How do You Treat Severe Upper Back Pain?

Upper back pain can be extremely debilitating and disrupt your daily life. While mild to moderate upper back pain often resolves on its own with rest, severe and chronic upper back pain typically requires treatment from a medical professional. This article will explore the common causes of severe upper back pain and provide an overview of the most effective treatment options.

Causes of Severe Upper Back Pain

The upper back, also known as the thoracic spine, extends from the base of the neck to the bottom of the rib cage. There are several potential causes of severe pain in this region:

  • Muscle strain – Overuse, improper lifting, or awkward movements can strain the muscles of the upper back. Strains cause microtears in the muscle fibers leading to inflammation and pain.
  • Herniated disc – Discs act as cushions between the vertebrae. A herniated disc occurs when the gel-like center pushes out through a tear in the outer lining. This can irritate nearby nerves and cause severe pain.
  • Spinal stenosis – Narrowing of the spinal canal puts pressure on the spinal cord and nerves. This is often caused by age-related wear and tear of the spine.
  • Compression fracture – A break in one of the vertebrae of the upper back usually due to osteoporosis. This causes the vertebrae to collapse and put pressure on nerves.
  • Fibromyalgia – A chronic condition characterized by widespread muscle pain and tenderness. The upper back is commonly affected.
  • Arthritis – Osteoarthritis and rheumatoid arthritis can lead to inflammation and deterioration of the joints in the upper back.


Severe upper back pain should always be evaluated by a doctor. After discussing your symptoms and medical history, your doctor will perform a physical exam assessing your range of motion and areas of tenderness. They may order imaging tests such as x-rays, CT scans or MRIs to look for underlying structural problems. Blood tests can also help rule out inflammatory causes. Identifying the source of the pain will inform the appropriate treatment approach.

Treatment Options

Here are some of the most common treatments for severe upper back pain:


  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen help reduce inflammation and pain.
  • Muscle relaxants relieve muscle spasms that contribute to back pain.
  • Topical analgesics provide targeted pain relief when applied directly to the back.
  • Steroid injections can be given to directly decrease inflammation around the spinal nerves.

Physical Therapy

Physical therapists employ various techniques to alleviate pain, improve mobility, and correct problems with posture, alignment, and strength:

  • Stretching and gentle exercises improve flexibility and take pressure off the back.
  • Manual therapy techniques such as massage, mobilization, and manipulation loosen tight muscles.
  • Postural training helps correct muscle imbalances.
  • Heat or ice therapy reduces inflammation and promotes blood flow.


Chiropractors use spinal adjustments and manipulations to realign the vertebrae, taking pressure off pinched nerves that cause pain. They may also incorporate massage, heat therapy, and exercise recommendations.


Acupuncture practitioners insert very thin needles into specific points along the back and neck. This is thought to reduce pain by releasing endorphins and changing processing of pain signals.


If conservative treatments fail to provide relief, surgery may be an option in some cases:

  • Discectomy removes part of a herniated disc to take pressure off the spinal nerve.
  • Laminectomy enlarges the spinal canal opening to create more space for nerves.
  • Spinal fusion permanently connects two or more vertebrae together for added stability.

Lifestyle Changes

Making certain lifestyle modifications can help manage back pain:

  • Maintain good posture and ergonomics when sitting at a desk or driving.
  • Lose excess weight to reduce stress on the back.
  • Exercise regularly to build core muscle strength that supports the back.
  • Use proper form when lifting heavy objects by bending knees and keeping back straight.
  • Manage stress through relaxation techniques like yoga and meditation.
  • Quit smoking, as it impedes healing and contributes to osteoporosis and disc degeneration.

Seeking prompt medical attention for severe upper back pain allows for an accurate diagnosis and tailored treatment plan to provide optimal relief. A combination of medication, physical therapy, chiropractic or massage, acupuncture, lifestyle changes, and possibly surgery may be warranted. Working closely with your doctor is key to finding the right therapies to successfully ease pain and restore mobility and quality of life on an ongoing basis.