What is upper back pain (thoracic pain)?

Upper back pain is pain or discomfort in or around your thoracic spine that involves your:

• bones
• joints
• muscles
• nerves
• any other body tissue

Your thoracic spine is the area between your neck (cervical spine) and lower back (lumbar spine). It is also known as the upper back. It is made up of 12 back bones known as vertebrae, which are numbered from T1 to T12. Each of these vertebrae is attached to your ribs.

Pain in the upper back is common. Around 1 in every 7 Australians report experiencing a back problem. There are many things that you can do to help you manage upper back pain.

What are the symptoms of upper back pain?

Symptoms of upper back pain can be similar to other back pain symptoms. In addition to pain, you may have difficulty with everyday activities. This may affect your emotional state.

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.

What causes upper back pain?

Upper back pain does not always have a specific cause. If your doctor can't find what caused it, they may describe it as 'non-specific back pain'. If there are no other worrying features, this means that your upper back pain isn't likely to be caused by:

• a specific medical condition
• illness
• serious physical damage

Some causes of non-specific upper back pain include:

• sprains and strains
• stress
• anxiety or depression
• lack of exercise
• living with overweight or obesity
• poor posture

Upper back problems can also result from heavy lifting or putting strain on your spine. This may happen at home or at work.

Upper back pain is sometimes a result of a sudden movement. Examples include:

• twisting while playing sport
• falling
• an injury from a car accident or at work

Few cases of upper back pain have a specific medical 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 — degeneration of the joints, particularly osteoarthritis (OA) in the spine, can cause back pain.
• osteoporosis — a condition that affects your bones, causing them to become weak. Osteoporosis can lead to painful fractures (breaks) of the bones in the spine, including compression fractures (where the back bones lose height or collapse).
• trauma — for example, from injury to the bones and soft tissues of the spine.

Upper back pain caused by infection in the bones, or a tumour (cancer) in the bones of the spine is rare.

When should I see my doctor?

See your doctor if you have upper back pain and:

• your pain worsens over a few weeks
• your ability to move is limited, or you feel unsteady
• you have unexplained weight loss
• you experience pain when taking a deep breath
• you have a fever

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

• a physiotherapist
• an exercise physiologist
• an occupational therapist

How is upper back pain diagnosed?

To diagnose upper 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, computed tomography (CT) or magnetic resonance imaging (MRI) scans, as these often aren't helpful when looking for the cause of or managing upper back 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. You can also manage your pain effectively in other ways. 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
• paracetamol — can help reduce pain and may be used if you have other health problems that mean you cannot take NSAIDs

There are also lifestyle changes that can help you manage your pain until it resolves. These include:

• exercise
• stress management
• weight management
• stretching and manual therapy from a trained professional

What are the complications of upper back pain?

The main complication of upper back pain is your inability to perform daily tasks.

Upper back pain is often linked with neck pain and lower back pain.

Can upper back pain be managed or prevented?

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

• Be physically active. 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.
• Maintain a healthy body weight. If you live with overweight or obesity, your spine carries an extra load.
• Quit smoking. Smoking increases your risk of osteoporosis and back pain and slows down healing.
• Ensure safe manual handling. If you have a physical job, you may be at risk of back injury. Your employer must keep your workplace safe and teach you how to handle heavy loads safely.
• Workplace design and posture. Your work may mean you sit or stand for many hours. Poor posture can cause back injury or pain. Set up your workstation so you can stand and sit in a way that supports your back.
• Read more on how to improve your posture.

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 Health Australia website for information about back pain and tips to manage and prevent back pain.
• Learn why physically activity is important by visiting the Australian Physiotherapy Association.
• MyBackPain has tips on managing back pain.
• 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 to speak with you 24 hours a day, 7 days a week.

Languages other than English

• The NSW Multicultural Health Communication Service has videos on understanding pain.
• Choosing Wisely Australia has a guide to the questions you should consider asking your doctor or healthcare provider
• Find more translated information on back pain at Health Translations.

Information for Aboriginal and/or Torres Strait Islander peoples

The Pain Management Network has resources on chronic pain and management.