Achieving an accurate middle back pain diagnosis is crucial in order to better the chances for successful symptomatic resolution. However, although most patients take the diagnostic phase of their back pain care for granted, this is precisely the step in which the entire process typically goes off course. The incidence of misdiagnosis in the back pain industry has reached horrific proportions, accounting for the pure fact that most patients who endure symptoms for more than a year will never fully recover.
Middle back pain syndromes are statistically far less often seen than lumbar or cervical dorsalgia issues. Additionally, the middle back is a very strong region and is not subject to the same types of injury and structural deterioration common to the low back and neck. This can make pinpointing the exact source and reason for pain in the middle back very difficult. However, this is not necessarily a bad thing, since patients who do not receive a diagnosis fare better according to many research studies than those who are labeled with any specific diagnostic conclusion. Since so many patients are misdiagnosed anyway, this is logical and might truly be a blessing in disguise.
This focused essay examines the difficulties of positively identifying the origin of back pain in the middle spinal region. We will focus on T5 to T12 as the location for our search, as this is generally defined as the mid back, but will also mention conditions that may affect the upper back at T1 to T4, as well.
Typically, most chronic middle back pain conditions will be referred to a specialist for diagnostic screening. The type of practitioner can vary greatly, with some patients choosing to consult with an orthopedist, while others make appointments for evaluations from orthopedic surgeons. Many patients with suspected nerve pain instead consult with a neurologist or neurosurgeon for diagnosis. A minority of patients may ask their physical therapist to diagnose their pain problem, especially if they have a pre-existing relationship with this doctor and have enjoyed good treatment results for other types of symptoms. Some patients choose to bypass the traditional medical approach altogether and seek primary care and diagnosis from their local chiropractor.
Regardless of what type of doctor is responsible for diagnosis, statistics clearly show that the source of pain will be difficult to identify in the majority of patients. This can lead doctors to trade in their usual problem of misdiagnosis for a completely new problem: educated guessing. So many middle back pain patients endure a number of diagnostic revisions in suspected pain causation, rather than any definitive diagnosis, since structural issues are absent and this leaves ample room for often subjective opinion, rather than evidence-based evaluation. When patients are “lucky” enough to demonstrate some form of significant spinal abnormality or obvious pathology in the middle back, then this will likely be labeled as the explanation for pain and treatment will begin. In these cases, the patient stands a better chance of actually receiving quality targeted care and enjoying eventual resolution of their pain.
Being that the middle back is not prone to the same incidence or degree of injury or degeneration, when compared to the lumbar or cervical regions, diagnosis of middle back pain may be quite a different process for some patients. When present, the usual (often scapegoat) conditions are implicated in most instances of mid back pain, with herniated discs, degenerative disc disease and spinal osteoarthritis taking the majority of blame in these cases. But, since these issues are not nearly as prevalent in the middle spine, the diagnostic theory often drifts to other suspected causations, including chronic muscular issues, including thoracic outlet syndrome with referred pain, fibromyalgia or muscle imbalances.
In our experience, these diagnoses are rarely correct and the incredible rise in muscle imbalance diagnoses is particular frightening, since this is a ridiculous assumption in most patients without diagnostic evidence in virtually every case. Some patients are told that their pain is idiopathic and are simply provided with symptomatic care for the unknown causation.
When an observer follows the results of diagnosis and treatment efforts and ascertains the long-term success of medical care, the patients who do not achieve a diagnosis actually fare much better statistically. These patients spend less money, spend less time and face less dangerous and less invasive treatments than patients who receive any definitive diagnosis. This is a frightening reality, but not surprising considering the related fact that patients who seek no professional help for any type of back pain also fare markedly better than those who do seek diagnosis and treatment.
With facts like these, it does not take a genius to understand that the back pain diagnosis system is very broken. Maybe not receiving a definite diagnosis of a source of pain in the middle back is actually one of the better fates a patient might enjoy. It is certainly better than receiving multiple mistaken diagnoses and spending time and money to treat these mistakes at risk to one’s general health. It is certainly better than undergoing unnecessary surgery, which is a very common eventuality for back pain sufferers. However, when pain is present, patients understandably want answers and will usually keep looking until they are labeled with a diagnosis, regardless of its accuracy or even scientific merit.
Mid back pain can be a torture, just like any other anatomical location. Patients write to us every day, asking for solutions to their pain, but often skip over the most important and vital step: diagnosis. Some hold on to theories that do not make sense, while others have already been treated for this incorrect diagnosis for years already without positive outcomes. They blame the ineffectiveness of the treatments, but never think to blame the obvious problem of misdiagnosis leading to failed therapy.
Without an accurate causative conclusion, the chance of successfully ending pain is like playing darts in the dark. You may hit the board, if you are lucky, but the chances of getting a bull’s eye are virtually nil. Remember this truth if your suffering does not respond to appropriate middle back pain treatment, despite having a diagnosis in place. In almost every case, this is a sure indicator of misdiagnosis. We see it day in and day out.
If no evidence of a structurally-based process can explain your pain without doctors getting “creative” in finding something that will earn them an easy payday for unneeded treatment, it might be wise to first consider the very real possibility that your agony is not spinally or even anatomically-based. A large percentage of middle back pain is caused by ischemia, which will not show up on any standard diagnostic test conducted in a laboratory setting. However, talking to a doctor who is well versed in mindbody medicine can identify this problem and put you on the path to relief. This topic is well covered throughout this website for further research and also forms the basis of my best selling book on curing back pain forever.