This topic provides an overview of upper and middle back pain. If you have low back pain or neck pain, see the topic Low Back Pain or Neck Pain.
Upper and middle back pain can occur anywhere from the base of your neck to the bottom of your rib cage.
Your ribs attach to a long, flat bone in the center of the chest called the sternum and attach to and wrap around your back. If a nerve in this area is pinched, irritated, or injured, you may also feel pain in other places where the nerve travels, such as your arms, legs, chest, and belly.
The upper and middle back (called the thoracic spine) has:
See a picture of the spine.
Upper and middle back pain is not as common as low back pain or neck pain, because the bones in this area of the back don't flex or move as much as the bones in your lower back or neck. Instead, they work with the ribs to keep the back stable and help protect vital organs, such as the heart and lungs.
Upper and middle back pain may be caused by:
In rare cases, pain may be caused by other problems, such as gallbladder disease, cancer, or an infection.
Common symptoms of upper and middle back pain are:
More serious symptoms that need to be treated right away include:
Your doctor will first ask you about your past health, your symptoms, and your work and physical activities. Then he or she will do a physical exam. Your doctor may also order an imaging test, such as an X-ray or an MRI, to find out if something such as a broken bone or a herniated disc is causing your pain.
You may need more tests to check for other possible causes for your pain.
In most cases, people with mild to moderate back pain can manage their symptoms with:
But if your pain gets worse and you're having a hard time doing your daily activities, you may need to take a prescription pain medicine. Surgery is seldom used to treat upper and middle back pain.
There are several things you can do at home to help reduce your pain. For example:
Health Tools help you make wise health decisions or take action to improve your health.
Learning about upper and middle back pain:
Living with upper and middle back pain:
In most cases, upper and middle back pain is caused by:
For example, some people hurt their backs when they:
Conditions that put pressure on the spinal nerves also can cause pain. These include:
In rare cases, upper and middle back pain may be caused by other problems, such as gallbladder disease, cancer, or an infection.
In general, symptoms of upper and middle back pain may:
In most cases, back pain gets better with home treatment. So unless you have signs of a severe illness, injury, or heart attack, you can give your back pain some time to work itself out before you call your doctor.
Call 911 or other emergency services immediately if:
Watchful waiting is a wait-and-see approach. If you get better on your own, you won't need treatment. If you get worse, you and your doctor will decide what to do next. If your back pain is mild to moderate, it probably will get better on its own. You can try home treatment to relieve your symptoms. If you don't feel better in 1 to 2 weeks, call your doctor.
Be sure to call your doctor right away if you start to have other symptoms or you have:
Health care professionals who often diagnose the cause of back pain include:
If your back pain is severe or long-lasting, health
professionals who can treat you include:
You can also get care
Your doctor will first ask you about your past health, your symptoms, and your work and physical activities. Then he or she will do a physical exam. Your doctor may also order an imaging test to find out if something such as a broken bone or a herniated disc is causing your pain.
The type of imaging test you have depends on what kind of problem your doctor suspects. You may have one or more tests, such as:
More tests may be done to check for other possible causes for your pain.
There are many treatments for upper and middle back pain. What works for someone else may not help you. Work with your doctor to find what is best for you.
Treatment for upper and middle back pain is based on:
In most cases, people with mild to moderate upper and middle back pain can manage their symptoms with:
If your back pain doesn't get better or it gets worse, your doctor may recommend:
In some cases, a back brace may be used to support the bones in the spine after a fracture.
Surgery is seldom used to treat upper and middle back pain. If your doctor recommends surgery, the type will depend on the problem you have. Before you decide to have surgery, it's a good idea to get a second opinion from a different doctor. Surgery choices may include:
Here are some other things you can do to feel
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
Esses SI, et al. (2011). The treatment of symptomatic osteoporotic spinal compression fractures. Journal of the American Academy of Orthopaedic Surgeons, 19(3): 176–182. Also available online: http://www.aaos.org/research/guidelines/guide.asp.
McIntosh G, Hall H (2011). Low back pain (acute), search date December 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Other Works Consulted
Hanson TJ (2008). Thoracic compression fracture. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 2nd ed., pp. 213–217. Philadelphia: Saunders Elsevier.
Mercier LR (2008). The back. In Practical Orthopedics, 6th ed., pp. 143–184. Philadelphia: Mosby Elsevier.
August 16, 2013
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
& Robert B. Keller, MD - Orthopedics
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