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Unbearable pain in thoracic region every morning

Hello fellow upper back pain sufferers!

My name's Charlie and I'm a 33 yr old illustrator in London UK. I'm at my wit's end with my back issues and thought maybe somebody out there might have some advice.

I've been waking up with back pain in my upper/thoracic region every morning for the past 6 months. The pain alleviates as soon as I get up, but sometimes lingers into the day. It seems to be lingering more often over time. I have a lot of tension in my upper back and neck and can make some pretty impressive crunching noises several times a day.

I've had this problem before - 3 years ago - but was able to 'cure' the issue with sports physio. This time, however, nothing seems to work.

The pain is a sharp, heavy ache, that feels like it's deep inside me, with some emphasis on the left thoracic area. It wakes me up around 6/7am, or around 6 hours after I fall asleep. I've been taking Naproxen for about a month, which has slightly alleviated the pain, but the effects of this drug are waning. I take cocodamol when I wake up.

I've seen various physios, sports physios, osteopaths, chiropractors...the exercises I did with the sports physio helped me to overcome this issue first time round, but do not work now. I had an x-ray recently which showed slight scoliosis of the spine, which I was told could be a contributory factor to the thoracic pain.

I've been seeing a senior physio consultant (NHS) in London for the past 2 months, who has me doing 45 minutes of stretches/strengthening exercises per day. I haven't noticed an improvement yet but have been advised to stick at them. She has also advised swimming (crawl), which hasn't helped so far.

I am an illustrator by profession, so spend around 6/7 hours a day at a desk. I try to get up and move around every 45 minutes or so.

I sleep on a Sleepeezee CONCEPT 1400 mattress, on a wooden-slatted bed. I've read that an air mattress can be a better option, but am not convinced this would work.

The pain and intrusion on my sleep is really affecting my life now. I'm desperate to sort this out or at least feel like I'm on a path to sorting it out! Right now I'm just getting more and more used to being miserable!

Any advice appreciated, thank you.




  • You seem to be getting a lot of treatment without a conclusive diagnosis, which is never a good idea.

    In your situation I would be pressing for tests and then more tests to discover the underlying cause of your pain.

    The problem with thoracic spine injuries is not only that they mimic a variety of unrelated conditions, but also that, wrongly treated, serious, irreversible damage can be done. That's why it is imperative to establish what is causing the problem before treating it.

    I'm not young enough to know everything - Oscar Wilde
  • Thanks for the comments and advice. After informing my NHS physio consultant that the exercises weren't improving my back issues, she literally said she had no idea what to do next, and has referred me to the Sports Physio Dept in the same hospital. Seeing them on Friday 13th(!). I am going to try to push for more tests - haven't had an MRI yet.
    Had a couple of sessions doing core training with a sports physio (private) that seemed to reduce the level of pain a little. Need to get down to the gym and continue this, though it's hard to muster the energy on so little sleep. The sessions involve sprinting on the treadmill, doing the plank, elevated pressups, and lots of other stuff.
    Purchased an RH Logic 4 chair for work, as meant to be best for back pain - made no difference so far.
    Naproxen has no effect whatsoever now so going to speak to GP about alternative pain medication.
    Pain is getting worse and lingering into the day now.
    Had an intense remedial massage the other day - was in agony throughout, and have felt no improvement as a result.
    Anyway, just thought I'd share my latest frustrations! Thanks for reading.

