Medicines for Upper and mid back pain

What it is

Thoracic back pain is pain in the upper or middle part of the back — the region of the spine between the neck and the lower back, behind the chest (the thoracic spine). It is less common than neck or lower back pain, but still frequent. Most thoracic back pain is "mechanical" — arising from the muscles, joints, ligaments and discs of the back — and is often related to posture (such as prolonged sitting, desk and screen work, or hunching), muscle strain or tension, overuse, minor injury, or wear-and-tear changes; stress can contribute to muscle tension too. It typically causes an ache, stiffness, or sometimes sharper pain in the upper or mid back, which may be worse with certain movements or postures and eased by others. Most such pain is not serious and improves over time with simple measures. However, thoracic back pain warrants a little more awareness than lower back pain, because — while still uncommonly — the thoracic region is a location where certain other causes can occasionally produce back pain: these include problems with the bones (such as a fracture, including osteoporotic fractures in older people), and, rarely, other conditions (including some affecting organs in the chest or abdomen, or, very rarely, more serious spinal conditions). So, although most thoracic back pain is benign and mechanical, certain "red flag" features prompt assessment.

How it is treated

For the common mechanical thoracic back pain, management is similar to other mechanical back pain and most cases improve: staying active and continuing normal activities as much as possible (prolonged rest is unhelpful), simple pain relief and, where suitable, anti-inflammatory measures, applying heat, and addressing posture and ergonomics (for example improving desk, screen and seating set-up, and taking breaks from sustained postures). Exercises and physiotherapy help — including stretching, strengthening, posture work, and gradually returning to activity — and are useful for persistent or recurrent pain. Managing stress and muscle tension can help. Most mechanical thoracic back pain settles over a few weeks. Importantly, a doctor will be alert to "red flag" features that would prompt further assessment — such as significant trauma, pain following a fall (especially with osteoporosis risk), pain that is constant, progressive or worse at night, pain with fever or unexplained weight loss, neurological symptoms (such as leg weakness or numbness, or bladder or bowel problems), or thoracic back pain in someone with a history of cancer — as these can indicate a cause needing investigation. Chest or back pain that could be from the heart or another internal cause is also assessed appropriately. The reassuring message is that most upper and mid back pain is mechanical, not serious, and improves with staying active, posture changes, pain relief and exercises — while certain red-flag features should be checked.