Diagnosing Upper and Middle Back Pain


Pain in the upper and middle back may have many different causes. The thoracic spine experts at Och Spine at NewYork-Presbyterian will be sure to use a variety of resources to determine the root cause of your pain and ensure you receive the most appropriate and effective treatment. We may take the following steps to learn what is causing your discomfort:

  • Medical history review to learn about your symptoms as well as any prior medical conditions or injuries
  • Physical exam to assess your range of motion, strength, pain, and sensation
  • Imaging exams such as X-rays, computed tomography (CT) scans, and/or magnetic resonance imaging (MRI) help show the bones, discs, and nerves in and around your thoracic spine
  • Bone density scan, a type of X-ray used to check for osteoporosis, the most common cause of thoracic spine fractures

Nonsurgical Treatments for Upper and Middle Back Pain

Nonsurgical Treatment

Because we believe in treating our patients with the most conservative care, our thoracic spine specialists first consider nonsurgical upper and middle back pain treatment options.

Medications may be helpful to relieve thoracic spine pain in some patients. In addition to over-the-counter medicines like ibuprofen, prescription medications are often used in people with upper and middle back discomfort. Some patients benefit from muscle relaxants.

Physical therapy is a common treatment for upper and middle back discomfort and is also an important part of your recovery if you have had thoracic spine surgery. Physical therapists help patients learn about proper alignment of the thoracic spine and approaches to move safely and comfortably, while teaching ways to improve strength, posture, and flexibility. They may provide manual therapy to mobilize the soft tissues and gently manipulate the joints. Other techniques may include exercises you learn with your therapist and do at home to stretch and strengthen your upper and middle back muscles.

Specially trained physical therapists may use "directional preference" techniques to help identify and treat painful spine conditions. Directional preference exercises are determined during the physical examination of patients with back pain and referred pain from the spine, using directed repeated movements by the patient. These exercises have been shown to decrease radiating symptoms and increase function in many people with spine disorders. 

Acupuncture from a licensed acupuncturist has helped many people with upper and middle back pain. It involves the placement of very thin sterile needles into specific energy points in the body to unblock energy pathways and encourage the flow of "qi," the body's life force. 

Steroid spine injections provide short-term relief from upper and middle back pain and can allow you to engage more fully in physical therapy. The relief of pain may be immediate or gradual and can last up to several months. A physiatrist (physical medicine and rehabilitation doctor) or anesthesiologist can deliver the injection, guided by an X-ray technique called fluoroscopy to inject cortisone into the epidural space around the spine. 

Nerve blocks are a form of regional anesthesia. With this treatment, the nerve supply to the area of discomfort in the upper and middle back can be temporarily blocked with a local anesthetic (numbing medication). 

Radiofrequency ablation (RFA) is a same-day procedure performed under light sedation or an anesthetic. The doctor first performs a nerve block to determine the exact source of the pain. A needle is then inserted to target the nerve causing the pain, and heat is applied. This heat creates a lesion that blocks pain signals between the affected nerve and the brain.

At-home treatments can often work to help relieve upper and middle back pain. These may include over-the-counter medications such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAID) such as ibuprofen. Applying a heat or an ice pack and resting your back muscles may also be helpful. Regular exercise and stretching may not only relieve your upper and middle back pain, but can also prevent it from occurring in the first place. Always practice good posture. Slouching can exaggerate any existing upper and middle back pain and lengthen recovery time.

Thoracic Spine Surgery


Upper and middle back surgery may be an option if your pain cannot be effectively relieved using nonsurgical treatments or if it is damaging your nervous system. Our thoracic spine surgeons operate through small incisions whenever appropriate, using minimally invasive approaches. They use augmented reality technology and computer-guided navigation to precisely complete these procedures. 

Och Spine specialists' proven expertise has resulted from performing a high number of surgeries on the upper and middle back. Some patients may have outpatient surgery, enabling them to return to the comfort of their homes the same day and avoiding an inpatient hospital stay. 

Correction of thoracic spine deformities. Abnormal or excessive thoracic spine curvature—such as scoliosis or kyphosis (hunched back)—may be corrected with spinal fusion. The surgeon inserts titanium rods, plates, and/or screws during this complex procedure to bring the spine closer to normal alignment. 

Och Spine has helped people with thoracic spine deformities from across the nation and worldwide. People come to us after surgeries elsewhere have failed. Every year, our thoracic spine surgeons perform such "revision surgery" to restore comfort and function and enable our patients to return to the kinds of lives they wish to lead.

Treatment of vertebral compression fractures. Bracing may be tried first. If more treatment is needed, it may include vertebroplasty or kyphoplasty. During vertebroplasty, the surgeon injects artificial bone cement into a vertebra that has been fractured by osteoporosis. The cement stabilizes the bone and prevents further damage from occurring. With another treatment—balloon kyphoplasty—a tiny balloon is inflated inside the fractured vertebra to restore its height. The cement is then injected into the expanded space to ensure the bone does not collapse again. Both procedures are performed under X-ray guidance.

Microdiscectomy. Operating through a half-inch incision with x-ray guidance, the surgeon removes the bulge from the herniated portion of a thoracic disc and relieves pressure on the affected nerve. The surgeon uses a microscope to remove the herniation and free the nerve carefully. 

Laminectomy. This technique is used to treat spinal stenosis of the thoracic vertebrae. The surgeon enters through the back of the spine and removes the lamina (the section of bone that covers the spinal canal), thereby relieving pressure on the spinal cord. This surgery is typically performed with a discectomy.

Get Care

Receive Personalized Spine Care at Och Spine at NewYork-Presbyterian

Our renowned experience and successful results attract patients with upper and middle back pain from around the globe to seek relief from our spine experts. No matter your level of pain, condition, or degree of deformity, we will assemble the team you need to help you feel better. 

Every doctor at Och Spine has experience in various back and neck conditions and injuries. When you call us to make an appointment, we will work with you to identify the best physician for your specific need.

Give us a call at Och Spine to make an appointment and start your journey to a more comfortable life.