  • sandisandi Posts: 6,343
    edited 06/10/2014 - 7:39 AM
    It is a physical therapist who said they had no idea.........without any imaging studies to rule things in or out, it is guesswork trying to figure out what may be causing the pain.
    Needtosleep, the next step would be following up with that referral, and they should be able to order any imaging studies that they feel are necessary. Since you are in the NHS, do you also have the option for going private? If so, and you aren't satisfied with the treatment after your consult with the Sports doctor, it might be worth considering going private and consulting a surgeon once you have the imaging studies done.
    Physical therapy is just one step in getting treatment. If it was muscular, it may have helped to ease the symptoms. For now, you may want to stop the running, until you know what is causing the problem.
    Best of luck,
  • aliscottaaliscott Posts: 8
    edited 06/13/2014 - 4:54 AM
    EDITED to remove medical advice.
    . good luck
    5.06 You agree not to post information that is considered to be formal medical advice.
    5.12 You agree that any information, opinions or other content provided by doctors or patients on Spine-health.com forums is for educational purposes only and is not intended for medical diagnoses or treatment. Always consult with a physician for any health problem or medical condition.
  • aliscottaaliscott Posts: 8
    edited 06/14/2014 - 5:52 AM
    5.18 Spine-health.com reserves the right to edit, monitor and/or delete comments at our discretion without notice.
  • I've now been discharged from physio as none of the treatment was effective (aside from acupuncture providing very limited respite), and am now being seen by the rheumatology dept. Having another MRI next week. Apparently the cause of the pain could be related to my immune system reacting to inflammation in my spine, which was revealed in my first MRI last year.

    Anybody else have any experience of this diagnosis?


  • Hey there,

    I was curious to know if you had ruled out the possibility of scheuermanns disease. The scenario you're describing sounds a lot like what I experienced, and the pain...UNBEARABLE! Every breath feels like a long hot dull blade being driven into the center of my back just about bringing me to my knees. The thing with scheuermanns, is you have flare ups. I feel okay for awhile but then, out of nowhere, BAM! WelCome to hell.

    If you Google scheuermanns disease, it will show you pictures of people that are affected the worst. You would never be able to tell by looking at me and from what I understand, it isn't a degenerative disease. It's a malformation in the vertebrae that the diagnosed party was born with.
    Rachel stone
  • Rest.upRRest.up Posts: 1
    edited 07/03/2015 - 6:10 AM
    Not sure if it's the sand thing but I also suffer from severe upper back pain especially in the morning ... Sometimes it's so hard to even turn to my side .. I find the more I eat the worse it becomes. I'm currently having it investigated but thought if you haven't had a blood test you should try that.
    I keep getting recurring uveitis so the eye hospital found that I have HLA B27 gene .. Which basically causes inflammation that they say explains the uveitis, but it could also be the Eason for the back problem. Mine is still undergoing investigation and awaiting an MRI but I hope you find out what it is as that makes it easier to deal with.

    Take care

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  • itsautonomicitsautonomic LouisianaPosts: 1,807
    Need to sleep , glad something showed up that may clue in on the reason. As the last couple of posters listed so many things can cause pain. Its all about getting correct diagnosis and then cant find correct treatment. Keep everyone updated
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • Need To SleepNNeed To Sleep Posts: 6
    edited 02/25/2015 - 8:20 AM
    Hi everyone

    Thanks so much for the feedback and advice. following another MRI, X-ray, and blood tests, I've now been diagnosed with mild ankylosing spondylitis, which - I think - is a form of arthritis. The early morning agony is caused by inflammation in the spine. Treatment for now is just ibuprofen / naproxen / cocodamol / physio, but further down the line, if the vertebrae start to fuse (which is what AS causes), then I will have to use treatment that reduces the activity of my immune system as that's what leads to the painful inflammation. Which can then obviously make you susceptible to serious infection. It's basically the spine malforming and growing new bone. Gross!! Hopefully it won't get to that point - going to keep doing lots of exercise, stretching etc, and seeing the NHS rheumatology doctor every 2 months. Good to finally get some light shed on what's been a very painful and frustrating experience for the past 3 years, but pretty worrying all the same. I'm also experiencing sporadic pins & needles in my right arm which is due to some slight nerve damage in the vertabrae in my neck, from me manipulating it too much due to tension! So my advice would be to not do that. Pins and needles every day is bloody annoying!

