If your thoracic back pain is fairly minor and does not limit your activity you are probably safe working with the conservative treatments.
On the other hand, if your pain is severe and prevents normal activity or if your pain is persistent and does not respond to home treatments you may need to consider seeing your doctor.
Conservative Treatments not Helping?
If stretching and other home treatments do not make any difference you may need to question your diagnosis.
Is this really myofascial pain?
There are many different possible causes of referred pain that may be felt in your upper back.
Referred pain may be related to your heart, lungs, or other organs.
Rule Out more Serious Possibilities
Your doctor can evaluate you and order the appropriate studies to rule out the more serious causes of thoracic back pain.
Your doctor can order x-rays and other studies to rule out more serious causes of your thoracic back pain.
More Aggressive Treatments
If he decides that your thoracic back pain is myofascial pain related to the muscles.
He may consider sending you to physical therapy for a more aggressive stretching program directed at the specific muscles that are causing your pain.
If you continue to have pain after six weeks of physical therapy and aggressive stretching of the affected area your doctor may begin trialing some medications or refer you to a specialist for trigger point injections.
You may be given a short trial of naproxen, ibuprofen, or other anti-inflammatory drugs to see if it can be helpful for relieving your pain. Many times this type of pain will be caused by inflammation and relieving the inflammation can be very helpful.
These drugs can affect your blood pressure, your stomach, and your kidneys. You need to discuss this with your doctor who knows your medical history.
If your pain has a burning or tingling quality there may also be nerves that are inflamed or irritated and contributing to your discomfort.
Anti-seizure medications, such as pregabalin or gabapentin, can be helpful for this type of pain because they stabilize nerve membranes and help to relieve nerve pain.
Narcotic Pain Medications
If your pain is severe and prevents normal activity you may be given a narcotic pain medication such as morphine or hydrocodone.
Narcotic medications do have side effects, such as constipation and sedation, and the risk of dependence or addiction. Your doctor will monitor you closely to avoid problems and these medicines can be very effective for relieving pain.
Injections of local anesthetic and a steroid medication into tender areas can help relax muscles and relieve inflammation allowing for a quick return to normal activities.
Unfortunately, sometimes the pain will return and the injections will need to be repeated. Trigger point injections can provide long lasting relief but sometimes they need to be repeated several times.
You can find out more about trigger point injections at our Back Pain Injections page.