What is the cause of upper back pain with radiating pain down the right (R) arm for 2 weeks, after completing a course of muscle relaxers and steroids (corticosteroids)?

From the Guidelines

You should see a healthcare provider for evaluation of your upper back pain with radiation down your right arm, as this could indicate nerve compression such as cervical radiculopathy or a herniated disc. While you've completed a course of muscle relaxers and steroids, persistent symptoms warrant further assessment. In the meantime, you can take over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours with food) or acetaminophen (650-1000mg every 6 hours) for pain management, as suggested by studies 1. Apply ice for 15-20 minutes every 2-3 hours for the first few days, then switch to heat. Gentle stretching and maintaining good posture may help, but avoid activities that worsen the pain. The radiating pain down your arm suggests nerve involvement, which could be from inflammation or compression in your cervical spine. If you experience new or worsening symptoms like numbness, weakness, difficulty controlling bladder or bowels, or severe pain, seek immediate medical attention as these could indicate a more serious condition requiring urgent intervention.

Some key points to consider:

• Systemic corticosteroids are not recommended for treatment of low back pain with or without sciatica, as they have not been shown to be more effective than placebo 1.
• Nonpharmacologic therapy with proven benefits, such as spinal manipulation, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, yoga, cognitive-behavioral therapy, or progressive relaxation, may be considered for patients who do not improve with self-care options 1.
• Medications like gabapentin, benzodiazepines, and tricyclic antidepressants may be effective for pain relief, but their use should be weighed against potential risks and benefits 1.

It is essential to consult a healthcare provider to determine the underlying cause of your symptoms and develop an appropriate treatment plan.

From the Research

Possible Causes of Upper Back Pain with Radiating Pain

• The cause of upper back pain with radiating pain down the right arm for 2 weeks, after completing a course of muscle relaxers and steroids, may not be directly related to the studies provided, as they primarily focus on low back pain and lumbar disk herniation 2, 3, 4.
• However, one study suggests that upper extremity radicular pain can have a cervical origin terminating at the cervicothoracic junction (C8, T1) 5.
• Another possible cause could be radiation fibrosis syndrome, which can result in pain, sensory loss, weakness, and other signs and symptoms due to radiation-induced fibrosis 6.

Diagnostic Considerations

• A detailed history and physical examination with a thorough workup are required to exclude emergent or nonoperative etiologies of back pain 3.
• The examination should include an evaluation for radicular symptoms, and routine imaging is not recommended but is indicated when red flags are present, there is a neuromuscular deficit, or if pain does not resolve with conservative therapy 4.
• The study on T2 radiculopathy suggests that mechanical dysfunction of the upper thoracic vertebrae can cause upper extremity radicular pain, and a thorough examination of the cervicothoracic junction and upper thoracic region is necessary 5.

Treatment Options

• Conservative therapy, including nonsteroidal anti-inflammatory drugs, physical therapy, and cognitive behavioral therapy, may be effective in managing back pain 3.
• Nonpharmacologic treatment, such as counseling, exercise therapy, spinal manipulation, massage, heat, dry needling, acupuncture, transcutaneous electrical nerve stimulation, and physical therapy, may also be beneficial 4.
• In the case of T2 radiculopathy, manual therapy, corrective exercise, and pain modalities may be effective in reducing local tenderness and radiating pain 5.