Upper back pain involves the thoracic spine, the twelve vertebrae situated between the neck and lower back. This discomfort is highly common, affecting a large percentage of adults. While concern about serious conditions is understandable, most upper back pain is caused by mechanical issues. However, because cancer-related pain is possible, though rare, understanding the differences between common and concerning causes is important.
Common Musculoskeletal Causes of Upper Back Pain
The most frequent source of discomfort relates to the muscles and ligaments surrounding the thoracic spine. Poor posture, especially sustained slouching from prolonged desk work, places abnormal strain on supporting structures. This tension causes muscle deconditioning and can strain the trapezius and rhomboid muscles.
Muscle strain is also frequently caused by overuse, such as repetitive movements or lifting heavy objects improperly. These mechanical stresses can result in minor tears or ligament sprains. The resulting pain is usually localized, feels like a dull ache or tightness, and is often relieved by rest, position changes, or over-the-counter pain relievers.
Age-related degeneration, such as osteoarthritis, can affect the small joints of the thoracic vertebrae, causing pain worse with movement. Degenerative disc disease can also cause localized pain if a disc bulges or herniates. These common causes produce pain that is often positional or activity-related.
Cancers That Can Cause Upper Back Pain
Upper back pain linked to cancer is usually due to metastasis, the disease spreading from another site. The spine is the most common site for bone metastasis, and the thoracic region is frequently affected. Common cancers that metastasize to the spine include lung, breast, prostate, kidney, and thyroid cancers.
These secondary tumors establish themselves within the vertebral bodies, causing structural compromise and pain. Multiple myeloma, a cancer originating in the bone marrow, also frequently causes bone pain. Primary spinal tumors, which originate directly in the spine, are considerably rarer than metastatic disease.
Distinguishing Features of Cancer-Related Back Pain
The characteristics of back pain caused by malignancy differ significantly from those of common musculoskeletal discomfort. Cancer-related pain is frequently described as constant and progressive, meaning it does not fluctuate or improve with rest, position changes, or typical conservative treatments. This pain often persists for more than four to six weeks, failing to respond to standard therapies like heat, massage, or nonsteroidal anti-inflammatory drugs.
A particularly concerning feature is nocturnal pain, where the discomfort is so intense it wakes a person from sleep or is worse when lying down. The absence of a clear traumatic event or injury history preceding the onset of severe, unremitting pain should also raise suspicion for a systemic cause.
The presence of systemic symptoms alongside back pain acts as a significant warning sign, often called a “red flag.” These symptoms include unexplained weight loss, fever, chills, or drenching night sweats.
Neurological Red Flags
New neurological symptoms are a strong indication of potential spinal cord or nerve root compression, which requires immediate attention. These symptoms manifest as weakness, numbness, or tingling in the limbs, or changes in bowel or bladder function.
Medical Evaluation and Diagnostic Steps
A medical evaluation for upper back pain begins with a detailed history and physical examination, where the physician screens for red flags associated with serious pathology. The provider asks about pain characteristics, cancer history, and the presence of systemic or neurological symptoms. A neurological exam tests reflexes, muscle strength, and sensation to detect nerve compression.
If red flags are present, initial blood tests may be ordered to look for signs of inflammation or underlying systemic disease. These tests often include the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which can be elevated in cases of infection or malignancy. For patients with a history of cancer or other concerning symptoms, imaging is a necessary next step to visualize the spinal structures.
Plain X-rays can detect bone abnormalities, such as fractures or bone loss. Magnetic Resonance Imaging (MRI) is often the preferred test for suspected tumors or spinal cord compression. An MRI provides highly detailed images of soft tissues, including the spinal cord, nerve roots, and surrounding ligaments. Computed Tomography (CT) scans may also be used to visualize the bony architecture of the vertebrae.