EpistemisBack pain
Specialty: Musculoskeletal.
Why it occurs
- Thoracic paravertebral muscle contracture or strain
- Thoracic disc herniation or degenerative disc disease
- Osteoporotic vertebral crush fracture (common in the elderly after minimal trauma)
- Ankylosing spondylitis (dorsal inflammatory involvement)
- Scoliosis or structured hyperkyphosis
- Referred pain of visceral origin (thoracic aortic aneurysm, peptic ulcer, pancreatitis)
Initial workup
Simple radiograph of the AP and lateral dorsal column | Magnetic resonance imaging (MRI) of the thoracic spine (suspected spinal cord compression or infection) | Complete blood count, ESR and CRP | Bone densitometry (DEXA) if fragility fracture is suspected.
red flags
Sudden onset pain, tearing in nature, radiating to the abdomen or lumbar region with hemodynamic instability (dissecting aneurysm); localized nocturnal bone pain associated with unexplained weight loss (neoplasia/metastasis); concomitant fever with hypersensitivity to spinal percussion (discitis/osteomyelitis).
Standard management
- Ibuprofen — 400-600 mg every 8 hours orally, indicated for pain of acute inflammatory mechanical etiology
- Cyclobenzaprine — 5-10 mg orally before bed; muscle relaxant for associated muscle spasm
- Tramadol — 50 mg every 8 hours orally; weak opioid analgesic for moderate to severe refractory pain
- Alendronate (70 mg once a week orally, indicated for osteoporosis after stabilization of a compression fracture).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 4