Middle Back Pain: Causes & How to Get Relief

Key takeaways:

• Middle back pain is often related to structural injury of the thoracic spine.
• Typically, the worst symptoms last only a few days.
• The pain can be treated with simple rest, ice, and over-the-counter pain medication.
• Pain along with fever, chills, numbness, tingling, weakness, or loss of bowel and bladder control are signs of a more severe condition; you should seek medical attention immediately for any of these symptoms.

What is middle back pain?

Middle back pain is a condition that affects many people at some point in their lives. It is also called thoracic back pain because the bones of the thoracic spine make up the middle back. They extend from the base of the neck to the bottom of the ribcage. While less common than neck and lower back pain, middle back pain can cause great discomfort and interfere with your daily life.

This article will discuss the common causes of middle back pain and how they develop. It will also cover potential sources, how to recognize them, and ways to avoid developing pain. In addition, you’ll learn about when to be concerned and when to seek medical attention. Whether you are dealing with occasional, daily, or constant pain, understanding the possible causes can be the first step toward relief.

Common causes of middle back pain

Most causes of middle back pain are structural in origin. It may be caused by injury, overuse, or continued daily stress on the bones, ligaments, muscles, or disks. It’s important to recognize these injuries early. Doing so can help prevent worsening as well as promote early healing.

Muscle strain or sprain

Muscle strains or sprains are injuries that occur when the muscles or ligaments in the back are overworked. When that happens, it can result in stretching or tearing of fibers. These injuries lead to decreased support for the back. Thus, you may find even normal daily activities to be painful.

Activities that may lead to injury:

• Repetitive motions when working or exercising;
• Sudden movements during activities;
• Poor posture;
• Poor form when lifting heavy objects.

Symptoms you may experience:

• Dull, aching, or sharp pain;
• Muscle tightness;
• Sudden, shooting pains known as spasms;
• Pain worsens with specific movements or positions.

Herniated disk

A spinal disk acts as a cushion between each bone. It is made of a rubbery outer surface with a gel-like substance in the middle. When a disk is injured, this substance is squeezed out (herniates) and may push on the nerves.

Activities that may lead to a herniated disk:

• Repetitive motions when working or exercising;
• Sudden movements during activities;
• Improper form when lifting heavy objects.

Symptoms you may experience:

• Sharp, shooting pains down your back;
• Numbness or tingling;
• Worse pain with specific movements or positions.

Osteoarthritis

As people age, the joints and disks in the back wear down. Pain results from the bones rubbing together, and that causes arthritis. Arthritis is common in older adults but may also affect younger patients if they’ve had a prior back injury.

Symptoms you may experience:

• Stiffness that improves throughout the day;
• Pain worse with movement or standing for long periods;
• Reduced flexibility or a worsening arch in the mid-back.

Lifestyle factors

Several lifestyle factors may cause middle back pain, or make it worse. One of the most common risk factors is obesity. When someone is obese, it puts strain on the spine and increases the risk of structural injuries. Obesity can also worsen or prolong symptoms of middle back pain.

Work-related or hobby-related injuries are also common. This is often due to improper form when lifting or prolonged sitting or standing. Recognizing these factors early may help you adjust your lifestyle behaviors to decrease the risk of developing injury.

Less common causes of middle back pain

Along with structural issues, middle back pain may also be a sign of other conditions. When rooted in more serious problems, middle back pain is often associated with additional complaints.

Infection

An infection of the bones in the back (vertebral osteomyelitis) is often the result of a bloodstream infection. This infection can start from many different sources. It can also spread to the disks or develop into a pus-filled mass called an abscess. Symptoms of a spinal infection are typically accompanied by a fever unless the immune system is not functioning properly.

Symptoms you may experience:

• Persistent back pain when sitting or lying still;
• Worsening pain with movement or pushing on the affected area;
• Symptoms of nerve compression (shooting pain, numbness, tingling, weakness, or loss of bowel or bladder control).

Tumors

When cancer spreads to the spine, the middle back is the most common location. Over time, cancers destroy the bones they affect. This increases the risk of breaks or fractures with minor injuries. Widespread cancer is associated with symptoms such as night sweats, unintentional weight loss, and fatigue. Back pain associated with these symptoms may indicate an undiagnosed cancer or one that has returned.

Symptoms you may experience:

• Constant, dull pain;
• Pain unrelieved with rest or worse at night;
• Symptoms of nerve compression.

Referred pain

Referred pain is caused by a problem with an internal organ. Your brain then perceives pain at a specific location in the body. Referred pain is not worsened by movement or by pushing on the affected area. You will likely have other complaints too, such as nausea, abdominal pain, or vomiting.

Special locations of referred pain for key organs include:

• Liver and gallbladder: right-sided middle back pain;
• Pancreas: middle back pain;
• Kidney: pain on either side of the middle back.

Underlying medical conditions

You may also have an underlying medical condition that’s causing pain in your middle back. These conditions affect multiple areas, and you may notice other symptoms like joint pain, fatigue, muscle aches, or rashes. Following are some problems associated with middle back pain.

• Rheumatoid arthritis
• Ankylosing spondylitis (chronic inflammatory disease)
• Reactive arthritis
• Psoriatic arthritis
• Inflammatory bowel disease
• Constipation
• Fibromyalgia

How to treat middle back pain

Middle back pain can range from mild to severe. It may limit your ability to perform daily tasks. Understanding the initial steps in treatment can help provide some relief from severe symptoms. It is important, however, for you to recognize warning signs that indicate the need to seek medical attention.

Over-the-counter pain medications

Acetaminophen (Tylenol) and ibuprofen (Advil) are over-the-counter pain medications that can help relieve middle back pain. They work better if taken at regular intervals and when used together.

