Right Upper Back Pain: Causes, Symptoms, and Solutions

Right upper back pain, spinal pain, most severe in the morning, better or absent in the evening?

Hello Doctor: A few months ago, I experienced pain in my right shoulder and the area behind it.
I thought it was a strain from doing housework (as a single parent), and it improved when I stopped doing chores, but due to the busy nature of housework, it often recurs.
Sometimes, when I turn the steering wheel while driving, I hear a sound from my right shoulder and arm.
Wearing pullover shirts causes pain in my right shoulder and arm, so I switched to button-up shirts.
A few months ago, one day (not sure if it was after that), while sitting on the sofa talking to someone (venting about extremely stressful matters), I suddenly felt intense pain in the area of my right scapula near the spine.
However, upon closer inspection, the pain seems to be on the right side, close to the spine.
Using a topical patch was not very effective, and the pain has been recurring more frequently.
The pain radiates from the aforementioned point to the shoulder blade, but sometimes it shifts to the cervical-thoracic junction.
Most of the pain is concentrated in these two areas, and occasionally, I experience mild pain on the left side or lower right side, which is confusing as it seems to move around.
I later realized that the pain is worse in the morning and less severe or completely absent at night.
Lying down or sitting usually does not help and sometimes worsens the pain.
I tend to avoid using the computer or reading and writing, but walking seems to alleviate the discomfort; walking is better.
Recently, I have been under a lot of stress, and sometimes in the morning, the pain is so severe that I feel difficulty breathing, accompanied by anxiety (I have a long history of irritable bowel syndrome).
I am also worried because earlier this year, a doctor mentioned that I have dense breast tissue and that tumors are highly correlated, as I had just undergone a mammogram.
Additionally, I have adenomyosis and fibroids in my uterus, so I want to minimize exposure to X-rays.
Could you please advise what this might be and which specialty I should consult? Thank you very much!

Lu Mama, 50~59 year old female. Ask Date: 2018/08/20

Dr. Shi Guozheng reply Orthopedics

It could be myofascial pain syndrome, and you can consult either an orthopedic specialist or a rehabilitation physician.

Reply Date: 2018/08/20

More Info

Understanding right upper back pain can be complex, as it may stem from various causes, including muscular strain, nerve irritation, or even referred pain from other areas of the body. Based on your description, it seems that your pain is multifaceted and may be influenced by both physical and psychological factors.

Possible Causes of Right Upper Back Pain
1. Muscle Strain: Given that you mentioned doing housework and experiencing pain after physical activity, muscle strain is a likely culprit. Repetitive movements or poor posture while performing tasks can lead to overuse injuries in the muscles of the upper back and shoulders.

2. Nerve Compression or Irritation: The pain you feel near the spine could indicate nerve compression, possibly due to a herniated disc or spinal stenosis. This can lead to pain radiating from the spine to the shoulder and arm.

3. Referred Pain: Sometimes, pain in the upper back can be referred from other areas, such as the neck or even the abdomen. Given your history of gastrointestinal issues, it’s worth considering that some of your discomfort may be related to visceral pain.

4. Psychological Factors: You mentioned experiencing significant stress, which can manifest physically. Stress and anxiety can lead to muscle tension, particularly in the neck and upper back, exacerbating pain.

5. Postural Issues: Poor posture, especially during prolonged activities like sitting at a computer or driving, can contribute to upper back pain. If you find that walking or moving around alleviates your discomfort, it may indicate that static positions are aggravating your condition.

Symptoms to Monitor
- Pain Location: Note if the pain is localized or if it radiates to other areas, such as the arm or neck.

- Pain Intensity: Assess whether the pain is sharp, dull, or throbbing, and how it changes with different activities or positions.

- Associated Symptoms: Pay attention to any other symptoms, such as difficulty breathing, which could indicate a more serious condition.

Recommended Solutions
1. Physical Therapy: Consulting a physical therapist can provide you with tailored exercises to strengthen the muscles around your shoulder and upper back, improve posture, and alleviate pain.

2. Pain Management: Over-the-counter pain relievers like NSAIDs (e.g., ibuprofen) can help reduce inflammation and pain. However, consult a healthcare professional before starting any medication.

3. Stress Management: Since you mentioned high stress levels, incorporating stress-reducing techniques such as mindfulness, yoga, or deep-breathing exercises may help alleviate both physical and emotional discomfort.

4. Ergonomic Adjustments: Evaluate your workspace and daily activities for ergonomic improvements. Ensure that your computer screen is at eye level, and consider using a chair that supports your back properly.

5. Consult a Specialist: Given your complex symptoms and history, it may be beneficial to see a specialist such as an orthopedic doctor or a neurologist. They can perform a thorough evaluation, possibly including imaging studies, to rule out any serious underlying conditions.

Conclusion
Your right upper back pain could be due to a combination of muscular strain, nerve issues, and psychological stress. It’s essential to approach this problem holistically, considering both physical and emotional factors. By consulting with healthcare professionals and making lifestyle adjustments, you can work towards alleviating your pain and improving your overall well-being. Remember to listen to your body and seek help when needed, especially if your symptoms persist or worsen.

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