Pain in the upper back

The causes of upper back pain are often unknown and may not be detected by imaging tests. Prolapsed discs, spinal arthritis, and muscle spasms are the most common diagnoses. Other problems can also cause upper back pain.

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Lumbosacral radiculitis

The sciatic nerve is a very large nerve that starts in the lower back. It forms at the spine and is made up of branches of the roots of the lumbar spinal nerves. It runs through the pelvis and then down deep into each buttock. It then runs down into each leg. It is the longest and widest nerve in the body.

Upper back pain is not a diagnosis, but a description of symptoms. Anything that puts pressure on one or more lumbar nerve roots can cause pain in one or all areas of the sciatic nerve. A herniated disc, spinal stenosis, osteochondrosis, spondylolisthesis or other vertebral disorders can all put pressure on the sciatic nerve. And then there is pain in the upper back, it can radiate to the back, to the legs.

In some cases, sciatic nerve pain can be distressing when a muscle deep in the buttocks pinches the sciatic nerve. It is called the piriformis muscle. The pain condition is called piriformis syndrome.

This syndrome usually develops after an injury and can sometimes be difficult to diagnose.

Upper back pain due to emergencies

Several other serious medical conditions can also cause back pain. Often these symptoms develop over a short period of time and become more severe. Some of these conditions include:

• Infections in the bone (osteomyelitis) or disc (diskitis)
• Cancer that has spread to the spine from another part of the body (most commonly lung cancer, colon cancer, prostate cancer, and breast cancer)
• Cancers that develop in the bones (the most common diagnosis in adults, particularly multiple myeloma, especially in middle age or older adults), benign tumors such as osteoblastoma or neurofibromas, and blood cancers including leukemia can also cause back pain in children or adults.
• Injuries

Other causes of upper back pain include:

• Fibromyalgia and other pain syndromes.
• Diseases that cause back pain that arise from organ problems, they are also associated with the spine (which is usually located next to them). Such diseases include ulcers, kidney disease (including kidney stones), ovarian cysts, and pancreatitis.
• Chronic diseases of the uterus or pelvic organs can lead to upper back pain in women.

Risk factors

In most known cases, back pain begins with an injury, as well as after lifting heavy objects or sudden movements. Not all people have back pain after such injuries. In most cases, the causes of back pain remain unknown.

Aging

The intervertebral discs can begin to deteriorate even before age 30. One-third of adults over age 20 show signs of a herniated disc (though only 3% of these discs cause painful symptoms). As people continue to age, their discs lose moisture and shrink in size, increasing the risk of spinal stenosis. The prevalence of back pain and sciatica is greater in women during menopause, as they lose bone density.

In old age, the incidence of osteoporosis and osteoarthritis with back pain is a common problem for women and men. However, the risk of low back pain does not necessarily increase steadily with age.

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High-risk occupations

Occupations that involve lifting, bending, twisting, and holding awkward positions, as well as those that cause whole-body vibrations (such as driving intercity trucks), are particularly at risk for developing lower back pain in the upper back. The longer a person continues this type of work, the higher the risk.

A number of companies are developing programs to protect against back injuries. However, the elementary load on the back during prolonged sitting at the computer can increase the risk of developing upper back pain, despite all protective equipment: corsets, orthopedic chairs, etc. Office workers, in addition to having chairs, tables and equipment that support the back and help maintain good posture, are also required to take care of a straight back while sitting and during breaks during work.

Back pain causes significant loss of time and money at work. According to the WHO, back pain is the cause of 60% of absences from work due to pain related to the upper back.

Osteoporosis

Osteoporosis is a condition characterized by progressive loss of bone density, thinning of bone tissue, and increased vulnerability to fractures. Osteoporosis can be caused by chronic diseases, hormonal deficiencies, or old age. Regular exercise and vitamin and mineral supplements can reduce and even reverse bone density loss.

