relief.