    Thanks again

  • Bart_ManBBart_Man Posts: 1
    edited 08/21/2015 - 7:47 AM
    Hi Charlie, or "need to sleep". I am so glad I found your post, as I have the exact same symptoms you do. Doctors here in Canada keep saying that it's a mechanical problem with my spine, but none of them can explain why I'm in agony in the morning and why it goes away during the course of the day. I'm from Europe originally and I'm going to go there to have some tests done (doctors in Canada can't even spell the only language they speak, let alone make a correct diagnosis of anything other than a common cold).

    Anyway, I have other very obvious issues with my immune system, causing two distinct auto immune problems in my body, AS is not a far stretch.

    By the way I'm not the kind of person who reads symptoms and then starts to become convinced that what I'm reading about is what I have (hypochondriac), but it fits the picture a hundred percent.

    I'll get some MRIs done, thanks for telling your story man! I'm 34 by the way. I don't have any pins and needles, but sometimes get a numbness in my left arm, and it's not due to my heart. Could be related to the spine, could not be, we'll see.

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  • edited 07/03/2015 - 5:57 AM
    I have the exact same problem, i have had it for almost 3 years now and no one has a clue.
    Did you get a diagnosis?
  • Jacob2275JJacob2275 Posts: 1
    edited 08/21/2015 - 7:46 AM
    Hello everyone.
    I'm Jacob a singer/songwriter from London 23 years of age!
    A few months ago now I slipped 2 discs in my lower spine. The slip caused nerve compression in both of my legs and loss of feeling plus sciatica (good fun) but the most recent developments of my back problems is waking up around 6/7 every morning with a heavy dull ache through my upper back and sometimes neck. I'm constantly changing my sleeping position to get away from the pain and nothing helps. I found it interesting that one of you related the pain to a reaction from inflammation of the spine which would make a lot of sense in my case.

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  • Jacob2275, I had the same thing happen. I had a weight lifting injury in my lower back a few months ago. I never seemed to fully recover (always had a tiny discomfort in my lower back)

    Now a week ago I started waking up with the same "heavy dull" pain every morning. The pain seems to go away as soon as I get up and start my day but comes back next morning.

    It get the feeling it's gonna be very hard to get a diagnosis for this
  • SavageSavage United StatesPosts: 5,427
    edited 10/25/2015 - 1:41 AM
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  • Hi everyone

    Just a quick update if anyone's interested. After getting diagnosed with mild AS in January this year, I've managed to find ways to control pain and discomfort, mainly through exercise, physio, and diet. After initially taking lots of NSAIDS like naproxen and ibuprofen, I decided I didn't want to continue doing that long-term, and read lots of stuff about how a no starch / low starch diet can assist in alleviating the symptoms of AS. Obviously anything relating to nutrition and pain control is controversial due to the impossibility of double-blind tests, but I've found this dietary approach has helped me a lot, and I'm also eating a lot more healthily (all fresh food, no more rubbish).

    I do still have a really crunchy neck and am manipulating it daily to relieve tension, which, according to my physio, isn't something to worry about....except this morning I did it and felt a nasty twinge in my neck and now can't turn left. Hopefully nothing permanent. Earlier this year I had an ECG at the neurophysiology hospital in London to test for nerve damage after getting recurrent pins and needles in my right hand whenever I turned my head. Turns out the symptoms were due to the AS. Now whenever I get pain anywhere I attribute it to AS.

    Anyway. Generally positive. Hope that info's helpful to someone.