Persistent back pain in children is more likely to have a serious cause and will require treatment more often than in adults.

Fractures in athletes

Spinal fractures (spondylolysis) are a common cause of back pain in young athletes. Sometimes a fracture involving the spine may not be as bothersome for a week or two after the injury. Spondylolysis can lead to spondylolisthesis, a condition in which the spine becomes unstable and the vertebrae slip relative to each other.

Hyperlordosis

Hyperlordosis is a congenital deformity with an inward curvature of the lumbar region. Scoliosis, a curvature of the spine in children, does not usually cause back pain. But diseases associated with it can cause pain in the sacrum and hip joints in children and young adults. These can be complications in the form of rheumatoid arthritis, which is now defined by doctors as a separate medical problem. Injuries can also cause back pain in children.

Pregnancy and upper back pain

Pregnant women are prone to upper back pain due to the shifting of abdominal organs, forward weight distribution, and weakening of pelvic ligaments as the body prepares for labor. Taller women are at greater risk than shorter women.

Psychological and Social Factors of Upper Back Pain

Psychological factors are known to play an important role in shaping the three stages of low back pain.

Some research suggests that depression and the inability to cope with it are more likely to trigger the onset of back pain than physical problems.

A "passive" coping style (unwillingness to confront problems) is closely associated with the risk of developing neck or low back pain.

Research

Social and psychological factors, as well as job satisfaction, all play a major role in the development of back pain. For example, in one medical study, physiologists and psychologists compared the health of truck and bus drivers. Almost all of the drivers liked their jobs. Half of them reported lower back pain to doctors, but only 24% eventually took sick leave due to back pain.

Bus drivers, on the other hand, reported much lower job satisfaction than truck drivers, and these workers with back pain had significantly more pain-related absences than satisfied truck drivers, despite having less back strain.

Another study found that pilots who said they enjoyed their jobs had significantly fewer back problems than their crews. And yet another found that low rank, low social support, and high physical stress in soldiers were associated with an increased risk of back pain.

The likelihood of developing upper back pain

Depression and a tendency to complain in response to stress also increase the likelihood that acute back pain will become a chronic condition. How a patient perceives and copes with pain at the onset of an acute attack can actually make the difference between a patient regaining health or developing chronic conditions. Those who tend to overreact to pain and fear for their lives tend to feel out of control, which increases the risk of developing long-term back problems.

Research also shows that patients who report long-term emotional distress to doctors have poorer outcomes after surgery.

It should be noted that the presence of psychological factors in no way diminishes the reality of the pain or eliminates the side effects. Recognizing this in many cases of low back pain can help the physician determine the range of treatment.

Upper back pain - localization

Upper back pain travels down the leg along the path of the sciatic nerve. Sciatica pain typically occurs when the nerve roots in the spinal cord are compressed or damaged. Symptoms may include tingling, numbness, or back pain that radiates to the buttocks, legs, and feet.

The pain or numbness associated with sciatica can vary widely. It may feel like a mild tingling, a dull ache, or a burning sensation. In some cases, the pain is severe enough to render a person immobile.

The pain most often occurs in the back on one side and may radiate to the buttocks, legs, and feet. Some people experience sharp pain in one part of the leg or thigh and numbness in other parts of the leg. The affected leg may feel weak or cold, and blood flow to the leg may be impaired.

The pain often begins slowly and may gradually increase:

• At night
• After a person has been standing or sitting for a long period of time
• When sneezing, coughing or laughing
• After walking more than 50-100 m (especially if it is caused by spinal stenosis)

Sciatica pain usually resolves within 6 weeks unless there are other underlying conditions. Pain that lasts longer than 30 days, or is made worse by sitting, coughing, sneezing, or straining, may require recovery longer than that. Depending on the cause of sciatica, pain symptoms may come and go.

