What is Thoracic Pain

espalda dolorThoracic pain, also known as mid-back pain or upper back pain is much less common than low back or neck pain. Frequently thoracic back pain has a benign musculoskeletal origin, but may indicate a more serious underlying problem. The word thoracic means “pertaining to the chest” hence the thoracic spine forms the back of the chest wall. With markedly less mobility than the cervical spine above and lumbar spine below, the thoracic spine’s main function is to provide protection for the vital organs in the chest, such as the heart and lungs, as well as allow stability for standing upright.

Even though the majority of mid-back pain is harmless, when present in the following situations an individual should seek medical attention:

  • History of a recent infection
  • Temperature over 100° F
  • IV drug use, which increases risk of an infectious cause
  • Unexplained weight loss, which may be associated with cancer

When the following conditions are present, one should seek emergency care:

  • Weakness or paralysis
  • Loss of bowel or bladder control
  • Prior history of cancer
  • Recent significant trauma such as a fall from a height or motor vehicle accident

Causes of Thoracic Pain

There are many probable causes of thoracic pain including spinal stenosis or hematomas. Diseases of the spinal column like a compression fracture, tumor, and scoliosis can also cause more problems.
Thoracic spondylosis is the result of abnormal wear and tear that causes gradual narrowing of the disc space and deformed bone growth (bone spurs). This combination leads to increased pressure on surrounding tissue and nerves causing pain, and possibly weakness, numbness in the arms or shoulders, and even headaches.
Arthritis and other forms of pain that affect the discs of the spine may also cause thoracic pain.

Additional risk factors for thoracic pain include the following:

  • Age of 40 years or greater
  • History of injury
  • Deformities (scoliosis or kyphosis), arthritis, or narrowing of the spine
  • Poor posture or excessive sitting
  • Heavy physical work
  • Smoking or drug abuse
  • Poor physical condition and lack of exercise

Treatment for Thoracic Pain

The most common treatments are non-prescription medications such as non-steroidal anti-inflammatory drugs or acetaminophen. More powerful medications may also be prescribed by your physician.
Epidural steroid injections are also commonly used to treat degenerative and arthritic joint conditions. Often the goal of ESIs is to provide sufficient pain relief to permit more aggressive physical therapy and greater functional recovery. The procedure involves injecting a combination of a corticosteroid and local anesthetic under x-ray guidance into the epidural space, which is the space around the spinal cord. The steroids act at nerve roots as they branch from the spinal cord by decreasing inflammation and irritation.

Facet blocks are an injection of local anesthetic and steroid into the facet joint under x-ray guidance. This procedure is effective in treating arthritic pain of originating from the facet joints.

Spine surgery may also be necessary for certain extreme cases.

Physical therapy, exercise, proper nutrition, and yoga may also provide long and short term relief.

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Though rare, there are some conditions affecting the middle back area that may require more than simple medication and exercise. If you are experiencing chronic or unusual thoracic pain, consult your physical for more information and treatment options.

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