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When should I worry about upper back pain?

Upper back pain is discomfort in the upper and middle region of the back. This includes pain between the bottom of the neck and the bottom of the rib cage. Upper back pain is common and usually not a cause for concern. However, severe or persistent upper back pain may indicate an underlying medical issue that requires treatment. Here is some guidance on when upper back pain warrants a trip to the doctor.

Mild, Infrequent Pain

Mild or moderate upper back pain that comes and goes is usually nothing to worry about. This type of pain may result from muscle strain due to poor posture, overuse, or injury. Basic self-care steps can often resolve mild, infrequent back pain:

  • Apply heat or ice to the painful area
  • Use over-the-counter pain medication
  • Perform gentle stretches and exercises
  • Improve posture and take frequent breaks when performing repetitive tasks
  • Get a massage to relax tight muscles

If the pain lasts more than a week or keeps recurring, see a doctor to identify the underlying cause.

Severe or Persistent Pain

Seek prompt medical attention if you have:

  • Very severe pain – Upper back pain that is sudden and intense may indicate a serious problem like a fracture, herniated disc, or pinched nerve.
  • Persistent pain – Upper back pain lasting more than 1-2 weeks may require evaluation and treatment to resolve.
  • Pain that worsens or changes – Worsening pain or pain that changes in nature or location over time should be evaluated.
  • Difficulty moving the back – Inability to turn the neck or bend the upper back requires prompt medical care.

Severe, persistent, or worsening upper back pain may result from:

  • Spine conditions – Herniated discs, spinal stenosis, fractures, arthritis
  • Muscle and ligament sprains or strains
  • Pinched nerves
  • Fibromyalgia
  • Kidney problems – Kidney stones, infections
  • Lung conditions – Pneumonia, pleurisy, tumors

Proper diagnosis and treatment can provide relief from chronic upper back pain and prevent complications. Seek immediate care for sudden, severe upper back pain after an injury or accident.

Pain with Other Symptoms

Seek medical care if upper back pain occurs with:

  • Weakness – Leg weakness can signal a serious spinal cord problem.
  • Numbness or tingling – Numbness or tingling in the arms or hands may result from a pinched nerve.
  • Fever, chills, or unexplained weight loss – These can indicate an infection or other illness causing referred upper back pain.
  • Shortness of breath or cough – Back pain with breathing difficulty may signal a lung or heart issue.
  • Abdominal pain – Gallstones, pancreatitis and other abdominal issues can sometimes radiate pain to the upper back.

Upper back pain accompanied by troubling symptoms warrants prompt medical assessment. Call 911 immediately for paralysis or loss of bowel/bladder control.

Risk Factors

Certain medical conditions that increase the risk of upper back pain include:

  • Arthritis
  • Osteoporosis
  • Spinal abnormalities such as scoliosis
  • Prior back surgeries or trauma
  • Strenuous jobs involving repetitive bending and lifting
  • Obesity
  • Smoking
  • Age over 65 years

See a doctor if you have any of these risk factors and experience recurring or worsening upper back pain.

When to Seek Emergency Care

Some signs indicate a medical emergency requiring immediate medical attention:

  • Sudden, severe upper back pain, especially after an injury or accident
  • Pain, numbness or weakness in arm(s) or leg(s)
  • Difficulty walking or standing due to upper back pain
  • Loss of bowel or bladder control
  • Fever and upper back pain

Call 911 or go to the ER if you have severe upper back pain along with any of the above emergency symptoms. These may indicate a spinal injury, fracture, infection, or other serious medical issue requiring hospital care.

When to See a Doctor

Schedule an appointment with your doctor if you have any of the following:

  • Persistent upper back pain lasting over 1 week
  • Recurrent episodes of upper back pain
  • Inability to identify a cause for the upper back pain
  • Pain that interferes with work, sleep or daily activities
  • Pain not improving with home treatment
  • Upper back pain with concerning symptoms like numbness or abdominal pain

A doctor can evaluate your symptoms, order imaging or lab tests if needed, and provide an accurate diagnosis and proper treatment plan. Many causes of upper back pain respond well when treated early.

Diagnosing Upper Back Pain

To diagnose the cause of upper back pain, the doctor will:

  • Take a full medical history and ask about symptoms
  • Perform a physical exam testing range of motion and assessing symptoms
  • Order diagnostic tests as needed, such as:
    • X-rays
    • MRI scans
    • CT scans
    • Bone scan
    • Electrodiagnostic tests
    • Bloodwork

Based on the results, the doctor will determine if the back pain is from a strained muscle, herniated disc, spinal arthritis, bone fracture, or other condition. An accurate diagnosis is essential for proper treatment.

Treatment for Upper Back Pain

Treatment options will depend on the cause and severity of upper back pain, but may include:

  • Medication – Over-the-counter or prescription NSAIDs, muscle relaxants, analgesics.
  • Physical therapy – Stretching, exercises, massage, heat/cold therapy.
  • Bracing – Special back braces can provide compression and improve posture.
  • Injections – Steroid injections can reduce localized back pain and inflammation.
  • Surgery – Rarely needed for upper back pain, but may be required for serious spine conditions or nerve compression.
  • Lifestyle changes – Improving posture, losing weight, quitting smoking.

Most cases of mild to moderate upper back pain improve with conservative treatment focused on managing symptoms. Surgery and invasive treatments are usually last resort options.

Preventing Upper Back Pain

You can reduce your risk of developing upper back pain by:

  • Maintaining good posture when sitting and standing
  • Stretching the neck, shoulders and upper back
  • Exercising to build core and upper body strength
  • Using ergonomic chairs and workstations
  • Avoiding bending, lifting and twisting motions when possible
  • Wearing supportive footwear
  • Quitting smoking
  • Maintaining a healthy weight
  • Treating medical conditions that can contribute to back pain

While not always preventable, upper back pain can often be avoided with proper strength, flexibility and lifestyle habits.


Upper back pain is very common but usually not a cause for concern. Seek prompt medical care for sudden, severe, persistent or worsening upper back pain. Mild or moderate pain that comes and goes can often be managed with self-care. But recurrent or chronic upper back pain should get evaluated to identify any underlying medical issue requiring treatment. Catching and addressing problems early is key to resolving upper back pain and preventing complications.