Thoracic Back Pain

What is the Thoracic Spine?

Your thoracic spine is the mid-back region. It is located between the neck (cervical spine) and the low back (lumbar spine) and has limited motion. It consists of 12 vertebrae, labeled T1–T12.

The main functions of the thoracic spine are:

• To provide an anchor for the ribcage, and help protect vital organs, namely the heart and lungs.
• To protect the spinal cord as it courses through the bony canal formed by the vertebrae.

What Causes Thoracic Spine Pain?

One-Time Injuries

In some instances, your thoracic spine pain may be caused by an injury associated with a one-time event. These include:

• Sprains and strains – Because motion is limited and many muscles attach to the thoracic spine, the most common cause of thoracic spine pain is myofascial (muscle and its associated connective tissue). There are many muscles that attach to the thoracic spine, which provide movement to the shoulders and arms.
• Compression fractures – Vertebral compression fractures can be a cause of severe thoracic spine pain. This most commonly occurs in elderly patients, patients who have sustained trauma, or who have a history of osteopenia/osteoporosis.

Wear-and-Tear Injuries

As we age, it is normal to have some degeneration in the components of the spine. These include:

• Intervertebral Discs – Discs are composed of a well-hydrated center called the nucleus pulposus, which is made up of about 80% water. This part of the disc is subject to high pressures and acts as a pivot point for the spine. This is surrounded by a tough outer ring of fibrous collagen called the annulus fibrosus, which absorbs spinal stress. Disc-generated pain can occur as a result of degeneration and/or tears in the disc.
• Zygapophyseal (AKA facet) joints – These are small, paired joints of the spine. They are moveable connections that, along with the discs, provide structural stability while still allowing movement. Just like other joints in the body, these joints have cartilage and a small amount of fluid. Facet joint pain can occur as a result of degeneration or injury.

Nerve Injuries

Nerve pain in the thoracic spine is uncommon, but can include:

• Thoracic Radiculopathy – This issue is caused by compression of a nerve root as it exits the spinal column. This compression can be caused by a disc bulge or facet joint enlargement. It is often described as a burning, electric pain that begins in the back and wraps around toward the front of the chest or abdomen. It can also be associated with numbness in those same areas. This type of pain is rare in the thoracic spine.
• Post-herpetic Neuralgia – This issue is most often associated with shingles. Because shingles resides in and affects nerve tissue, it can cause lingering nerve pain symptoms. It is important to note that not all patients with post-herpetic neuralgia have a history of shingles and the related rash.

Treatment for Thoracic Spine Pain

At the Denver Spine and Pain Institute, we recommend conservative treatments whenever possible. Depending on the specific cause of your pain, your treatment may include:

• Physical therapy – This is one of the mainstays of treatment for thoracic spine pain. The goals of physical therapy are to improve mobility by addressing decreased or abnormal range of motion. It is also used to decrease pain and address any mechanical or muscular conditions, including any postural abnormalities, that may be present.
• Medication – Anti-inflammatory medications (ibuprofen, naproxen), acetaminophen (Tylenol), and muscle relaxants can help provide short-term relief of symptoms, making it easier for you to participate in physical therapy.
• Injections – If the combination of physical therapy and medications don’t provide enough relief, injections may deliver the long-term relief of symptoms you desire. Our specialists will attempt to identify the most likely pain generator and deliver medication via injection to that area with the use of image guidance. These injections can be both diagnostic and therapeutic.
• Regenerative medicine – Regenerative medicine therapies include platelet rich plasma (PRP) and stem cell treatments.
• Spinal Cord Stimulation – Spinal cord stimulation treatment is used in cases of refractory thoracic spine pain.

If these conservative treatments fail to provide adequate relief, surgery may be necessary. Our team will perform all appropriate diagnostic testing prior to your surgical consultation to determine the precise cause and location of your pain. These diagnostic tests will provide your surgeon with the information necessary to plan your procedure.