  • mjplayfulmmjplayful Posts: 1
    edited 01/16/2016 - 3:15 AM
    I wake up with this back pain too but I just chalk it up to sleeping bad. I tend to sleep on my stomach with my arms folded under me mummy style. I figure it's causing my shoulders to relax slumped forward because my back isn't flat. It goes away when I a) get up or, b) I put a pillow under my upper body or c) lay with my arms out above my head.
  • SavageSavage United StatesPosts: 5,427
    Welcome to Spine-Health
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  • "rest.up" and "need to sleep" - 

    im on here because I just woke up with excruciating morning back pain Yet again. I'm sick of not getting sleep because of it. And massaging it doesn't help. I need to get up and get off my back for the pain to go away. I had this same thoracic problem in 2008 for about 3 months and I could only sleep an hour or two at a time. I would just cry and cry. Probably a combination of pain and being sleep deprived.

    my doctors didn't have much to say because I had so many lumbar spine problems as it was, but nothing explained this.  I couldn't even take a deep breath because that inhale stretched every part of my back till It felt liked my rib cage  was Going to break. It hurts to roll to my sides too. I just need to sit up.

     in 2006 I was diagnosed with Ankylosing Spondylitis (AS) because of a combination of recurring Iritis (Uveitis), HLA-B27, and severe Sacrolitis. The rheumatologists (I saw many) ordered an MRI of my lumbar spine every 6mobths for a few years to monitor fusing, but no change was noted so they began to reconsider diagnosis. To date, half have agreed with AS and half have not. The first question they always ask me, though,  is, "how long does your morning stiffness last?"

    the ones who have ruled out AS, especially because I am a woman and it is more common and severe in men, have simply told me I have something in a disease class called sero - negative spondylo arthropathy. I think there is a more modern name for that, actually. I've refused TNF Inhibitors because of my research on them and saw no need without really active and increasing symptoms. 

    Because of of this thread I'm going to make an appointment with a new rheumatologist and present my thoracic pain to see if it's related to my other AS symptoms. I just wish I could find some relief this minute.  I'm really tired.   I'm also going to try changing my diet right away.. 

    Thanks everyone!
  • MariaCMMariaC Melbourne, AustraliaPosts: 1
    Thanks for the valuable information - I too have same symptoms which are so painful that I dream for a good night sleep and to awake refreshed with no pain.
       I recently have commenced gym to strengthen lower back and to start getting some fitness program however it does not help. I also am careful with my diet and have reduced carbs and cheese products which my naturopath has encouraged me to do so. With some informal advice on this webpage I now feel confident to go to the doctor for additional help and tests. I actually thought it was my bed (which is NOT that old or it is supposed to be therapudic bed) NOW I can do something about it without any hestitation that there is a problem.
        Thank you for all your advice.
  • KenehKKeneh SingaporePosts: 1

    I am 28 this year and i am also experiencing upper back pain when i wake up every morning. This pain seems to disappear as the day progresses, but it comes back every morning (it is like an alarm clock telling me its time to wake up -.-). My doctors have diagnosed it as muscle spams and gave medicine to relax the muscle and reduce inflammation. However this does not help. Thanks for sharing your experience anw! 
  • I just woke up with some pretty awful pain, originating somewhere around the thoracic 5-9 vertebrae.  I've been seeing  ortho-spine specialists for the past 10months due to lower back pain, and  have been diagnosed with "adult isthmic spondylolisthesis" - but this morning's pain was definitely not that.  In fact, after a cortisol/cortisone shot in the lower back a couple weeks ago, the lower back hasn't been a major problem.  My upper/middle back has loosened up now (couple of hours since getting out of bed), but it was tough to take a deep breath when I woke up.  

    This morning upper/middle back pain has occurred before but not recently.  This was the first time in a few months, maybe 4-6, I don't recall exactly.  In the past I think i've mostly attributed it to overdoing it at the gym.  I suppose that *could* be a contributing factor to this morning's pain, since I do exercise/train a lot (4-6 times per week, weights, running, cardio), but I don't think yesterday's routine was special in anyway, in fact, it was probably a little lighter than normal.  The more curious factor seems to be diet and timing.  One deviation from the norm is that I at a lot of bread last night and did so later than normal. I don't know if my normal diet would qualify as a fully fledged "paleo", but I normally do avoid breads, cereals, pastas, or other refined carbs. Last night however, I had an insatiable hankering for PB&J's, and I ate a few about 1 hour before laying down to sleep.  

