Pain is a highly subjective and unpleasant experience that informs a person that something is wrong with his or her body. When pain occurs in the upper back region, it can be brought about by psychological or physiologic origins just like any painful experience.
Upper back pain can be a symptom of any condition. Therefore, thorough medical assessment and performance of diagnostic tests should be done by a licensed health practitioner prior to determining the real cause of upper back pain.
Types and Sources of Pain
Before delving deeper solely into the mechanisms of upper back pain, it is important to know about the different types of pain and their corresponding sources. Pain can be acute if it occurs suddenly, has a short duration (less than six months), and is easily treated or alleviated by medication, rest, or other forms of treatment. If the pain persists over a period of more than six months and does not respond to treatment well, this is classified as chronic pain.
Chronic pain is further subdivided into three types:
Chronic Non-malignant Pain
This type of chronic pain is characterized by being recurrent and continuous. It is experienced by those who have severe burns, back pain, or rheumatoid arthritis.
Chronic Intermittent Pain
As its name suggests, this type of pain occurs only at specific times while pain-free periods occur. This is usually experienced by those who suffer from migraines, cluster headaches, irritable bowel syndrome, Crohn’s disease, and other gastrointestinal disorders.
Chronic Malignant Pain
This pain type is associated with the diagnosis of cancer and can be caused by cellular destruction, deep bone pain, nerve injury, infection, or lack of oxygen supply to affected body parts.
As a person suffering from upper back pain, you will need to know if the type of pain you have is acute or chronic. This will help your physician in accurately diagnosing the cause of the pain. Furthermore, determining the source and cause of one’s pain is equally important to understand the person’s pain experience and provide steps to alleviate it.
This type of pain is characterized by a sudden onset of sharp pain or by a slow onset and burning feeling. This tends to occur when the skin surface is damaged and the nerve endings for pain are stimulated. It is usually easily localized and treatment can begin right away.
Deep Somatic Pain
Somatic pain is characterized by less localized, diffused pain, and is often coupled with nausea, decreased heart rate, fainting, pallor, sweating, and other somatic symptoms. This occurs because the pain originates from the deep body structures and then this pain radiates from the primarily affected site. For instance, deep somatic pain occurs in people with lumbar disk problem, rheumatoid arthritis, and osteomyelitis.
If the somatic pain is caused by damage to the body walls, muscles, and bones, visceral pain is caused by pain originating from damaged body organs. It is characterized by a dull, poorly localized, vague pain that radiates to different parts of the body. Conditions that bring about visceral pain are acute appendicitis, cholecystitis, and inflammation of the gallbladder, pancreas, ureters, kidneys, lung walls, gastric tract, and the heart muscles. Visceral pain is also known to cause referred pain.
Referred pain is the term used for pain felt in a part of the body that is distant from the source of the pain stimulus (usually visceral body organs). The pain may depend on the damage and the stimuli from the affected organ/s. It is often confusing and thorough assessment is needed. For example, having a heart attack is commonly associated with pain in the left arm, jaw, shoulder, and back. Often, it is not felt as pain in the heart. Referred pain to these areas occurs since the nerve endings surrounding them are also near the nerve endings of the heart.
Upper Back Pain Causes
Lower or upper back pain, especially if chronic, most likely is a referred pain. This symptom appears due to a problem with a deep somatic and/or visceral organ. The pain is experienced in different locations in the upper back due to the location of the spinal cord nerves connected to the affected organ.
Upper Back Pain Symptoms
There are several symptoms associated with upper back pain and this may be throbbing pain or you may experience piercing or sharp pain or it may be a localized pain. Again, this pain is to be of a permanent nature or only appears when you undertake any particular physical activity. The pain may be severe to chronic and require immediate medical help and hospitalization.
When you experience upper back pain you may have a fever as well as a headache. In most cases, there will be neck pain combined with shoulder pain. Many people experience stiffness in the back while others have reported of swelling or redness on the back. In course of time, you will experience discomfort and fatigue while this may also lead to sleeplessness, anxiety, stress, and depression. Under such circumstances, it is always better to consult with your doctor for his or her expert opinions.
The presence of upper back pain can be caused by a number of conditions. It can be due to a localized, superficial wound that you have not noticed before, or it could be from over-exercised muscles, or it is referred pain from other organs. Below are the most common upper back pain symptoms and the most likely underlying conditions that cause them.
- Pain in the ShouldersThis could be radiated pain from the inflammation of the pleural cavity surrounding the diaphragm. This can occur after a blunt trauma during motor vehicle accidents, falling, even during hazing.
- Upper Back Pain between Shoulder Blades This type of pain is the hallmark of cholecystitis, the inflammation of the gallbladder wall. This condition needs immediate medical attention since it may require surgery.
- Pain in the Left Jaw, Neck, Shoulders and Middle Back This type of referred pain is associated with myocardial ischemia or heart attack. The type of pain experienced is often sharp and occurring suddenly in the upper back.
- Pain in the Upper Right Back (Right Scapula)This type of pain may extend to the upper right shoulders and often indicates a perforated duodenal ulcer or cholecystitis. If the referred pain is associated with cholecystitis, the pain may occur suddenly, increase over time, coupled with tenderness in the right upper quadrant of the abdomen.
- Upper Left Back PainThis is one of the signs of pancreatitis. This referred pain can also extend to the middle back.
- Pain in the Area below the Shoulder Blades (Scapula)It is often indicative of a penetrating duodenal ulcer.
- Pain in the Area along the SpineThis pain could be a sign of spinal fracture or compression that is common in osteoporosis. Consult a doctor for accurate diagnosis of this type of pain.
