Many people experience back pain. Back pain can occur anywhere from below the neck and shoulders (upper back pain) to the areas above the hips (lower back pains). Middle back pain or mid-back pain occurs between the upper and lower regions of the back, which include the spine, ribs, and muscles. It is less common that lower back or neck pain.

The type of pain experienced will depend on the cause. Some may experience acute back pains while others suffer from chronic pain lasting for months. It can be a dull, aching pain or a stabbing, burning pain that is more severe.

Some forms of mid-back pain may be relieved by sitting, but can worsen when lying down, resulting in increased pain during sleep. Many people lose sleep because of these symptoms and wake up with the pain still present.

Other symptoms may be associated with mid-back pain, including abdominal pain, rib pain, pain in the hips, shoulder or neck, pain during breathing, headaches, weakness, numbness, fever, anxiety, or depression.

What Causes Back Pain at Night?

One obvious cause of mid-back pain is blunt trauma to the spine, ribs, or muscles in this area. This could result from a fall or another accident. The pain may be acute and last until the swelling or inflammation is resolved. If the trauma causes a fracture to the spine then numbness or weakness of the lower body may result, requiring emergency medical attention.

Mid-back pain may also result from an acute or sudden movement during work, sports, or other activity. Twisting or bending may lead to muscle spasms, strains, or sprains, especially in people who are usually sedentary. It may be related to the overuse of muscles or the inflammation of muscles, ligaments, or tendons.

Several factors can increase the risk of middle back pain, including advancing age, congenital abnormalities of the spine, obesity, pregnancy, poor posture, sedentary lifestyle, anxiety, and stress.

The following conditions that can cause middle back pain require careful diagnosis from a health professional.

Spine Disorders

• Osteoarthritis - This involves degenerative changes that lead to the inflammation of joints anywhere in the body, including the spine.
• Osteomyelitis - An infection of the bones. If it involves the spine, it can cause back pain.
• Osteoporosis of the spine - This involves the loss of bone density, resulting in the weakening of the affected bones.
• Misalignment of the spine - This may be due to either a kyphosis (an abnormal curvature of the spine, resulting in humpback) or scoliosis (sideward spinal curve). The pain may be mild and dull, but also chronic, causing sleeplessness.
• Diseases of the spine - A tumor or cancer of the spine, or any infection or inflammation in the spinal joints (spondylitis) can cause chronic, severe pain.
• Other conditions of the spine - These usually involve degenerative changes related to aging that cause inflammation and narrowing of the spine (called spinal stenosis), leading to impingement of nerves or the discs (herniated discs) between the spinal bones.

Disorders of the spine may cause chronic back pain that may also result in bladder problems, weakness of the legs, or even paralysis. However, proper diagnosis using CT scans, x-rays, and other imaging techniques is necessary. Treatment may involve medical and surgical techniques.

Rib Problems

The ribs are attached to the spine at the back, so any trauma or condition affecting these may cause mid-back pain. Between the ribs are muscles (intercostal muscles) that may become irritated and inflamed. This often occurs when a person twists and bends sideways while pushing or lifting something. This intercostal pain usually causes difficulty taking deep breaths. When the intercostal pain involves the inflammation of the nerve running along the rib, intercostal neuralgia has occured. This type of pain appears suddenly and can worsen with movement of the spine, incorrect posture, breathing, sneezing, coughing, or even talking.

Other Causes

There are other common conditions in areas beyond the back that may cause pain radiating into the back. These include:

• Fibromyalgia, a medical condition that is characterized by widespread pain and abnormal sensitivity to pressure that is perceived as intense pain. This is associated with joint and muscle pain, sleep disturbances, fatigue, and depression. Despite the the wide range of symptoms experienced by the patient, no anatomical abnormalities may be found, making it difficult to diagnose and treat.
• Heart attacks may cause chest pain that radiates to the middle section of the back, including the left shoulder and arm. Symptoms may be sudden and severe, but some experience silent attacks. This is a medical emergency requiring immediate intervention.
• Indigestion can cause bloating, gas, belching, nausea, abdominal pain, and even back pain. These symptoms usually occur after overeating, drinking alcohol while eating, or consuming greasy or spicy foods.
• Kidney stones can cause one-sided mid-back pain below the ribs. They may result in extreme, sharp pain in the side or back that may occur sporadically or constantly. Changing positions usually does not relieve this pain. Associated symptoms include fever and chills, nausea and vomiting, frequent urination and blood in the urine. Immediate medical treatment is necessary.

How to Alleviate Symptoms

Unless the cause of your mid-back pain requires surgical or pharmaceutical intervention, most other causes of back pain may be relieved by simple measures including:

• Over the counter medicines like acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (Advil, Motrin).
• Relaxation and stress management
• Avoiding a sedentary lifestyle and increasing physical activity to strengthen back muscles. Try walking, swimming, or yoga.
• Improving posture, especially when sitting for extended periods.
• Improving body mechanics during work and avoiding lifting or pulling heavy objects.
• Physical therapy and/or massage.
• Applying an ice pack, warm compress, or heating pad on the back to reduce inflammation.
• Improving the diet to reduce weight and avoid digestive problems.