From the Guidelines
Thoracic scoliosis can indeed cause back pain, particularly when the curvature exceeds 50 degrees or when it leads to excessive pressure on surrounding muscles, nerves, and joints. This condition can result in muscle fatigue, tension, or spasms in the mid-back region as the body compensates for the abnormal spinal alignment 1. The pain associated with thoracic scoliosis is often a result of the biomechanical stress placed on the spine and surrounding structures due to the misalignment of the vertebrae, leading to muscle imbalances, joint dysfunction, and potential nerve compression over time.
Some key points to consider in the management of thoracic scoliosis-related back pain include:
- The role of physical therapy in strengthening core muscles to support the spine and reduce pain
- The use of pain medications, such as NSAIDs (ibuprofen, naproxen), to manage inflammation and discomfort
- The potential need for bracing to support the spine, especially in cases where the curvature is significant
- The consideration of surgical intervention in severe cases with significant pain or neurological compromise
It's essential to approach each case individually, considering the degree of curvature, the presence of any red flags (such as trauma, myelopathy, or prior thoracic spine fusion), and the patient's overall health status, as outlined in the ACR Appropriateness Criteria for thoracic back pain 1. By prioritizing a comprehensive assessment and tailored treatment plan, healthcare providers can effectively manage thoracic scoliosis-related back pain and improve patient outcomes.
From the Research
Thoracic Scoliosis and Back Pain
- Thoracic scoliosis can cause back pain, as evidenced by studies that have investigated the relationship between scoliosis and back pain 2, 3, 4, 5.
- The type and localization of the curve can impact the level of pain, with lumbar and thoracolumbar curves being more painful than thoracic curves 4.
- Back pain in patients with thoracic scoliosis can present with specific features, such as asymmetrical localization and cruralgia, which can differentiate it from non-scoliosis-related pain 4.
- Psychological factors, such as pain catastrophizing and self-reported state of mental health, can also contribute to back pain in patients with thoracic scoliosis 5.
- Morphological factors, such as deformity severity and pelvic asymmetry, can also play a role in back pain in patients with thoracic scoliosis 5.
Predictors of Back Pain in Thoracic Scoliosis
- Increased primary thoracic curve magnitude (> 26°) at 10 years after surgery has been identified as a primary predictor of increased pain in patients with thoracic scoliosis 3.
- Poor mental health score has also been associated with an increased rate of pain in patients with less coronal deformity (< 26°) 3.
- Male gender and revision surgery may also play a role in increased pain, although the overall frequency of these variables is low 3.
Management of Back Pain in Thoracic Scoliosis
- Physiotherapy scoliosis-specific exercises (PSSE) can produce benefits in subjects with scoliosis, including improving back asymmetry and reducing related pain 2.
- PSSE can also improve breathing function in more severe cases of thoracic scoliosis 2.
- Epidural analgesia can provide adequate analgesia after thoracotomy, although scoliosis patients may have substantial anatomic variations that make epidural catheter placement more difficult 6.