The sensation of burning in the upper back, often felt between the shoulder blades or along the spine, is a common and distinct type of discomfort. This feeling is frequently described as searing, prickly, or a dull heat, differing significantly from a simple ache or tightness. The upper back, or thoracic spine region, is complex, containing numerous nerve roots that branch out to the chest and abdomen. This intricate network means the burning sensation can originate from various sources, ranging from muscular strain to nerve irritation or internal organ issues. Understanding the nature and context of this symptom is the first step toward identifying its cause.
Musculoskeletal and Postural Origins
The most frequent source of a burning sensation in the upper back relates to the muscles, ligaments, and skeletal structures. These mechanical causes are often linked to daily habits and physical stress. A muscle strain, such as in the rhomboids or trapezius, occurs when fibers are overstretched or torn, usually following heavy lifting. This injury causes localized inflammation perceived as persistent, hot soreness, often worsening with motion or pressure.
Poor posture, particularly the rounded shoulders associated with prolonged desk work, places chronic stress on the upper back muscles and spinal ligaments. This sustained tension fatigues the muscles, causing them to develop painful myofascial trigger points. These points generate a burning pain often felt deep between the shoulder blades. Minor ligamentous sprains also contribute by causing inflammation in the joints.
This burning discomfort is considered somatic pain, originating from the body’s supportive structures. This type of pain typically changes in intensity with movement, specific postures, or when the affected muscle is palpated. The pain may ease with rest or position changes that relieve strain. Addressing these issues often involves physical therapy, stretching, and correcting ergonomic setups.
Neuropathic Causes
When the burning sensation is described as sharp, electric, or shooting, it suggests a neuropathic origin, indicating the nerve itself is irritated or damaged. This discomfort arises because the nerve misfires, interpreting pressure or inflammation as heat or burning. Irritation of nerves exiting the thoracic spine can lead to pain that radiates along a specific dermatome.
A common cause is thoracic radiculopathy, where a nerve root is compressed as it exits the spine, often due to a herniated disc or a bone spur. The compression causes inflammation and generates the characteristic electric-shock or stinging pain that can wrap around the rib cage or remain focused in the back. Unlike muscle pain, this nerve compression pain does not always respond to changes in position.
Another distinct neuropathic cause is Shingles (Herpes Zoster), a viral infection affecting the nerves. If the virus reactivates in the thoracic nerves, it causes intense burning, tingling, and hypersensitivity to touch on one side of the upper back. This pain typically precedes the blistering rash. The burning may persist after the rash heals, a condition known as post-herpetic neuralgia.
Referred Pain from Visceral Sources
A burning feeling in the upper back can be a manifestation of referred pain, which originates in an internal organ but is perceived in the back. This occurs because sensory nerves from internal organs (viscera) converge with nerves from the skin and muscles (soma) at the same spinal cord segment. The brain misinterprets the internal pain signal as coming from the back.
Gastroesophageal Reflux Disease (GERD) is a frequent source of referred upper back pain, where stomach acid backs up into the esophagus. While the primary symptom is heartburn, this irritation can be referred to the mid-back or between the shoulder blades due to shared nerve pathways. This pain may feel like a deep, dull ache, often worsening after large meals or when lying down.
More serious internal conditions also cause referred discomfort. Gallbladder problems, such as gallstones, commonly cause pain that refers to the right upper back or shoulder blade. Cardiac issues, like angina or a heart attack, can present atypically as vague pain between the shoulder blades. This referred visceral pain remains constant regardless of movement, distinguishing it from musculoskeletal pain.
Recognizing Warning Signs and Seeking Medical Help
While many causes of a burning upper back sensation are treatable conservatively, certain accompanying symptoms serve as “red flags” requiring immediate medical attention. Any burning pain accompanied by severe chest pain, shortness of breath, or profuse sweating should be treated as a medical emergency, as these may signal a cardiac issue. Pain radiating down the arm or into the abdomen also warrants prompt evaluation.
Other serious warning signs include sudden weakness or numbness in the arms or legs, difficulty walking, or loss of bladder or bowel control. These neurological symptoms suggest a potential compromise of the spinal cord or major nerve roots. Similarly, burning pain accompanied by a fever, unexplained weight loss, or pain that is significantly worse at night should be assessed by a healthcare professional.
A doctor typically begins with a physical examination and detailed medical history. Diagnostic steps may include imaging tests like X-rays to assess bone structure, or Magnetic Resonance Imaging (MRI) scans to visualize soft tissues such as discs and nerves. Blood tests may also be ordered to check for inflammatory or infectious conditions. Persistent or worsening burning pain should always be professionally assessed to ensure an accurate diagnosis and appropriate treatment plan.