Expert: Gerald Anzalone, D.C. - 12/20/2006

Question
I've have middle back pain for a few months now. I'm pretty sure it all started when I was drying my hair with a towel and  I heard/felt a slight pop in my upper/middle back. After that, there was a twinge when I looked right or left. I went to a doctor who gave me some muscle relaxers and things improved a bit, but then the symptoms began to come back.
This back pain doesn't hurt when I look to the side, but it is localized in pretty much the exact same place. The pain is basically a soreness (not intense) that increases when I turn my torso. It feels like the day after a heavy workout day. The pain is mid-back, feels like the muscles on both side of the spine. The thing is, during the worst periods it feels like the pain extends through/around to the right front side of my abdomen in a dull ache that can be constant. I'm a bit of a worrier and I wonder what the odds are of it being something more serious with my kidneys or something? I don't have any problems with urinations or anything.
I just started seeing a chiropractor, 4th visit, and was wondering how long it should take for things to start to improve. They haven't yet.

thanks,
Michael

Answer
Michael,

If I read your description of your symptoms correctly, it would appear that the pain that you're experiencing primarily in your mid-back, or the thoracic spine, is in the paraspinal region, or the muscles along side of the spine, rather than more centrally in the spine itself.

If that is the case, I would examine the spine for trigger points in the musculature, which may produce radiating pain. Trigger points are nodules that develop in injured or over-used muscles, and they are potent generators of pain. Based on your description of your symptoms, I'm more inclined to consider a primary muscular problem since you seemed to obtain a lessening of symptoms with muscle relaxants.

However, if the pain is central in the spine, or has persisted for several months without significant improvement, I would recommend an x-ray or MRI scan to rule out an underlying pathological condition. Disc herniations are relatively uncommon in the thoracic spine, but they do occur. An MRI would be the best modality for evaluating for disc lesions.

Based on your description of symptoms, I am less inclined to be worried about kidney stones. Kidney stones should be considered in the presence of abdominal pain and flank pain, and renal colic often begins as flank pain. Your chiropractor might consider ordering a urine analysis, blood work (a complete blood cell count with differential analysis, kidney function, and concentrations of calcium, phosphate and uric acid, and a general chemistry panel) as well, or you might see your primary care physician for these tests to rule out an underlying pathological condition such as infection or kidney stones. Additional radiographic testing might be necessary if kidney stones are a concern.

I'm not sure what type of treatment you are receiving through your chiropractor, or if your symptoms are worsened or alleviated by certain movements, especially forward or backward bending. Pain or alleviation of pain based on certain movements can be diagnostic as well as therapeutic for certain types of mechanical back pain.

Other factors that may be important in evaluating these types of symptoms include age, medical history, increase of pain at night or fevers.

If you have not had any improvement in symptoms within 4 weeks of conservative care, I would see your primary care physician for additional evaluation. It's also important to let your chiropractor know how are your feeling and progressing with the treatment that you are receiving.

I hope that you found this answer helpful.