Your spine contains three main areas: cervical (neck), lumbar (low back), and thoracic (mid-back). The cervical and lumbar regions have a lot of movement and flexibility, so they experience the lion’s share of injuries. Your thoracic spine connects to your rib cage, so it’s less susceptible to injury.
However, when thoracic pain occurs, it can be just as debilitating as pain in the other two areas. You can experience thoracic pain after a traumatic injury like a car crash or after years of practicing poor posture.
Fortunately, Dr. Jay M. Shah specializes in complex thoracic pain issues at the SamWell Institute for Pain Management in Colonia, Englewood, and Livingston, New Jersey. As a board-certified sports medicine and interventional pain physician, Dr. Shah has extensive experience diagnosing spinal issues and treating them using the most advanced techniques and technologies.
Here, he explains the most common causes of thoracic pain and how he treats them.
What is upper thoracic pain?
Upper thoracic pain is discomfort or pain in the upper part of your back, specifically around the 12 vertebrae in your upper and middle back region. Symptoms may include localized pain, stiffness, tightness, or discomfort in the upper back. The pain can sometimes radiate to other body parts, such as the neck, shoulders, or arms.
Possible causes of upper thoracic pain include, but are not limited to, muscle strain, poor posture, disc problems, fractured vertebrae, and osteoarthritis. Sometimes, the pain stems from specific conditions like thoracic radiculopathy or thoracic facet pain syndrome, which Dr. Shah explains below.
Thoracic radiculopathy occurs when one or more nerve roots along your thoracic spine are compressed or irritated. This compression can result from disc herniation, bone spurs, or spinal stenosis.
With thoracic radiculopathy, you may experience:
- Tingling in your back, shoulders, or chest
- Traveling pain that radiates into your back, shoulders, or chest
- Muscle weakness and spasms
- Difficulty sitting for prolonged periods
- Inability to move sideways or bend backward
The pain can be sharp, similar to an electric shock, and may worsen with certain activities or positions and get better when you rest.
Thoracic facet pain syndrome
Thoracic facet pain syndrome occurs when you have degeneration or arthritis of the facet joints in your thoracic spine, usually between the third and sixth vertebrae. If your condition causes pressure on nearby nerves and organs, your symptoms could include:
- Back pain that worsens with twisting or extending the spine
- Difficulty standing or sitting for long periods
- Tenderness over the affected joints
- Chest pain
- Gastrointestinal problems
Treatment options for thoracic facet pain syndrome often involve a combination of pain management techniques such as physical therapy, medications, and, potentially, facet joint injections. These injections can reduce inflammation and provide pain relief.
How we diagnose thoracic pain
An accurate diagnosis is crucial to the treatment process, and no one is better than Dr. Shah at getting to the root cause of thoracic spine pain. Here are some of the tools, techniques, and technologies he uses.
The clinical picture is a physician’s comprehensive interpretation based on a patient’s history, symptoms, signs, and results of investigations.
When Dr. Shah develops your clinical picture, he doesn’t do it in isolation; he figures in various factors, such as causative elements, which could be anything from your genetic predisposition to environmental triggers.
He also considers factors that influence how you perceive and communicate your symptoms, lifestyle and habits, and age, gender, and overall health status.
Dr. Shah then compares your clinical picture with the established framework for understanding specific diseases or conditions.
These diagnostic techniques help Dr. Shah accumulate valuable information about your probable outcomes and treatment responses. It also helps him know where to investigate further using advanced technology and imaging.
How we treat thoracic pain
Dr. Shah develops a treatment plan for you based on his findings in the clinical picture and your unique symptoms and circumstances. Your personalized plan may include epidural steroid injections or spinal cord stimulation, two of the most effective treatments for thoracic pain.
Epidural steroid injections (ESIs)
ESIs are a common treatment option for thoracic radiculopathy. In this treatment, Dr. Shah injects a corticosteroid, an anti-inflammatory medication, and often a local anesthetic directly into the epidural space of your spine.
ESIs usually deliver significant relief from pain and inflammation.
Spinal cord stimulation (SCS)
SCS, another option for upper thoracic pain, uses a device that sends low-level electrical signals to your spinal cord or specific nerves to block pain signals from reaching your brain.
Dr. Shah implants the SCS device surgically under your skin, and you control it with an external remote. Before you qualify for SCS implantation, you undergo a week-long trial period to determine how you’ll respond to the device and the device’s likely effectiveness.
If you're experiencing upper thoracic pain, book an appointment online, or call SamWell Institute for Pain Management to discuss the best treatment options for your specific condition.