Herniated disc

A herniated disc, sometimes (incorrectly) called a slipped disc, is a common cause of severe upper back pain and sciatica. A disc in the lumbar region herniates when it ruptures or thins, causing the fluid inside the disc (the nucleus pulposus) to push outward.

A damaged disk can look different:

1. Bulge (prolapse) – the gelatinous nucleus has been pushed out of the disc a little and is evenly distributed around the entire circumference – by 2-3 mm.
2. Protrusion - the gelatinous core was displaced somewhat asymmetrically and in different places - from 4 to 15 mm.
3. Extrusion - the gelatinous nucleus protrudes widely beyond the vertebrae or breaks off from the disc in the form of a drop.

Nature of pain

Leg pain can be even worse than back pain when doctors diagnose herniated discs. There is also medical debate about how herniated disc pain develops and how often it causes lower back pain.

Many people have disc problems, bulges or protrusions of the discs and do not suffer from back pain. Extrusion (which is less common than the other two types of herniation) is much more likely to cause back pain, as the nucleus pulposus extends far enough to press on the nerve roots, most commonly the sciatic nerve. Extrusion herniations are very rare, however, while sciatic pain and back pain are very common. But there can be other causes of lower back pain in the upper back.

"Cauda equina syndrome"

The fibrous band that surrounds and protects the disc contains a dense network of nerves and high levels of peptides that enhance pain perception. Ruptures of this ring are common in patients with degenerative disc disease. This results in the so-called cauda equina syndrome – compression of a bundle of spinal nerve roots that resemble a horse’s tail. The cause is usually massive extrusion of the disc body.

The cauda equina syndrome leads to serious consequences - complications of the intestines and bladder. This can cause permanent urinary incontinence if surgical treatment is not performed in a timely manner.

Cauda equina syndrome includes:

• Dull pain in the back
• Weakness or numbness in the buttocks area - the area between the legs, or on the inner thighs, in the back and legs
• Inability to control urination and bowel movements
• Pain is accompanied by fever (may indicate infection)

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Lumbar degenerative joint disease

Osteoarthritis, which can cause upper back pain, occurs in the joints of the spine, usually as a result of aging, but also as a reaction to previous back injuries, excessive wear of the intervertebral disc, fractures. The cartilage between the joints of the spine is destroyed and additional bones grow, bone spurs develop. The intervertebral discs dry out and become thinner and more fragile. The speed at which these changes develop varies depending on the characteristics of the human body.

These changes result in a gradual loss of spinal mobility and a narrowing of the space between the spinal nerves and the spinal cord, eventually leading to spinal stenosis. Symptoms may be similar to those of a herniated disc or spinal stenosis (narrowing of the spinal canal).

Spinal stenosis

Spinal stenosis is a narrowing of the spinal canal, or opening (called neural foramina), where the spinal nerves pass through the spine. The condition usually develops with age, as the discs become drier and begin to shrink. At the same time, the bones and ligaments of the spine swell or grow due to arthritis and chronic inflammation. However, other problems, including infections and congenital bone defects, can sometimes cause spinal stenosis.

Most patients report a gradual worsening of their condition and back pain not all at once. Some people may have minimal back pain, but at some point any disorder may occur, such as minor injuries, which lead to disc inflammation, which can put pressure on the nerve roots and cause pain in the upper back or elsewhere.

Nature of pain

Patients may experience pain or numbness that may radiate down both legs or affect only one side of the back or hip. Other symptoms include a feeling of weakness and heaviness in the legs or buttocks. Symptoms are usually present or will worsen only when the person is standing or walking. Often, symptoms are relieved or eliminated when the person sits and leans forward. These positions can create more space in the spinal canal, thereby reducing pressure on the spinal cord or spinal nerves. Patients with spinal stenosis are usually unable to walk for long periods of time, but they may be able to ride a bike with little back and leg pain.

Spondylolisthesis

Spondylolisthesis occurs when one of the lumbar vertebrae slips over another, or ends up on the sacrum.