    Add to the mix - I've also been diagnosed with ulcerative colitis. The initial UC diagnosis was from a rather severe episode that occurred almost 6 years ago. I haven't had any major flare-ups until a couple of months ago.  I met with a gastro about 3 weeks ago, and resumed medication (mesalamine and omeprazole) that seems to have alleviated the flare-up's symptoms, and for the most part, my stomach has been feeling better/normal again for the last 2-3 weeks.

    With all of this in mind, I'm wondering about the potential links b/t the following:
    1 - high/excessive carbohydrate intake
    2 - late night eating, soon before bed
    3 - history of ulcerative colitis
    4 - end result = subsequent morning back pain in 
    upper/middle of the  (epicenter somewhere b/t thoracic vertebrae 5-9)

    I've had this morning upper/middle back pain before, but it's hasn't been consistent. I *think* that past occurrences might also have correlated with late night eating, but I'm not 100% sure, since my lower back has been center stage.  This time around, however, the lower back didn't seem to be a problem at all.  That's probably because of the cortisol shot a couple of weeks ago, which does seem to have helped that region of the back some.  Then again, i suppose the more severe upper/middle back pain might be completely masking the lower.  Anyway...

    Any suggestions on where/whom to go to for identifying/clarifying/isolating the causes behind the morning upper/middle back pain?  Orthopedist or Gastroenterologist or some other specialist that overlaps the 2?  I have been trying to inform both specialists of all my issues, but I wonder if there is another that I should also try?   I could certainly continue my own nightly PB&J experiments, but I'm hoping there might be a slightly more advanced approach.

  • cocuccocu ItalyPosts: 1
    There is a condition called Enteropathic Arthritis, similar to Ankylosing Spondylitis, that may affect people who have any form of IBD (inflammatory bowel disease). I have got a microscopic colitis and have been diagonosed with sacroiliitis compatible with  Enteropathic spondyloarthritis. Apart from my symptoms in the sacrum, I also suffer from severe upperback pain that gets worse during sleep. As some other people in this forum, the pain tends to get slightly better during the day but at night things get worse and worse. I also spend most nights on the sofa, it seems to be softer and appears to get the shape of my body more easily compared to my bed. I have changed so many mattresses with no success. My rheumatologist says the inflammation is confined to the sacroiliac joints and that there is no sign of it in the upper back. So they suppose it could be a mechanical problem. So I have tried physio, stretching and so on for a long time, with no improvement. I am kind of desperate. I am taking TNF-alpha inhibitors, to control the inflamation, but with no pain relief whatsoever. My point is: why do I feel better on the sofa? Why most beds aren't good for me? Should I carry on looking for the ideal bed? Probably I should get a very soft mattress. Most of the "good mattresses" aren't soft at all.
    I would like to thank everybody for sharing their experiences. For a long while I felt like I was the only one in the world who was experiencing this condition. No doctor has a clue of what to do for me. My dream? A full resting night of sleep, possibly free of pain. Nothing more than this. Will this happen?
  • I have same issue 2 am. I am up on here hoping for an idea how to stop the pain. I look at the bed and dread  sleep. I know when I get up in got start the trying to catch the pain all over again. 2 different doc 2 different diagnosis. 1 doc say I won't walk when I am 50. Other says it posture. So I got a little mad hired a personal trainer. She had me do a cable deadlift. Next day I felt better. The next day after I hurt bad. I started deadlift a lot right before bed. And stretching a lot. My pain still bad, but somedays i can catch the pain on a lower dose of meds. Plus I am so exhausted I can get a few hours sleep. 
  • JuleseJJulese Philly suburbsPosts: 3
    I was diagnoses with scoliosis and spondylolisthesis after falling during an earthquake and fracturing L5 leading to a fusion L3-S1 in 1990. I was a nurse until this happened. I eventually became a healthcare consultant and was a road-warrior for 19 years. After spending many long hours working on a laptop I realized this was the leading cause of my upper back pain. Our necks are not meant to support a 9 pound ball (head) in one position for long periods. Things improved when I began to stretch every 20 minutes and even better now that I'm retired. But when I do anything with my arms & upper back (cooking, baking, etc.) my pain returns. I've been using a TENS device with pretty good results and it helps me sleep too. I'm going through the motions to determine if an intrathecial pump will be effective for my pain vs. SCS. Once I get that feedback from medical professionals I'll post it.
  • Friends, Have you supposed the possibility of lack D vitamin? I've already read something about it, but not completely.
  • Hi Spine suffers, I too have AS, and 22 degree scoliosis, bending get toward the right.  I have a  shorter right leg as a result of femur fracture at age 15, 50 years ago.  I am 65 years old and have suffered for many years.  Stiffness, clicking cracking throughout the spinentire every DAY!!!  I finally started to seek professional help about 5 years ago. 

