Thoracic back pain is a common ache or discomfort in the area of the middle and upper back. The thoracic region of the spine runs from the base of the neck to the bottom of the chest area, just below the breastbone.
The back has many small bones, muscles, and soft tissues that surround and protect the spinal cord. Nerves also leave the spinal cord in the back. Pain may be caused by stress, strain, or injury to any of these structures, such as:
Rarely, thoracic back pain is associated with more serious problems like an infection in the spine, heart or lung problems, or cancer.
Damage to the tissue of the back can occur with:
Pain may start after lifting, bending, or twisting your back, but it is usually caused by a buildup of small injuries or irritation rather than the one time movement.
Medical conditions that may increase your chance of thoracic back pain include:
The intensity and duration of the pain will depend on the cause.
Irritation or damage of muscle or soft tissue may cause:
Irritation of the nerves may cause:
Your condition may be a combination of any or all of the symptoms above. The symptoms may occur in intensive bursts or be consistent. It may make daily tasks impossible.
You will be asked about your symptoms and medical history. A physical exam will be done, which will include an assessment of the spine and muscles. Your strength, flexibility, sensation, and reflexes may be tested. The doctor will likely know if it is a minor issue or if further testing is needed.
Imaging tests may be done if the pain is severe or is not going away as expected. Images of the spine and surrounding structures may be taken with:
Pain due to medical conditions, such as a fracture or arthritis, will be treated by managing the conditions.
In most cases, thoracic back pain will go away after giving the area time to recover. Major treatment, such as surgery, is rarely helpful.
Treatment options include:
For most, absolute rest is not helpful but 1-2 days of rest may be suggested for severe pain.
Activities that cause pain will be limited or adjusted for a period of time, and then gradually resumed as soon as possible. Recovery time is often shorter for those who stay reasonably active.
Medications may be recommended to help manage discomfort such as:
Physical therapy may be recommended for pain that is limiting daily function or pain that is recurring. A therapist can provide stretching and strengthening exercises to help regain muscular and postural balance. Instruction may also be provided on irritating factors like sitting posture or lifting techniques.
Therapy may also include heat, cold, massage, or ultrasound treatments for more immediate pain relief.
To help reduce your chance of thoracic back pain:
American Pain Society
Ortho Info—American Academy of Orthopaedic Surgeons
Back Care Canada—Canadian Spine Society
Canadian Pain Society
Acute thoracic spinal pain. National Health and Medical Research Council website. Available at: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp94b.pdf. Published February 2004. Accessed January 26, 2015.
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Evaluation of neck and back pain. The Merck Manual Professional Edition website. Available at: http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/neck_and_back_pain/evaluation_of_neck_and_back_pain.html. Updated March 2013. Accessed February 29, 2016.
Examination of the spine. Patient UK website. Available at: http://www.patient.co.uk/doctor/examination-of-the-spine. Updated August 21, 2014. Accessed February 29, 2016.
Peh W; Image-guided facet joint injection. Biomed Imaging Interv J. 2011;7(1):e4.
Thoracic back pain. Patient UK website. Available at: http://www.patient.co.uk/doctor/thoracic-back-pain. Updated May 29, 2013. Accessed February 29, 2016.
Last reviewed March 2017 by EBSCO Medical Review Board Michael Woods, MD, FAAP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.