Treatment Overview

There are many treatments for upper and middle back pain. What works for someone else may not help you. Work with your doctor to find what is best for you.

Treatment for upper and middle back pain is based on:

• How bad your symptoms are.
• How much your symptoms prevent you from doing your daily tasks.
• How well other treatments have worked.

Treatment for mild to moderate pain

In most cases, people with mild to moderate upper and middle back pain can manage their symptoms with:

• Over-the-counter pain medicines, such as acetaminophen (for example, Tylenol) and nonsteroidal anti-inflammatory drugs (for example, Advil, Aleve, aspirin, and Motrin), to reduce pain. But if these don't get rid of your pain, you may need a prescription pain medicine that is stronger.
• Heat or ice to reduce pain and stiffness.
• Exercise to stretch and strengthen the muscles of your back, shoulders, and stomach.
• Physical therapy to help increase your flexibility, strength, and balance. Your physical therapist may teach you an exercise program so you can do it at home.
• Massage to help reduce muscle tension and pain and improve blood flow.
• Spinal manipulation to help relieve pain and improve function. It can range from massage and slow pressing to a quick thrust.
• Acupuncture. It involves putting tiny needles into your skin at certain points on the body to promote healing and pain relief.

Treatment if back pain gets worse

If your back pain doesn't get better or it gets worse, your doctor may recommend:

• Prescription medicines, such as opioids, to help reduce pain.
• Muscle relaxants to help reduce pain and muscle tension and improve mobility.
• Antidepressants, such as amitriptyline and duloxetine, to help treat long-lasting (chronic) back pain.
• Steroid shots to help reduce swelling and relieve pressure on nerves and nerve roots. But there is little evidence showing that these shots can help control back pain.

In some cases, a back brace may be used to support the bones in the spine after a fracture.

Surgery is seldom used to treat upper and middle back pain. If your doctor recommends surgery, the type will depend on the problem you have. Before you decide to have surgery, it's a good idea to get a second opinion from a different doctor. Surgery choices may include:

• Kyphoplasty or vertebroplasty. Bone cement is injected through a needle into the broken vertebrae to try to stabilize the bone. These surgeries are not done very often, because most fractures heal on their own. And there is no evidence that kyphoplasty or vertebroplasty are better than nonsurgical treatment.¹
• Herniated disc removal. It removes the portion of the disc that is herniated and pushing into the spinal canal. In most cases, herniated discs that occur in the upper and middle back are small and don't need surgery. But you may need surgery for a large herniated disc that presses on the spinal cord.
• Spinal decompression for stenosis. It widens the spinal canal that has narrowed, and it relieves pressure on the spinal cord or nerves. This procedure is not done very often, because spinal stenosis in the upper and middle back is rare.