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Q: What could cause upper back pain?
A: Back pain is a very common symptom in many patients. Usually, it has benign causes, although it may occasionally have serious causes. Most frequently, back pain occurs in the lower back, although it may also occur in the upper back. Serious conditions as a cause of the back pain are more frequently found in older patients. Spontaneously occurring back pain in middle-aged or older persons, usually associated with an increase in pain when touched and/or irritation of the nerve roots, may be due to inflammation in the spine (osteomyelitis), fracture, or malignancy.
When back pain is due to malignant causes, it is usually associated with weight loss, fever, and/or failure of pain relief with bed rest. When the pain is due to osteomyelitis, it is usuallly associated with fever and an increase in the white blood cell count.
In younger patients, back pain is usually due to a herniated disc (i.e., a slipped disc), which impinges on a nerve root, thus causing pain. In addition, back muscle strains also frequently present with symptoms of back pain.
When back pain is associated with siffness in the morning, which then improves during the day, it may be due to a disease referred to as ankylosing spondylitis. Back pain may also be due to pathology within the chest cavity or chest wall (presenting as upper back pain), abdominal cavity or abdominal wall (presenting as lower back pain), or in the pelvic area (also presenting as lower back pain). For example, a dissection of the aorta (i.e., a rupture within the wall of the aorta), may present with acute onset of pain in the upper back (between the shoulder blades, i.e., the scapula). In the evaluation of nontraumatic back pain, laboratory or radiologic studies are not usually necessary within the the first few weeks of the onset of pain, unless a serious condition is suspected. It should be emphasized that CT scans and MRI studies in the evaluation of back pain may be misleading because of their high false-positive rate. In fact, over 60% of patients who do not have any symptoms of back pain have a bulge or protrusion of an intervertebral disc on CT scan or MRI.
Treatment of back pain due to a slipped disc or to muscle strain consists in giving medication to for the pain (such as nonsteroidal antiinflammatory drugs, as for example, ibuprofen), and possibly muscle relaxants. In addition, a few days of bed rest is often benefitial to improve symptoms. Furthemore, patients should protect their back in performing daily activities. If pain persists in spite of treatment, a large or worsening neurologic deficit is present, or a neurologic deficit is present which fails to respond to therapy, orthopedic or neurosurgical consultation is required.
Updated: 07/09/99
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