Understanding Thoracic Back Pain Differential Diagnosis

Dec 5, 2023 | Pain Management

If you’re experiencing chronic pain in the middle area of your back, it’s possible that your healthcare providers may have a difficult time pinpointing its true cause. In order to identify the source, a medical professional may consider performing a comprehensive differential diagnosis. 

In this post, we’ll provide a deeper understanding of thoracic back pain, its causes, the role of differential diagnoses, and effective pain management strategies.

Basic Anatomy of the Thoracic Spine

The thoracic spine is the middle segment of your backbone, located between the cervical spine (neck) and the lumbar spine (lower back). It consists of twelve vertebrae labeled T1-T12, and it provides stability and protection for your vital organs, particularly the heart and lungs.

Chronic pain in this area can result from various factors, including prolonged poor posture, intervertebral disc problems, spinal joint dysfunction, injuries, or muscle strain. Regardless of the source, chronic thoracic back pain can disrupt your daily activities and reduce your overall quality of life.

Common Causes of Thoracic Back Pain

Thoracic back pain can arise from several causes, such as:

Muscular Irritation

Overuse or strain of muscles and ligaments in the thoracic region can lead to chronic pain.

Joint Dysfunction

The joints connecting the ribs to the thoracic spine may become dysfunctional due to injury or arthritis, causing pain.

Herniated Discs

Although less common in the thoracic region than in the neck or lower back, herniated discs can also cause mid-back pain.


This condition often affects the thoracic vertebrae, leading to compression fractures and chronic pain.

The type and severity of pain can vary widely from patient to patient. Muscular irritation, for example, might result in a dull ache, while a herniated disc might cause sharp, radiating pain.

Differential Diagnoses of Thoracic Back Pain

A differential diagnosis is a process medical practitioners use to distinguish a specific condition from others that present similar symptoms. In the case of thoracic back pain, a differential diagnosis may include:

  • Musculoskeletal pain which is often due to muscle strain or joint dysfunction
  • Spinal disc disorders including conditions such as herniated discs or degenerative disc disease
  • Vertebral fractures which are commonly caused by osteoporosis or trauma
  • Spinal stenosis which occurs when the spinal canal narrows, pressing on the spinal cord and nerves
  • Myofascial pain syndrome referring to pain caused by trigger points in muscles

Identifying these differential diagnoses involves a detailed medical history, physical exam, and possibly imaging studies like X-rays, MRI, or CT scans.

Managing and Treating Thoracic Back Pain

Treatment options can vary depending on the specific diagnosis. They may include:

• Physical therapy and exercise to help improve posture, strength, and flexibility

• Prescription medications such as non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or muscle relaxants

• Interventional procedures like steroid injections or nerve blocks which often provide more immediate pain relief

• In severe cases, surgery might be needed to treat conditions like herniated discs or fractures

Remember, what works for one person may not work for another. Always discuss your options with your healthcare provider to find the best course of action for you.

Treat Back Pain and More With HPM

HPM operates pain management clinics at rural hospitals across the country. Our specialists are medically trained to pinpoint, diagnose, and treat a long list of painful conditions, including thoracic back pain. 

No matter where you are or what type of pain you’re experiencing, we’re here to help. Contact us today to find an HPM location near you and take the first step towards a pain-free life.