However, you should use the medicines as directed on the packaging. You may consider talking with your doctor if you have medical conditions that limit your ability to take them.

Bed rest

Limiting your activity for the first day or two may initially improve your symptoms, especially when you have spasms. But resume your normal daily activities as soon as possible. That’s important for preventing the development of stiffness, as prolonged bed rest can worsen symptoms.

Ice versus heat therapy

After an injury, ice may provide some relief by reducing inflammation and swelling. You may consider icing the area for 20 minutes every few hours. As the inflammation improves, you may switch to heat therapy. It will relax your muscles and help decrease stiffness.

Muscle relaxants or opioid pain medication

Muscle relaxants like cyclobenzaprine and methocarbamol, or opioid painkillers, may also help with muscle spasms or severe pain. These drugs are considered when home therapies are not effective at relieving symptoms. They require a prescription, so you must consult a doctor before taking them.

How to prevent middle back pain

Focusing on prevention can help with long-term relief from middle back pain. Keep in mind, though, that these recommendations target structural causes. They will not help with pain that’s related to other medical conditions.

Core strengthening or stretching

The stomach, side, and back muscles play important roles in preventing back pain. Exercising and strengthening your core muscles helps support the back and reduce the chance of injury.

Strengthening these muscles also improves balance and posture, which reduces the risk of injury. And stretching is important to decrease the strain on your spine from tight muscles.

Ergonomics

Ergonomics is the practice of having good posture when performing any task. It includes standing up straight, sitting correctly when working at a computer desk, and lifting heavy objects with good form. Proper form helps reduce the strain on your back and decrease the risk of injury.

Weight loss

Obesity can cause or worsen back injuries. Weight loss reduces the daily strain on your back and decreases the risk of injury. Yet, weight loss can be more difficult once your back is already injured. Therefore, maintaining a healthy weight before an injury occurs is important.

When to see a medical provider about middle back pain

As stated throughout this article, the common causes of middle back pain are structural. Often, they can be managed with simple home treatments. It is critical, however, to recognize the warning signs and when you should see a doctor or go to the emergency room.

You should see a doctor if:

• Severe pain has not improved after a few days and is keeping you from performing normal daily activities;
• Severe pain that cannot be relieved with over-the-counter medications;
• Personal history of cancer with new severe back pain.

You should go to the emergency room if:

• Your pain is associated with new neurologic symptoms, such as numbness, muscle weakness, or loss of bowel or bladder control;
• Severe pain associated with persistent fevers (>100.4 °F or 38 °C);
• Pain with a history of intravenous drug use.

Questions to ask your medical provider about middle back pain

• Should I have any specific tests or imaging studies to determine the cause?
• How long should I expect to have pain or discomfort? If it goes away, will it come back?
• What might indicate that I should return for another evaluation of my symptoms?
• What exercises or stretches should I do to prevent or relieve the pain?
• Will injections help my back pain?
• When should I consider seeing a specialist for evaluation or to get a second opinion?

Frequently asked questions: middle back pain

What are the red flags for middle back pain?

Red flags indicate that something more severe is the cause of the pain. These include fever, unintentional weight loss, numbness, tingling, weakness, or loss of bowel or bladder control. If you experience any of these symptoms along with severe back pain, please see a doctor or go to the emergency room.

What if you only feel middle back pain when breathing?

Middle back pain when breathing may indicate that you have a problem with your chest wall or lungs. This might be a broken rib if you had a recent injury to your back. Or, it could be pneumonia, a blood clot, or a buildup of fluid around your lungs. You should consider seeking medical attention if you have these symptoms.

How can you sleep comfortably with middle back pain?

Sleeping can be challenging with back pain, especially for stomach sleepers. The best position when you have pain is lying on your back with a pillow under your knees. This is effective because it helps take pressure off your spine.

Can constipation cause middle back pain?

Severe constipation may cause back pain by putting pressure on the nerves as they exit the spine. However, most back pain related to constipation is in the lower back.

Managing middle back pain

Middle back pain can cause a lot of discomfort and stress. The first step is to recognize a potential reason for the pain so you can start the proper treatment. Weight loss, proper form when performing daily activities, and core muscle strengthening can help keep your spine healthy and prevent episodes of middle back pain. Seek medical attention early if you have any red flag signs of middle back pain.

General Medicine follows a strict editorial process, including using real experts to write our articles, vetted primary sources, fact-checking, a secondary medical review, and updates as necessary. This article was medically reviewed and fact checked by Dr. Lane Thaut, DO.

Sources

Chiodo, Anthony E., et al. "Back Pain." Principles of Rehabilitation Medicine Ed. Raj Mitra. McGraw-Hill Education, 2019, https://accessmedicine.mhmedical.com/content.aspx?bookid=2550&sectionid=206762393.

Della-Giustina, David, and Jeffrey Dubin. "Neck and Back Pain." Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e Eds. Judith E. Tintinalli, et al. McGraw-Hill Education, 2020, https://accessmedicine.mhmedical.com/content.aspx?bookid=2353&sectionid=222325511.

Engstrom, John W. "Back and Neck Pain." Harrison's Principles of Internal Medicine, 21e Eds. Joseph Loscalzo, et al. McGraw-Hill Education, 2022, https://accessmedicine.mhmedical.com/content.aspx?bookid=3095&sectionid=262789801.

Flynn, John A. "Acute Back Pain." Principles and Practice of Hospital Medicine, 2e Eds. Sylvia C. McKean, et al. McGraw-Hill Education, 2017, https://accessmedicine.mhmedical.com/content.aspx?bookid=1872&sectionid=146975751.