Why do I have pain in mid back?

I am 45 Years Old. My Mid Back Hurts, Should I be Worried?

Yes. Mid back pain is less common than lower back pain and neck pain. Non-traumatic "Mid back Pain" must be evaluated sooner than later.

Mid Back Pain in Young Individual Aged 45 Years

What are the Common Causes of "Mid Back Pain" in Young People?

Mid Back Pain may be traumatic or non traumatic in origin.

Traumatic Mid Back Pain In Young People Is Caused By:

  • Auto Accident
  • Work Accident1
  • Fall
  • Lifting or carrying heavy objects

Injuries- Whiplash Injury After Automobile or Work Accident or Fall may cause:

  • Fracture of vertebrae, facet joint, lamina, transverse process or spinous process.
  • Tear and sprain of ligaments.
  • Tear and sprain of muscles.
  • Dislocation of facet joint or vertebrae.

Non-Traumatic Mid Back Pain In Young People Is Caused By Following Diseases:

  • Mechanical or Musculoskeletal Problems:
    1. Muscle Spasm - continuous contraction of paravertebral muscles causes severe pain.
    2. Fibromyalgia.
    3. Myofascial Pain.
    4. Chronic Fatigue Syndrome.
    5. Facet Joint Disease - Facet joint hypertrophy and facet joint arthritis.
  • Discogenic - Bulge disk, herniated disk and degenerative disk disease.

Discitis

  • Inflammatory - Discitis, facet joint arthritis and osteomyelitis.
  • Space Occupying Lesions - Epidural abscess2 and epidural hematoma.
  • Osteoporosis - Fracture of body of vertebra (compression fracture), facet joint, spinous process and transverse process.
  • Cancer and Metastasis
    1. Primary Cancer: Vertebral body tumor.
    2. Metastasis of Vertebral Body and Spine - from primary tumor of breast, lung, and prostate tissue.
  • Bone Disease - Osteoporosis, scoliosis, spondylolisthesis, rheumatoid arthritis, osteoarthritis, ankylosis spondylitis, and spinal stenosis.
  • Systemic Disease - Like endometriosis, kidney disease can cause referred pain to mid back.

How Common is Mid Back Pain in Young People?

Mid back pain is less frequent than lower back pain and neck pain. Severity and impairment caused by mid back pain is also less disabling than neck and lumbar pain.3

Should A Young Person Aged 45 Years Be Having Other Symptoms with "Mid Back Pain"?

You may be unable to sleep because of severe pain. Weight loss may be because of chronic illness like infection or cancer causing back pain. Fever suggests infection, discitis or epidural abscess1. You may suffer with difficulties in breathing (dyspnea) or pain during inspiration (inhalation of air). Pain may radiate along the ribs to front of chest wall called intercostal neuralgia.

What is Intercostal Neuralgia?

Intercostal neuralgia is a chest wall pain radiating from posterior spine along the ribs to anterior chest wall. It is caused by pinch nerve at foramina or in spinal canal. Intercostal neuralgic pain is also observed after fractured ribs and shingles. Shingle pain is also called post-herpetic neuralgia.

What are the Causes of Pinch Nerve at Foramina or Spinal Canal?

Pinch nerve can be benign or serious. Benign causes of pinch nerve are disk bulge, disk herniation, osteophytes or subluxation of vertebrae and disk degenerative disease. Serious conditions causing pinch nerve pain is rare. Serious conditions are epidural hematoma, epidural abscess, metastasis or primary vertebral cancer and fracture of lumbar vertebrae secondary to osteoporosis.

When Should A Young Individual Consider his Mid Back Pain As Emergency and Must Visit ER or Specialist?

Shortness of breath after mid back injury may be an emergency. Shortness of breath after mid back or chest injury may be caused by collapse lungs known as pneumothorax (accumulation of air under pressure around the lungs). Pain associated with persistent and continuous tingling, numbness and weakness of chest wall as well as breathing difficulties indicates you must see a specialist or visit ER as soon as possible. Numbness and weakness may be secondary to spinal or foraminal stenosis. Pain with occasional tingling and numbness lasting short period is secondary to benign pinch nerve, but needs further investigation to evaluate cause of pain and treatment options.

When Should A Young Individual Consider Further Investigation For Mid Back Pain?

Acute or chronic mid back pain should be investigated as soon as possible.

Which Investigations are Most Favorable to Diagnose Mid Back Pain?3

Most favorable initial investigation is X-Ray and MRI or CAT scan.

  • X-ray - Check osteoporosis, patchy osteoporosis and any fracture of vertebral column.
  • MRI or CAT scan to rule out disk herniation, disk bulge, facet joint diseases, degenerative disk diseases, epidural abscess, any cancer tissue within or around spinal canal, epidural hematoma and epidural abscess.

Which Other Investigations May Need to be Considered to Diagnose Mid Back Pain?

  • Bone Scan - May detect osteoporosis changes even sooner.
  • Bone Densitometry - Osteoporosis detected following X-ray imagery as early as two weeks.
  • Blood examinations to rule out infection and abscess.
  • EMG (Electromyogram) studies to diagnose muscle diseases.
  • Nerve Conduction Study.
  • Electrocardiogram.
  • Discograpy.
  • Ultrasound Studies.

Who Should A Young Individual Consult Mid Back Pain Complaints?

Complaints such as shortness of breath and breathing difficulties should be evaluated as soon as possible. If primary care physician is not available you should visit ER. Primary care physician should evaluate mild to moderate pain secondary to non-traumatic disease. After initial clinical evaluation further investigations will be suggested as indicated. Diseases such as degenerative disk disease, epidural hematoma and epidural abscess are curable diseases without any residual complications if treated earlier. Following initial evaluation and investigation you may be referred to see a neurologist, PMR physician, neurosurgeon or orthopedic surgeon.

What are the Treatment Options For My Mid Back Pain In Young People?

Treatment choice is either non-invasive or invasive treatment.

Non-Invasive Treatments For Young People Having Mid Back Pain Are:

  1. Medications:
    • NSAIDs - Pain associated with tissue inflammation- recommend. Non steroidal anti inflammatory drugs or medications (NSAIDS).
    • Opioids - Side effects or inadequate pain relief with NSAIDS.
    • Muscle Relaxants - Baclofen, Soma, Flexeril, Robaxin, and Skelaxin.
    • Adjuvant Pain Meds - Lyrica, Neurontin, Elavil, and Cymbalta.
  2. Manual Directed Therapy4:
    • Massage.
    • Chiropractic Treatment.
    • Osteopathic Joint Manipulation.
    • Acupuncture.
    • Physical Therapy.

Invasive Treatment For Young People Having Mid Back Pain Are:

  1. Interventional Pain Treatment:
    • Peripheral Nerve Block with cortisone injection.
    • Epidural or Caudal Cortisone Injection.
    • Sympathetic Ganglion Block.
    • Nerve Ablation - Using cryo or radiofrequency technique.
    • Spinal Cord Stimulator.
    • Intrathecal Pain Medication - Intrathecal pump.
  2. Surgery:
    • Removal of skin tissue or hardware causing pain.
    • Excision of cancer tissue.
    • Radiation treatment to shrink the tumor mass to release pressure on nerves.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: January 18, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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