Upper Back Pain: Causes and When to Seek Help

Upper back pain?

Hello Doctor, about six months ago, I woke up one morning and noticed soreness in the upper back on both sides (from the shoulders down to the upper waist).
The pain on the left side is about 80%, while the right side is about 20%.
I initially thought it was due to poor sleeping posture or my mattress or pillow (I've had the mattress for 15 years and the pillow for over a year).
However, after changing the mattress and pillow, and doing morning and evening stretches, heat therapy, and massages, the soreness persists.
Although it feels better after stretching and moving around in the morning, I still experience discomfort.
Now, if I lie flat for about 1-2 hours, I feel uncomfortable, as if my upper back is being compressed.
I also have hyperthyroidism and a slightly elevated heart rate.
Which specialty should I consult for this condition? Thank you, Doctor.

Miss Yang, 30~39 year old female. Ask Date: 2019/11/13

Dr. Liao Yaopan reply Family Medicine

Hello, it is recommended to have an evaluation by an orthopedic or rehabilitation specialist.
Hyperthyroidism should be regularly monitored by an endocrinologist at Changhua Hospital.
Take care.

Reply Date: 2019/11/13

More Info

Upper back pain can be a complex issue, often stemming from a variety of causes, and it is essential to approach it with a comprehensive understanding of potential underlying factors. Based on your description, it seems that you have been experiencing persistent discomfort in your upper back for the past six months, which has not improved despite changes in your sleeping arrangements and attempts at self-care through stretching, heat application, and massage.

Possible Causes of Upper Back Pain
1. Muscle Strain or Sprain: One of the most common causes of upper back pain is muscle strain or sprain, often resulting from poor posture, overexertion, or sleeping in an awkward position. Given that you mentioned a significant change in your sleeping arrangements, it is possible that your muscles are still adjusting or that the underlying issue has not been fully resolved.

2. Postural Issues: Prolonged periods of poor posture, especially if you spend a lot of time sitting or working at a computer, can lead to muscle imbalances and discomfort in the upper back. This can be exacerbated by stress, which often leads to muscle tension.

3. Degenerative Disc Disease: As we age, the discs in our spine can degenerate, leading to pain and discomfort. This is more common in individuals over the age of 30, but can occur earlier, especially in those with a history of spinal issues.

4. Thoracic Outlet Syndrome: This condition occurs when blood vessels or nerves in the space between your collarbone and your first rib become compressed, leading to pain in the shoulders and neck, as well as numbness in the fingers.

5. Referred Pain: Sometimes, pain in the upper back can be referred from other areas, such as the heart or lungs. Given your history of hyperthyroidism (甲亢), it is crucial to consider that your symptoms may be related to your thyroid condition, especially if you are experiencing increased heart rate or other systemic symptoms.

When to Seek Help
Given that your symptoms have persisted for six months and have not improved with conservative measures, it is advisable to seek medical evaluation. Here are some recommendations on when and where to seek help:
1. Primary Care Physician: Start with a visit to your primary care physician. They can conduct a thorough physical examination, review your medical history, and assess your symptoms. They may also order imaging studies, such as X-rays or an MRI, to rule out structural issues in the spine.

2. Physical Therapy: If your primary care physician suspects that your pain is related to muscle strain or postural issues, they may refer you to a physical therapist. A physical therapist can provide targeted exercises and treatments to strengthen the muscles of your back and improve your posture.

3. Orthopedic Specialist: If there are concerns about degenerative changes in the spine or other structural issues, an orthopedic specialist may be necessary. They can provide a more in-depth evaluation and discuss potential treatment options, including injections or surgery if needed.

4. Neurologist: If you experience any neurological symptoms, such as numbness, tingling, or weakness in your arms or legs, it would be prudent to consult a neurologist. They can evaluate for conditions such as thoracic outlet syndrome or other nerve-related issues.

5. Endocrinologist: Since you have hyperthyroidism, it may also be beneficial to consult with an endocrinologist to ensure that your thyroid levels are well-managed, as fluctuations in thyroid hormone levels can sometimes contribute to muscle pain and discomfort.

Conclusion
In summary, while upper back pain can often be attributed to muscle strain or poor posture, your persistent symptoms warrant a thorough evaluation to rule out any underlying conditions. It is essential to seek help from a healthcare professional who can guide you through the appropriate diagnostic process and treatment options. Remember to communicate all your symptoms clearly, including any changes in your overall health, to ensure a comprehensive approach to your care.

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