    The shorter leg is direct result of the fractured femur , where I recently learned that bones have "growth plates".  The growth plate was fractured as well, thus the left leg continued to grow and the right leg was healing.  At age 15 for a male teenager, you grow like weeds.  I had no immediate affect except for walking with limp especially if I tired.  After 15 years of this experience, standing or slow walking started to contribute to lumbar pain and stiffness.  Strolling with my wife - that slow walk while shopping was killing get me.  Saw a chiropractor for the first time at age 35, 20 years after the event.  As soon as I walked into his office, at first glance without any x-rays taken, he said: your hip is lower on the right, totally out of alignment, and you have problems and will many more down the line.  Boy oh boy was he right.  

    At that point, I added a small insufficient lift to my right shoe.  It was perhaps 3/8 inch rubber lift to dress shoes.  That helped to limit the limp, but it was old not correct anything.  The chiropractor said the correction should be done subtlety,  because like a crooked beam in a house, as you look to correct that bend, all the other walls could crack.  Over the next 30 years, the walls started to "crack".  I have cervical, thoracic and lumbar disk issues, most seriously AS , and scoliosis , all contributing to many health issues.  My wife is sick of hearing about it,  me too!,  

    Here's what I've done in the past 5 or 6 years.  I now have all my shoes corrected to about 7/8 inch height adjusted on the right shoe, I see a Spinal Pain Management physician, he diagnosed the AS.  I went to a new chiropractor for about 14 months 3x a week for 6 more ths, then 2x a week for 8 months.  It helped to a point.  PT on and off for 6 to 8 week periods.  Now I do PT prescribed stretches at least 5 days a week.  I also take supplements like Joint compounds, tumeric, boswellia, bromelain,  on and off probiotics.  But, I wake each day with pain and stiffness with multi-joint (fingers, ankles, knees, and of course all up and down my spine), cracking.  I have been told there is no surgery, only pain management.  The doctor doesn't believe in supplements, but I find they help.  No cures, but helps.  If it becomes especially bad, I take advil  on a limited do basis.  

    I'll leave with this,  posture correction, sitting correctly, stretches all help in the management of the condition.  Oh yeah I wear a weight lifting belt on occasion,  and started working out with weights , 20 years ago.  
  • SavageSavage United StatesPosts: 5,427
    Hello diegoverly !
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  • For the last 6 months I have been waking to sever back back both middle and lower it started off waking me up at around 5am and I couldn't stay in bed once it woke me up once I am up it is fine although as time goes on the pain goes on a bit more into the day but I don't really notie that, the pain isnt getting better or worse but I am waking up earlier and earlier and now t's waking me as early as 1.30am and it's really starting to get to me, One week I think it is getting better then the next I am back to square one the only time in 6 months that I had a good night sleep was when I was on holiday in Tahiti, the Chiro and Physio are stumped as to what it is but the Chiro said it could possibly be from subconscious stress, Am thinking of trying an oseopath or kinesioligist, has anyone tried them for this pain? 
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