What is upper back pain (thoracic pain)?

Upper back pain is pain or discomfort that involves the bones, joints, muscles, nerves or any other body tissue in or around your thoracic spine. Your thoracic spine (upper back) is the area between your neck (cervical spine) and lower back (lumbar spine). It is made up of 12 back bones known as vertebrae, which are numbered from T1 to T12. This section of your back is where your ribs attach to your spine.

Pain in the upper back is common, with around 1 in every 7 Australians reporting that they experience some sort of back problem. There are many things that you can do to help you live well with upper back pain.

What are the symptoms of upper back pain?

Symptoms of upper back pain can be similar to other back pain symptoms.

Back pain can be acute or persistent:

• Acute back pain usually begins quickly and lasts for a relatively short time.
• Persistent back pain, also called chronic back pain, is pain that lasts for more than 3 months.

Upper back pain is sometimes a result of a sudden movement, for example, twisting while playing sport, falling, or an injury from a car accident or at work.

Often, you won’t know how a back problem started. Even if your pain persists, in most situations, there are things you can do to manage it — back pain is more likely not to be due to a serious medical condition.

What causes upper back pain?

For around 9 in every 10 people with upper back pain, there is no specific cause. If your doctor can’t find what caused it, they may describe it as ‘non-specific back pain’. This can be reassuring, because it means that your upper back pain isn’t caused by a specific medical condition, illness or serious physical damage. It’s rare for back pain to be caused by a serious medical problem and even severe pain does not usually mean you have a serious medical problem.

Some causes of non-specific upper back pain include:

• soft tissue sprains and strains
• stress
• anxiety or depression
• sleep problems
• lack of exercise
• living with overweight or obesity

If you suddenly need to increase the load on your spine, this can also cause back problems. This may happen for a number of reasons at home or at work. For example, if your child, partner or parent become sick, you may need to lift or carry them; if your job changes, you may need to carry more than usual.

Very few cases of upper back pain have a specific cause. Some specific causes of back pain include:

• thoracic spondylosis — degeneration (‘wear-and-tear’), of the spine. Most people will have some degree of wear and tear as they age, although not everyone will have pain.
• ‘slipped disc’ — also known as a prolapsed or herniated disc. This is when one of the discs that sit between the bones of the spine is damaged or weakened. The disc bulges and presses on the nerves of the spine and may cause pain, tingling or numbness down one or both legs.
• arthritis — osteoarthritis (OA) is the most common cause of arthritis in the spine. People with OA commonly have less pain in the morning, worse pain with movement and improvement with rest.
• osteoporosis — a condition that affects your bones, causing them to become weak. Osteoporosis does not itself cause pain but can lead to painful fractures (breaks) of the bones in the spine, including compression fractures (where the back bones loose height or collapse).
• trauma — for example, from injury to the bones and soft tissues of the spine.

Very rarely (in fewer than 1 in every 100 cases), upper back pain is caused by infection of the bones of the upper back, or a tumour (cancer) in the bones of the back.

When should I see my doctor?

See your doctor if:

• your pain worsens over a few weeks
• your ability to move is limited, or you feel unsteady
• you have problems controlling your bladder or bowel
• you have unexplained weight loss
• you have redness or swelling on your back
• there is sudden significant weakness or numbness, or pins and needles in your legs
• you have a fever

Other health professionals might also help you manage your pain. Ask your GP about a referral to a:

• physiotherapist
• exercise physiologist
• occupational therapist

How is upper back pain diagnosed?

To diagnose upper (thoracic) back pain, your doctor may:

• ask you questions about your back pain
• ask about any other symptoms or health concerns
• do a physical examination

Usually, you won’t need x-rays, CT or MRI scans, since these aren’t helpful when looking for the cause of upper back pain. They usually don’t change how you manage your pain.

For more information about questions to ask your doctor before you get a medical test, treatment or procedure visit Choosing Wisely Australia.

How is upper back pain treated?

Back pain often goes away on its own, but there are ways you can manage your pain effectively. Your doctor may recommend or prescribe medicines for a short time to help you return to regular daily activities:

• non-steroidal anti-inflammatory drugs (NSAIDs) — remember to only use the lowest dose for the shortest time possible
• topical medicines — these are rubs, gels, ointments, sprays, patches and creams applied to your skin (topically). Some topicals contain medicines such as NSAIDs and corticosteroids.

Medicines that are not effective for back pain include paracetamol and opioids. Read more on opioid medicines and pain.

There are also many lifestyle changes, such as exercise, and stress and weight management, that can help you manage your pain until it resolves.

Can upper back pain be managed or prevented?

You can reduce your chances of having back pain from injuries by trying these approaches:

• being physically active: Your body needs to move. Regular exercise improves flexibility, muscle strength and bone health. Start slowly and gradually increase intensity. A physiotherapist or exercise physiologist can create a program for you.
• maintaining a healthy body weight. If you are living with overweight or obesity, your spine carries an extra load.
• quitting smoking. Smoking increases your risk of arthritis, osteoporosis and back pain and slows down healing.
• safe manual handling. If you have a physical job, you are at risk of back injury. Your employer must keep your workplace safe. They must teach you how to handle heavy loads safely. You should cooperate with your employer’s efforts.
• workplace design and posture. Your work may mean you to sit or stand for many hours. Poor posture can cause back injury or pain. Your workstation should be designed to allow you to stand and sit in a way that supports your back.

Resources and support

• Visit WorkSafe Victoria to watch videos explaining manual handling in the workplace and how to prevent injury.
• Find a physiotherapist — use the Australian Physiotherapy Association search tool to find physiotherapists to prevent or treat upper back pain.
• See the Musculoskeletal Australia website for information about back pain and tips to manage and prevent back pain.
• Learn about why it is important to be physically active at the Australian Physiotherapy Association website.
• Call the National Arthritis and Back Pain Help Line on 1800 263 265.
• For help to quit smoking, call Quitline or Aboriginal Quitline (staffed by Aboriginal counsellors) on 13 7848 (13 QUIT).
• You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

Other languages

• NSW Multicultural Health Communication Service on managing pain
• Choosing Wisely on questions to ask your doctor or healthcare provider