UPPER/MIDDLE BACK PAIN (SEE ALSO LOW BACK PAIN)

The upper or middle part of the back is the section between the neck (cervical) and the lower (lumbar) region and plays an important part in framing the upper body. This region is also called “thoracic,” or pertaining to the chest. There are twelve vertebrae in the upper spine (T1 – T12), and each of the top nine is attached to a rib that sits on either side of the spine. The ribs curve around and attach to the breastbone in front, making a strong and stable cage to support the upper body and protect the heart and lungs. This structure and the muscles attached to it also support the scapula, or shoulder blades, and the entire shoulder girdle. Because the thoracic spine is designed to give us strength and stability, as opposed to the mobility and flexibility provided by the cervical and lumbar portions of the spine, it is much less likely to be injured or to degenerate over time. Although thoracic back pain is not a very common type of spinal disorder, it can cause significant pain and discomfort, usually from muscular and connective tissue irritation (myofascial pain) and joint dysfunction. Twisting, unexpected movement, bending sideways or moving/lifting incorrectly can aggravate thoracic pain incorrectly.

Symptoms
Sharp pain upon onset
Tightness or stiffness
Burning or throbbing pain

Causes
Pain referred from the lumbar spinal region
Deconditioning, or lack of use leading to muscle weakness and lack of strength
Poor posture
Overuse injuries
Trigger point pain
Trauma, such as a car accident or sports injury

Causes not common but deserving consideration are
A compression fracture of the vertebra can occur with trauma, or, in women with osteoporosis, without trauma
Spinal disc herniation can occur and cause pain that wraps around the rib cage
Degenerative disc disease
Spondylolisthesis (the displacement of a vertebra onto the vertebrae below it)
Spondylosis (degenerative osteoarthritis of the spinal joints)

Treatment
It is important to condition and strengthen the muscles that are actually supporting the spine and also stretch the opposing muscles so that there is a balance, which will create stability.
Treat the muscle itself if there are trigger points, or tender areas, with trigger point therapy (direct manipulation of the area), or trigger point injections.

Exercise
Physical therapy
Joint manipulation
Massage therapy
Ice and/or heat therapy
Analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs)
Non-surgical spinal decompression
Proper posture and attention to ergonomics
Proper nutrition and weight management
For both treatment and diagnosis of spinal joint pain there are different types of injections available, where an anesthetic (numbing medicine) and/or a corticosteroid (anti-inflammatory medicine) are injected into the affected area.
Facet joint injections
Epidural steroid injections
Medial branch blocks
Selective nerve root blocks
Trigger point injections
Radiofrequency ablation (RFA). RFA uses radiofrequency energy to stop nerve function so that the nerve can no longer transmit pain

Integrative therapies
Meditation
Yoga
Mindfulness training
Cognitive-behavioral therapy emphasizing pain management
Dealing with depression
Deep abdominal breathing
Progressive muscle relaxation
Visualization and guided imagery
Tai chi
Acupuncture
Biofeedback

Information and Resources
BRAIN
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424
http://www.ninds.nih.gov

Information also is available from the following organizations:

American Chronic Pain Association (ACPA)
P.O. Box 850
Rocklin, CA 95677-0850
ACPA@theacpa.org
http://www.theacpa.org
Tel: 916-632-0922 800-533-3231
Fax: 916-652-8190

National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse
1 AMS Circle
Bethesda, MD 20892-3675
NIAMSinfo@mail.nih.gov
http://www.niams.nih.gov
Tel: 877-22-NIAMS (226-4267) 301-565-2966 (TTY)
Fax: 301-718-6366

American Academy of Family Physicians
11400 Tomahawk Creek Parkway
Suite 440
Leawood, KS 66211-2672
fp@aafp.org
http://www.aafp.org
Tel: 913-906-6000/800-274-2237
Fax: 913-906-6095

American Academy of Physical Medicine & Rehabilitation
330 North Wabash Ave.
Suite 2500
Chicago, IL 60611-7617
info@aapmr.org
http://www.aapmr.org
Tel: 312-464-9700
Fax: 312-464-0227