OpenHealth Q&A

Persistent Mid-Back Pain in a 29-Year-Old Male: A Comprehensive Overview

**Patient Profile:** 29-year-old male **Medical History:** Diagnosed with Type 1 diabetes managed solely with insulin **Previous Treatments:** Nonsteroidal anti-inflammatory drugs (including celecoxib), muscle relaxant (Norflex) yielded no relief. Pregabalin was attempted but resulted in adverse effects without benefit. **Occupation:** Works in a warehouse involving repetitive lifting and carrying (weights between approximately 30 to 40 kg). Engages in gym workouts around four times a week. **Primary Concern:** Ongoing localized thoracic pain on the left side for about 1.5 years. **Pain Characteristics & Location:** * The pain is described as deep and located in the mid-back area beneath the shoulder blade on the left side. * A **precisely defined, small tender point** can be palpated, noted by healthcare providers as **located paraspinally at the T8–T9 region** (previous examinations also flagged the T6–T7 area). * Pain sensations range from a deep ache or tight feeling, escalating to a **burning sensation** after exertional activities, with intermittent sharp jabbing sensations resembling electric shocks. **Pain Assessment:** * Severity while resting: **5–7 out of 10** * Severity following activity: **6–8 out of 10** **Pain Triggers:** * Engaging in **scapular retraction** (drawing shoulder blades back) invariably results in sharp stabbing pain restricted to the same localized area. * Movements involving thoracic **rotation to the right** and **side-bending to the right** exacerbate pain. * Workouts focused on the back often heighten symptoms, particularly post-exercise. **Additional Symptoms:** * No regular occurrences of numbness, tingling, or weakness in the arms, nor evident dermatomal pain radiation. * Occasionally, sleep is interrupted due to pain. * Absence of systemic issues like fever or weight loss. **Clinical Evaluation Findings:** * Notable point tenderness at specified spinal levels; thoracic range of motion is largely intact, though certain actions trigger discomfort. * Strength in shoulders appears normal (rated 5/5), with some observations recording slight scapular asymmetry and control difficulties. **Diagnostic Findings:** * **Thoracic X-ray (September 2025):** Vertebrae are well-aligned, no urgent abnormalities; only slight postural curvature or scoliosis noted. * **Thoracic MRI (1.5 Tesla, October 2025):** Resulted in normal findings with no evidence of disc herniation or protrusion, spinal cord appears unaffected, foramina are clear, facet joints intact, and no acute changes in costovertebral structures or muscular irregularities. * **EMG/NCS (November 2025):** No indicators of radiculopathy (C5–C8) or brachial plexus damage to explain the symptoms. * Routine lab tests and inflammation markers returned normal results. **Discussion Points:** Given the specific tenderness at the T8–T9 paraspinal area, the presence of burning pain following exertion, and the sharp discomfort during scapular retraction—all despite clear thoracic MRI and EMG results—what differential diagnoses warrant consideration? Potential options include issues related to costovertebral or costotransverse joints, rib dysfunction, pathological changes in thoracic facets, myofascial trigger points or deep muscle issues, and possible nerve entrapments. What appropriate next steps should be pursued, such as initiating a targeted physical therapy strategy, implementing diagnostic blocks or injections, conducting further imaging, or referring to a specialist?

Answers (1)

2/16/2026, 8:20:54 AM

OpenHealth AI

Main Points: Persistent mid-back pain in your case can stem from various musculoskeletal issues given your specific symptoms and occupational activities. Since previous treatments haven't provided relief, targeted interventions are crucial. We'll focus on pain management through physical therapy, identifying potential trigger points, and assessing your activities and postures.

Explanation: Your described pain characteristics and tenderness around the T8–T9 region, combined with the lack of systemic symptoms or significant findings in diagnostic imaging, suggest a musculoskeletal origin, likely involving myofascial pain syndrome or muscle strain rather than nerve-related issues. The sharp pain during specific movements raises the possibility of joint or soft tissue involvement. Additionally, your physically demanding job may exacerbate the problems if proper ergonomics are not maintained.

Next Steps:

1. Physical Therapy: Start a targeted physical therapy program focusing on strengthening the muscles around your thoracic spine and improving posture. A therapist can also provide manual therapy techniques to release trigger points, particularly in the affected area. Emphasize:

   • Core strengthening exercises.
   • Stretching and flexibility exercises for the thoracic spine.
   • Techniques for proper lifting and body mechanics related to your work.

2. Pain Management Techniques: Consider utilizing non-invasive pain relief strategies such as:

   • Heat or cold therapy (e.g., heat packs before activities and ice afterward) to reduce pain and inflammation.
   • Gentle stretching or yoga, focusing on thoracic mobility, can be beneficial.

3. Activity Modification: Evaluate your lifting techniques and ensure you are using proper form to avoid aggravating your back pain. If possible, incorporate rest periods and avoid repetitive movements that trigger pain. Speak with your employer about modifications or varying your tasks to reduce strain.

4. Trigger Point Injections: If physical therapy does not yield satisfactory results, discuss the option of trigger point injections with your healthcare provider, which can help reduce localized pain.

5. Monitor Progress: Keep a pain diary recording activities that trigger your symptoms, pain levels before and after activities, and any modifications that help relieve discomfort. This information can inform your therapy and any future consultations.

6. Consider a Specialist Referral: If you continue to experience significant pain despite these interventions, consider a referral to a pain specialist or an orthopedic doctor with expertise in musculoskeletal issues.

By focusing on these steps, you can develop a comprehensive approach to managing your back pain while maintaining your quality of life and physical activities. Please keep me updated on your progress or if you need further information on any specific aspect.