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Why do I Have Sharp Pain in the Top of My Back?

Upper back pain can be caused by a variety of conditions affecting the muscles, bones, nerves, and organs in the upper back region. While occasional mild pain may resolve on its own, sharp and persistent upper back pain should be evaluated by a doctor to determine the underlying cause and appropriate treatment.

The most common causes of sharp pain in the upper back include:

Muscle Strain

Muscle strains and sprains are a frequent cause of upper back pain. The upper back contains complex muscles like the trapezius and rhomboids that can become strained due to poor posture, sudden movements, heavy lifting, or overuse injuries. Acute muscle strains cause localized pain and muscle spasms in the upper back. Applying ice packs, taking anti-inflammatory medications, and resting the strained muscle can help reduce discomfort. Gentle stretching and exercises may help prevent future muscle strains.

Pinched Nerve

A herniated disc, bone spur, or narrowing of the spinal canal can pinch nerves emerging from the spinal cord. This can cause sharp shooting or burning pain in the upper back, shoulders, and neck along with numbness or tingling in the arms and hands. See a doctor for an exam and possible imaging tests to diagnose a pinched nerve. Treatments like physical therapy, injections, or surgery may be needed for symptom relief.


Osteoarthritis of the upper spine can develop with aging and cause stiff, achy pain between the shoulder blades. Rheumatoid arthritis and other inflammatory types of arthritis can also affect the upper back joints and soft tissues. Anti-inflammatory medications, hot/cold therapy, and physical therapy provide arthritis pain relief.

Bone Fracture

An acute blow or injury to the back along with severe trauma like a car accident could result in a vertebral fracture in the upper spine. This causes sudden, intense upper back pain along with tenderness and swelling over the fracture site. Seek emergency care for suspected fractures to prevent further injury. Treatment involves immobilization in a back brace and pain medications during the healing process.

Heart Attack

Heart attacks can cause referred pain perceived in the upper back, shoulders, and arms. This is due to the way heart nerve signals are processed by the brain. Sharp upper back pain accompanying chest tightness, shortness of breath, and sweating should be evaluated immediately to rule out a heart attack. Call 911 if you suspect you or someone else is having a heart attack.


The pancreas sits in the upper abdomen behind the stomach. Inflammation of the pancreas, called pancreatitis, can refer pain to the upper back. Acute pancreatitis causes severe abdominal pain that radiates to the upper back along with nausea and vomiting. Gallstones, alcohol use, and certain medications are common causes. Treatment involves fluids, pain control, and medications while acute attacks resolve.

Lung Conditions

Sharp upper back pain may signal an infection, blood clot, or collapsed lung in the lung tissue nearest the back. Pneumonia, pleurisy, pulmonary embolism, and pneumothorax can all present with upper back pain and difficulty breathing. Seek medical care for evaluation and proper treatment of suspected lung conditions.

Kidney Stones

Kidney stones can become lodged in the narrow ureters causing blockage of urine drainage from the kidneys. This typically causes severe abdominal and flank pain that may radiate to the upper back. Pain medications, IV fluids, and lithotripsy to break up stones are used to manage kidney stones along with techniques to prevent recurrence.

Treatment Options

  • Over-the-counter pain relievers like acetaminophen or NSAIDs to reduce inflammation and discomfort
  • Apply heat or cold packs to the upper back
  • See a physical therapist for posture correction and therapeutic exercises
  • Stretch and strengthen back muscles through yoga, tai chi, or pilates
  • Use good body mechanics and avoid lifting heavy objects
  • Get massage therapy to relax tight muscles
  • See a chiropractor for spinal manipulation and mobilization
  • Try muscle relaxers, injections, or prescription medications from your doctor
  • Use transcutaneous electrical nerve stimulation (TENS) for nerve pain
  • Consider surgery if conservative treatments fail and there is a clear anatomical cause

When to See a Doctor

You should make an appointment with your doctor if you have:

  • Severe or persistent upper back pain that does not improve with rest
  • Pain that interferes with sleep or daily activities
  • Pain, tingling, or weakness in the arms or hands
  • Difficulty breathing along with upper back pain
  • Fever, chills, or unexplained weight loss with back pain
  • Back pain after a fall, blow, or injury to the spine
  • Back pain in older adults who are at higher risk for serious causes
  • Pain not relieved by over-the-counter medications and self-care

Sharp upper back pain has many potential causes. Seeking prompt medical attention can help diagnose serious conditions requiring specific treatment. With an accurate diagnosis, upper back pain can often be managed with conservative therapies and lifestyle changes.