In children, spondylolisthesis usually occurs between the fifth bone in the lower back (lumbar vertebra) and the first bone in the sacrum. It is often due to a birth defect in this area of the spine. In adults, the most common cause is degenerative joint disease (such as arthritis). The pain usually occurs between the fourth and fifth lumbar vertebrae. It is more common in adults over 65 and in women.

Other causes include spondylolisthesis due to stress fractures (usually in gymnasts) and traumatic fractures. Spondylolisthesis can sometimes be associated with bone disease.

Spondylolisthesis can range from mild to severe. It can lead to lordosis (abnormal increase in lumbar lordosis), but in later stages, or it can lead to kyphosis in the upper spine.

Symptoms may include

• Lower back pain
• Pain in the hips and buttocks
• Muscle pain
• Numbness in some parts of the body

Neurological disturbances (leg weakness or changes in sensation) can result from pressure on the nerve roots and can cause pain that travels down the legs.

Inflammatory diseases and arthritis

Inflammatory diseases and arthritis syndromes can cause inflammation in the spine. Rheumatoid arthritis can be localized in the cervical spine (neck). A group of diseases in spondyloarthropathy can cause upper back pain. These include

Bechterew's disease is a chronic inflammation of the spine that can gradually lead to the fusion of the vertebrae. The vertebrae are usually stiff and painful in the morning, with pain becoming quieter with movement or exercise. In most cases, symptoms develop slowly over time. In severe cases, symptoms become much more pronounced over a short period of time, and the patient develops postural defects.

Reactive arthritis or Reiter's syndrome is a group of inflammatory diseases that involve certain joints, the lower back, the urethra and the eyes. There may be ulcers (lesions) on the skin and mucous membranes.

Psoriatic arthritis is diagnosed in about 20% of people with psoriasis, which contributes to the development of arthritis associated with the spine, as well as many joints.

Enteropathic arthritis is a type of arthritis associated with inflammatory bowel disease, the most common forms being ulcerative colitis and Crohn's disease. About 20% of people with inflammatory bowel disease experience symptoms of back pain.

There are many non-surgical treatments for these potentially dangerous conditions.

Osteoporosis and compression fractures

Osteoporosis is a skeletal disorder in which the amount of calcium contained in the bones slowly decreases to the point where the bones become brittle and prone to fracture. It usually does not cause pain unless the vertebrae become deformed, in which case the pain is often severe. More than one vertebra may be affected.

In case of compression fracture of the vertebrae, bone tissue of the vertebra collapse, more than one vertebra may lose its function. Fracture of the thoracic and lower spine vertebrae as a result of osteoporosis usually affects the fact that pain symptoms may increase when walking.

Pressure on the spinal cord can also be bothersome, creating symptoms of numbness, tingling, or weakness. Symptoms depend on the area of the back that is affected, but most fractures are stable and do not cause neurological symptoms.

Muscle and ligament injuries - lumbar deformities

Strains and injuries to the muscles and ligaments that support the back are the main causes of lower back pain. The pain is usually more widespread in the muscles near the spine, and may be associated with spasms in these muscles. Upper back pain may progress to buttock pain, but very rarely goes further down the leg.

Upper Back Pain Prognosis

Most people with acute back pain return to work within a month and are fully recovered within a few months. According to one medical study, about a third of patients with uncomplicated low back pain improved significantly after a week of treatment, and two-thirds of patients were fully recovered within seven weeks.

However, studies show that currently up to 75% of patients suffer at least one recurrence of back pain within a year. After 4 years, less than half of patients may no longer have symptoms of upper back pain.

Special health conditions of patients, which are taken into account by the doctor, can increase the rate of recovery.

For example, most patients with a herniated disc do improve (though actual physical improvement may be slower than pain relief). Researchers have looked at factors that predict an increased risk of pain recurrence and found that depression is the single most important factor for most who have not yet recovered.