Thoracic Back Pain

Authored by Dr Laurence Knott , Reviewed by Dr Adrian Bonsall on | Certified by The Information Standard

Thoracic back pain is pain that occurs in the thoracic spine. The thoracic spine is located at the back of the chest (the thorax), mostly between the shoulder blades. It extends from the bottom of the neck to the start of the lumbar spine, roughly at the level of the waist.

Researchers were asked to find out how many people got back pain and came back with the answer 'between 4 and 72 people out of 100'. Political pollsters who had never before heard such pinpoint forecasting immediately hired these researchers to predict the outcome of the next general election.

The truth is that unless the question is asked in exactly the same way, different surveys will give different answers. It's known that teenage girls are particularly prone to thoracic back pain. The dreaded backpack is undoubtedly to blame. Why anyone thought it was a good idea to get rid of school lockers and make children drag a hundredweight of books to and from school on their backs every day, I have no idea.

Who gets thoracic spine pain?

Surveys to find out how many people have thoracic spine pain produce very variable results. For example, when asked whether they have ever had thoracic spine pain, one survey reported a result of 4 out of a 100 people, whilst another said 72 people out of 100. It appears to be at its most common in children and teenagers, especially girls. Factors cited as causing thoracic back pain included backpack use, the height of school chairs, and difficulties with homework. Mental health problems seemed to be an associated factor. It also appeared to be common in the transition period between the early teens and late adolescence. Adults with thoracic back pain often have aches and pains elsewhere as well as difficulties going about their daily tasks.

The short answer, in most cases, is no. Most people with thoracic spine pain get better without treatment in a couple of weeks.

However, thoracic back pain is more likely to be due to a serious cause than pain in other areas of the spine. There is a whole list of things to look out for that might indicate there's a problem. The sort of red flags I'm going on about include pain coming on shortly after an accident, having a condition that causes a wonky immune system, feeling generally unwell, or having pain that's getting worse after a couple of weeks' treatment.

Thoracic spine pain is common, short-lived and of little consequence. However, it is also more likely than neck pain or low back pain to have a serious cause.

Thoracic back pain red flags

If you have thoracic spine pain, these are the alarm features to look out for:

  • Recent serious injury, such as a car accident or a fall from a height.
  • Minor injury or even just heavy lifting in people with 'thinning' of the bones (osteoporosis).
  • Age under 20 or over 50 years when the pain first starts.
  • A history of cancer, drug misuse, HIV infection, a condition that suppresses your immune system (immunosuppression) and use of steroids for a long time (about six months or more).
  • Feeling generally poorly - for example, a high temperature (fever), chills and unexplained weight loss.
  • A recent infection by a germ (bacterial infection).
  • Pain that is there all the time, severe and getting worse.
  • Pain that wasn't caused by a sprain or strain (non-mechanical).
  • Pain that doesn't get better after 2-4 weeks of treatment.
  • Pain that is accompanied by severe stiffness in the morning.
  • Changes to the shape of the spine, including the appearance of lumps or bumps.
  • Pins and needles, numbness or weakness of the legs that is severe or gets worse over time.
  • Passing wee or poo accidentally (can indicate pressure on the spinal cord).

The most common cause of thoracic back pain is inflammation of the muscles or soft tissues of the thoracic spine. This inflammation can occur for a number of reasons:

  • A sudden sprain or strain (as in car accidents or sports injuries).
  • Sitting or standing in a slouched position over time.
  • Using a backpack.
  • Sitting for a long time at a computer.
  • Lack of muscular strength (couch potatoes beware!).
  • Repeating a movement persistently that involves the thoracic part of the spine (as in sport or work): also called overuse injury.

Less common causes include:

  • Narrowing of part of the spine (thoracic stenosis) - usually due to wear and tear.
  • Slipped discs - these are common but rarely cause pain.
  • Fractures of the vertebrae (the bony components that make up the spine).
  • Osteoporosis.
  • Spinal infection.
  • Shingles (especially in people aged over 60 years).
  • Spinal osteoarthritis.
  • Ankylosing spondylitis - inflammation of the joints between the vertebrae.
  • Scheuermann's disease - an inflammation of the joints of the spine which results in spinal curvature.
  • Spinal tumours.

It shouldn't be assumed that all pain in the thoracic spine is coming from the spine itself. Other causes of pain in this area can include problems affecting the lung, the uppermost part of the gut (the oesophagus), the stomach, the gallbladder and the pancreas.

If it's a short-lived mild pain with an obvious explanation (for example, it came on after you took part in a tug-of-war contest), your doctor will probably suggest some treatment before arranging tests.

However, because back pain is more likely to be serious if it occurs in the thoracic area rather than in your neck or lower back, your doctor is likely to suggest tests if the pain persists, is severe, or is accompanied by any of the 'red flag' features mentioned in the Symptoms section.

The tests will depend on the conditions that the doctor wants to rule out. It's likely to include blood tests such as a full blood count and inflammatory markers, and maybe a magnetic resonance imaging (MRI) scan. An ordinary 'plain' X-ray doesn't give much information unless you have an unusual appearance of the spine or a fracture is suspected.

  • You may not need any treatment as many cases settle down without it.
  • If you have an underlying cause, this will need treatment of its own accord.
  • If the pain is coming from a joint in the spine (a facet joint) this may be helped by an injection performed under X-ray vision (imaging-guided intra-articular injection).
  • Surgery which opens the covering of the spinal canal (a procedure called laminectomy) to treat a slipped disc causing thoracic spine pain can be a dangerous operation. However, a less risky technique involving surgery through the skin (percutaneous thoracic intervertebral disc nucleoplasty) is sometimes performed.

The outlook (prognosis) depends on the underlying cause, your age and your general fitness.

Many cases settle down in a few weeks but it should be remembered that pain in the thoracic spine is more likely than pain in the neck or lower back to have a serious cause.

Further reading and references

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