Upper Back Pain: When to Seek Medical Help

Back pain

I have been experiencing pain in the left upper back for the past few months.
I previously underwent testing for ankylosing spondylitis, but the doctor said it was negative.
I have a long-standing history of gastroesophageal reflux disease (GERD) for which I am continuously taking medication, as well as cervical spondylosis (the doctor reviewed an MRI and said it is not severe, just advised to be careful not to bump into anything).
These two conditions have been present for a long time, but the back pain started recently.
I have tried using topical analgesics and patches, but they have not been effective.
Besides the back pain, I also have a slight pain in the chest area (located in the same area as the back pain), but I do not have any other symptoms or discomfort.
Doctor, what could be wrong with me? Which specialty should I consult?

Jinzhang, 30~39 year old female. Ask Date: 2017/02/20

Dr. Chen Taicheng reply Family Medicine

The causes of upper left back pain are numerous, with the most common being muscle, bone, and joint pain (such as from the shoulder joint, ribs, scapula, and various muscles, tendons, ligaments, and nerves, leading to strains, sprains, and arthritis).
Based on your description and age, conditions like ankylosing spondylitis and degenerative arthritis are likely ruled out.

More probable causes of upper left back pain include peptic ulcers (such as gastric ulcers), pancreatitis (possibly related to alcohol consumption or high cholesterol), urinary tract stones (such as left kidney stones), and cardiopulmonary issues (such as ischemic heart disease, which is less common at your age, aortic dilation or dissection, pneumonia, and other lung diseases).

It is recommended to follow this order for medical consultation: Orthopedics or Rehabilitation Medicine (to rule out musculoskeletal issues) → Gastroenterology (to rule out ulcers and pancreatitis) → Family Medicine or Cardiology (to rule out other internal medicine issues or stone problems).
Wishing you good health, Dr.
Chen Tai-Cheng from Taoyuan Hospital cares about you.

Reply Date: 2017/02/20

More Info

Upper back pain can be a complex issue, especially when it is accompanied by other symptoms such as heart-related discomfort or a history of conditions like gastroesophageal reflux disease (GERD) and cervical spondylosis. Given your situation, it is essential to approach this systematically to determine the underlying cause of your pain and decide when to seek medical help.

Understanding Your Symptoms
1. Location and Nature of Pain: You mentioned that the pain is primarily on the left side of your upper back. This could be muscular, skeletal, or even referred pain from another area, such as the heart or digestive system. The fact that you have a history of GERD could suggest that some of your discomfort might be related to esophageal irritation, which can sometimes mimic or contribute to chest and back pain.

2. Associated Symptoms: The presence of heart-related pain, especially if it is in the same area as your back pain, is concerning. While it may be musculoskeletal in nature, it is crucial to rule out any cardiac issues, particularly if the pain is new or has changed in character.

3. Previous Conditions: Your history of ankylosing spondylitis (AS) and cervical spondylosis should not be overlooked. Although your previous tests for AS were negative, it is worth considering that some forms of inflammatory back pain can be subtle and may require further evaluation. The cervical spondylosis, while deemed not severe, can still contribute to upper back pain through muscle tension or nerve irritation.

When to Seek Medical Help
You should consider seeking medical attention if:
- Pain Persists or Worsens: If your upper back pain continues to persist despite using topical treatments like pain relief creams or patches, it is a sign that further evaluation is necessary.

- New Symptoms Develop: If you experience new symptoms such as increased heart pain, shortness of breath, dizziness, or any neurological symptoms (like numbness or tingling), you should seek immediate medical attention.

- Impact on Daily Life: If the pain is affecting your ability to perform daily activities or sleep, it is time to consult a healthcare professional.

Which Specialist to See
Given your symptoms and medical history, the following specialists may be appropriate for your situation:
1. Primary Care Physician: Start with your primary care doctor, who can perform a thorough evaluation, including a physical examination and a review of your medical history. They can help determine if you need to see a specialist.

2. Rheumatologist: If there is a suspicion of inflammatory conditions like ankylosing spondylitis or other rheumatological disorders, a rheumatologist can provide specialized care and further testing.

3. Orthopedic Specialist: An orthopedic doctor specializing in the spine can evaluate your upper back pain, especially in relation to any structural issues or degenerative changes.

4. Cardiologist: Given your heart-related symptoms, it may be wise to consult a cardiologist to rule out any cardiac issues, especially if the pain is new or has changed in nature.

5. Physical Therapist: If musculoskeletal issues are confirmed, a physical therapist can help with rehabilitation exercises and pain management strategies.

Diagnostic Tests
Depending on the findings from your initial evaluation, your doctor may recommend further diagnostic tests, such as:
- X-rays or MRI: To assess the structural integrity of your spine and rule out any significant abnormalities.

- Electrocardiogram (ECG): To evaluate heart function if there are concerns about cardiac involvement.

- Blood Tests: To check for markers of inflammation or other underlying conditions.

Conclusion
In summary, while upper back pain can often be attributed to muscular or skeletal issues, your specific symptoms warrant a careful evaluation to rule out more serious conditions. It is essential to communicate all your symptoms clearly to your healthcare provider and follow their recommendations for further testing and treatment. Early intervention can lead to better outcomes and relief from pain.

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