- Pain in the Middle BackConstant, dull referred pain in the area around the middle back (posterior to the rib cage) is often associated with the distention of the renal capsules, a condition caused by acute pyelonephritis.
- Generalized Lower and Upper Back Pain in WomenThis may occur in obese, pregnant, or women who frequently wear high heels. High heels cause overstretching of the spine’s curvature which ultimately leads to pain.
Treatments for Upper Back Pain
Upper back pain relief can be achieved with pharmacologic and non-pharmacologic means. However, for severe upper back pain caused by a chronic disease, medical or surgical treatment should be explored first in order to alleviate pain more effectively. In concurrence with these treatments, non-pharmaceutical-based interventions can then work wonders for pain relief and reduction.
If your upper back pain is caused by a chronic malignancy or by a condition that affects deep somatic organs like the bones, anesthetic agents may be prescribed by your physician. Another treatment course is the use of analgesics. Depending on the cause, intensity, distribution, duration, and quality of pain, your doctor will follow the World Health Organization-approved “pain ladder” to manage pain.
The first step involves the prescription of non-opioids like acetaminophen or NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). If pain persists, step two calls for mild opioid-like codeine and oxycodone coupled with the previous non-opioid analgesics. Still, if the pain is unrelenting, step 3 will involve giving strong opioids like morphine sulfate and fentanyl with or without the non-opioid analgesics.
When taking pain medication, it is important to remember that some pain medications have a ceiling effect. This means that these medications have a maximum effective dose and taking more of it will not further alleviate your pain. You should also be aware of drug tolerance and dependence. Most step 2 and step 3 pain medications are highly-controlled substances to help prevent drug dependencies.
Non-Pharmaceutical Pain Treatments
This is a form of pain reduction therapy where the unaffected side of the body is stimulated to arouse the inhibitory neurons in the spinal cord. This can decrease the pain’s intensity and also serves as a form of distraction.
Transcutaneous Electrical Nerve Stimulation (TENS)
This is the use of bursts of electricity through the skin to reach deep and superficial nerves. This is most useful for those with chronic arthritic pain.
Upper back pain relief usually comes after a good back rub. This form of stimulation to the back is relaxing and can block pain to help you get a good sleep. Foot massage or reflexology can also work.
Acupressure or Acupuncture
Thin metallic needles inserted into meridian points in the body. It is believed that through this procedure, the body’s vital energy is influenced and helps in decreasing pain.
Music therapy can be used to calm and provide the distraction from aches and pains. You can listen to slow, calming soundtracks or musical accompaniments.
Progressive Relaxation Training and Deep Breathing
These are easy-to-form upper back pain exercises that are effective in reducing muscle tension on your backs and in decreasing anxiety. You can listen to these relaxations and breathing exercises at first and do them on your own once mastered.
Reading, watching, listening to comedic skits and shows can help increase the immune system’s Natural Killer (NK) cells. Nevertheless, laughing helps you feel better and become more relaxed.
Biofeedback teaches control over one’s body’s reactions to pain using biofeedback equipment. The machine shows your temperature, blood pressure, heart rate, respiratory rate, and other vital signs. Depending on your reaction to the electrical impulses sent through the electrodes attached to you, you will gradually be able to learn to manage your body’s response to pain triggers.
This form of alternative pain relief method is popular in East Asian countries. It hypothesizes that the magnets’ pull force increases blood flow to the affected body part and thus decreases pain.
Heat and Cold Applications
The use of warm and cold compresses, especially if they are within 4 to 5 degrees of the body’s temperature, can provide pain relief. If your back hurts, make sure to change your compresses within 5 to 15 minutes to ensure the effectiveness of this technique.
Meditation is a well-known but less practiced therapy to alleviate pain. When done correctly, your attention will be away from your pain. Whether you follow a specific meditation technique or just focus on the flow of your breath, it leaves you relaxed and peaceful afterward.
This can be used as another method for upper back pain relief as it can alleviate pain when the baroreceptors of the heart and carotid sinuses are stimulated. In this method, you will follow a rhythmical breathing pattern that will activate the brain’s gray matter. After doing this for quite some time, the process becomes automatic and your attention is diverted towards your breathing and its rhythm, not to your pain. This type of breathing technique is also used in the Lamaze birthing method.
Another non-pharmacologic way to reduce pain is through the guided visualization of a pleasant experience. With the help of a coach, you can imagine scenes, sounds smell that is pleasant and which will distract you from any pain. This technique is most commonly used with biofeedback and relaxation for optimal benefit.
This technique is often used for those experiencing chronic pain. It is performed by a skilled hypnotherapist who is thoroughly aware of the patient’s pain history and makes sure not to probe away unpleasant memories. Self-hypnosis is also possible if you have deliberately learned how to do spontaneous trance induction yourself.
How to Prevent Upper Back Injuries
Most of the time, prevention is better than cure. This applies to preventing upper back injuries as well. Listed below are different techniques you should keep in mind in order to have a healthy and ache-free back.
- Always be aware of your posture and follow proper body mechanics. Don’t slouch. Sit or stand straight.
- When standing for an extended period, regularly bend on knee and hip. Then rest your foot on top of a small stool if possible.
- When sitting down, make sure to position your knees higher than your hips.
- When sleeping, use a firm mattress that will provide optimum body support to the body’s natural curvatures.
- When exercising, follow exercises that strengthen the abdominal, lumbar, and pelvic muscles.
- Avoid exercises like spinal twisting, sit-ups, and toe-touching since they can cause pain when the spinal cord is flexed.
- Ask for help if you are lifting objects (especially if they weigh more than 25 pounds).
- Wear comfortable clothing and low-heeled shoes so that you can move freely and be supported well while doing physical activities.