From the Guidelines
For thoracic spine pain (M54.6), continuing the current plan of care with the bed wedge to offload the knees is recommended, as it helps reduce pressure on the spine by maintaining proper alignment during rest 1. The neurosurgery appointment that has been requested is appropriate for further evaluation of the thoracic pain, as a specialist can determine if surgical intervention might be necessary or if other treatments should be considered. While waiting for the neurosurgery consultation, consider adding non-opioid pain management options such as acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) if not contraindicated. Gentle stretching exercises focusing on the mid-back, application of heat for 15-20 minutes several times daily, and maintaining good posture throughout the day can also help manage symptoms.
Key Considerations
- Thoracic spine pain often results from muscle tension, disc issues, or vertebral problems, and a comprehensive approach addressing both symptom management and underlying causes typically yields the best outcomes 1.
- Imaging may be considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain, or for those patients presenting with red flags, raising suspicion for a serious underlying condition 1.
- Indication for surgery is usually severe, intractable pain, or progressive/severe myelopathy, and symptomatic thoracic disc herniations requiring surgery are rare, accounting for 1% to 2% of all discectomies 1.
Management Strategies
- Non-opioid pain management options: acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) if not contraindicated.
- Gentle stretching exercises focusing on the mid-back.
- Application of heat for 15-20 minutes several times daily.
- Maintaining good posture throughout the day. It is essential to prioritize a comprehensive approach that addresses both symptom management and underlying causes to yield the best outcomes for patients with thoracic spine pain 1.
From the Research
Current Treatment for Thoracic Spine Pain
The current plan of care for the patient's thoracic spine pain includes continuing the current plan of care, using a bed wedge to offload the knees, and requesting a neurosurgery appointment.
Evidence for Treatment of Thoracic Spine Pain
- A study published in 2019 2 found that active motion testing, palpation, and postural assessment were commonly used by physiotherapists in the UK to manage thoracic spine pain and dysfunction.
- Another study from 2018 3 reported on the use of McKenzie's Mechanical Diagnosis and Therapy (MDT) for the conservative evaluation and management of cervical and thoracic spinal conditions, including thoracic spine pain.
- A review of chronic pain and the thoracic spine published in 2015 4 discussed the use of therapeutic neuroscience education (TNE) and graded motor imagery (GMI) in the treatment of persistent spinal pain, although noted a lack of research on these approaches specifically for thoracic spine pain.
- A systematic review from 2009 5 found that thoracic spine pain is a common condition in the general population, with a higher prevalence in child and adolescent populations, and is associated with various biopsychosocial factors.
- A systematic review published in 2015 6 found that the evidence for noninvasive interventions for musculoskeletal thoracic spine and chest wall pain is sparse, but suggests that spinal manipulation may be associated with a small reduction in pain intensity, and that a multimodal program of care may lead to improvements in chest pain.
Considerations for Treatment
- The use of a bed wedge to offload the knees may help to reduce pressure on the thoracic spine and alleviate pain.
- Requesting a neurosurgery appointment may be necessary to rule out any underlying neurological conditions that could be contributing to the patient's thoracic spine pain.
- Further research is needed to inform evidence-based practice for the treatment of thoracic spine pain, including the use of exercise prescription and implementation of evidence-based practice 2.