From the Guidelines
Upper back pain is commonly caused by a combination of factors including poor posture, muscle strain, overuse injuries, and stress, as well as more serious conditions such as herniated discs, osteoarthritis, compression fractures, and myofascial pain syndrome. According to the most recent study published in the Journal of the American College of Radiology in 2024 1, thoracic back pain (TBP) can be caused by various factors, including inflammatory, neoplastic, metabolic, infectious, and degenerative conditions. The study highlights that TBP may be equally disabling and associated with significant morbidity, and that imaging may be considered in patients who have had up to 6 weeks of medical management and physical therapy with little or no improvement in their back pain.
Some of the key causes of upper back pain include:
- Poor posture, which can lead to rounded shoulders and forward head posture, placing excessive strain on upper back muscles
- Muscle strain from overuse injuries, stress, carrying heavy bags, or sleeping in awkward positions
- Herniated discs, osteoarthritis, compression fractures, and myofascial pain syndrome, which can cause more serious and persistent pain
- Inflammatory arthritis and other non-spine causes of TBP, which can overlap in clinical presentation
It is essential to note that imaging may not be necessary for uncomplicated acute TBP and/or radiculopathy, and that conservative therapy should be considered first-line for patients with subacute or chronic TBP without red flags or prior management 1. For mild to moderate pain, over-the-counter medications like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) can help reduce inflammation and discomfort, and applying heat for 15-20 minutes several times daily can relax tight muscles. Gentle stretching exercises targeting the upper back and shoulders can also provide relief, and maintaining proper ergonomics at workstations, taking regular breaks from sitting, strengthening core muscles, and practicing stress management techniques are effective preventive measures. If pain persists beyond two weeks, worsens, or is accompanied by numbness, weakness, or radiating pain, medical evaluation is necessary to rule out more serious conditions.
From the Research
Causes of Upper Back Pain
- Osteoporotic fractures can cause acute and chronic pain, including upper back pain, mainly affecting elderly patients with multiple comorbidities 2
- Fractures can induce both acute and chronic nociceptive and neuropathic pain, with central sensitization playing a pivotal role in developing and maintaining chronicity of post-fracture pain 2
- Fragility fractures, such as vertebral or hip fractures, can increase the risk of subsequent fractures and all-cause mortality, highlighting the importance of proper treatment and management of osteoporosis 3
- Poor adherence to national guidelines on osteoporosis treatment can lead to a higher risk of re-fracture and mortality, emphasizing the need for appropriate pharmacological treatment and calcium/vitamin D supplementation 3