Upper Back Pain

Chronic pain between the shoulder blades is a common and sometimes challenging entity to treat. Of course there can be pain up to and sometimes including the neck, and pain which coincides with lower back disorders. The first thing a pain management specialist does is to take a detailed history of the problem. He will want an occupational and activity description prior to and at the onset of pain. Next he will want to carefully examine the area looking for swollen or painful muscles, areas of pinpoint (or “trigger-point” pain), skin lesions like those with shingles, point tenderness or limited motion of the spine, and other specific findings. He will want to know what treatments had been tried in the past and how they affected the pain.

The proper management of middle back pain first requires a detailed evaluation and treatment is first directed at a potentially correctable cause. If the pain appears to be coming from an area of chronic inflammation or irritation of a nerve, a certain sequence of treatments may be initiated. The first is to be sure there has been an adequate trial of an NSAID like Motrin or Naprosyn, or a trial of adequate doses of Tylenol. Then it will be necessary to know if pain gels or pain patches have been tried. There are antidepressant medicines which can alter pain intensity and perception, and the pain specialist will want to know if these have been tried.

The next class of medicines which is effective in pain management is called the anti-seizure medicines like Neurontin or Lyrica. If these have been ineffective, he may wish to know if nerves in the area have been treated with ablation techniques or injection. If all of these modalities and others like physical therapy have failed, the pain specialist may consider a very careful and ongoing use of narcotic and non-narcotic pain medicine. Special screening tests are necessary to try to avoid the medicine being overused or distributed in improper ways. In most cases this can be a safe and effective treatment but there are isolated instances of misuse or addiction, and these have to be carefully watched for. It may not be possible to make all pain go away, but the object is restore function, activity, and a healthy outlook on life.