A pinched nerve in the upper back (thoracic radiculopathy) usually causes burning, sharp or shooting pain that starts beside the spine and wraps around the chest or upper abdomen in a band on one side. Tingling, numbness or skin sensitivity along that band is common. It is less common than a pinched nerve in the neck or lower back. Most cases ease with time and gentle movement over 6 to 12 weeks. Shingles can look identical before its rash appears.
Each of the 12 nerves in the upper and middle back leaves the spine between two vertebrae and runs around the body along a rib. If something narrows the opening or irritates the nerve root, the pain follows the nerve’s path. That is why the pain often feels like a belt or strap rather than a spot.
Common causes include a disc bulge, arthritis or bone spurs narrowing the opening, a stiff and irritated joint nearby, and less often a compression fracture. Diabetes can affect these nerves too, without any pinching.
Key takeaways
- Typical pattern: burning, sharp or shooting pain from beside the spine wrapping around the chest or upper abdomen on one side.
- Other symptoms: tingling, numbness or sensitive skin in the same band.
- Typical course: most cases ease over 6 to 12 weeks with gentle movement and time.
- Shingles mimic: shingles causes the same band of burning pain, often for a few days before a rash appears.
- Organ mimics: heart, lung, gallbladder and kidney problems can cause pain in the same areas and need ruling out when other symptoms are present.
Where are you right now?
- It has just started: check the safety sections near the end first. Watch the skin in the painful band for a rash over the next few days.
- Weeks in and not settling: go to “If it isn’t going to plan” and “Where else this could be coming from”.
- After an injection or surgery: follow your doctor’s or surgeon’s plan. Some nerve pain can continue for weeks after a nerve root injection or spinal surgery while the nerve settles.
- Getting back to work or sport: the “When can I…” table gives typical ranges.
What tends to help
These are the things I’d start with:
- Gentle movement: short walks and easy upper back rotation within comfort, several times a day.
- Position changes: moving every 20 to 30 minutes rather than holding one posture.
- Finding the easy position: many people find lying on the non-painful side, or on the back with a pillow under the knees, eases the band of pain.
- Loose clothing: sensitive skin often tolerates soft, loose layers better than tight waistbands or straps.
- Medicine: your doctor or pharmacist can advise on pain relief. Nerve pain sometimes needs a different medicine from ordinary pain relievers.
Week by week
- Week 1: pain is often at its sharpest, and a cough or sneeze can send a jolt around the ribs. Focus on comfortable positions, short walks and gentle movement.
- Weeks 2 to 4: many people notice the pain becoming less constant, with good and bad days. Gentle upper back mobility is usually built up.
- Weeks 4 to 8: strengthening for the upper back and shoulder blade muscles is added. Tingling or skin sensitivity often lingers after the pain eases.
- Weeks 8 to 12: most people are much improved. Some notice occasional twinges with long sitting or a hard cough.
- Beyond 12 weeks: pain that is still present needs a medical review, if it has not already had one.
Where else this could be coming from
- Shingles (herpes zoster): burning, tingling or itching in a band on one side, then a blistering rash in the same band, usually within 1 to 5 days. Antiviral medicine works best when started early, ideally within about 3 days of the rash appearing. People over 50 and those with weaker immune systems are at higher risk.
- Rib joint irritation: sharp pain beside the spine that catches on a deep breath or a twist, usually without tingling or numbness.
- Pain referred from the neck: a deep ache near the shoulder blade that changes with head movement, sometimes with arm symptoms rather than a band around the chest.
- Muscle strain: an ache along a muscle that is tender to press and changes with movement, without burning or numbness.
- Heart, lungs, gallbladder and kidneys: pain that does not change with spinal movement, especially with breathlessness, sweating, fever, nausea, pain after meals or urinary symptoms.
A band of burning pain around one side of the chest deserves a look at the skin before anything else.
Is this normal?
- My skin hurts when clothes touch it: skin sensitivity along the nerve’s path is common with an irritated nerve and also with shingles. Check the area daily for a rash.
- The pain is at the front of my chest or belly, not my back: the nerve runs all the way around, so pain can be felt mostly at the front. Chest pain with pressure, sweating or breathlessness needs urgent care.
- Coughing sends a jolt around my ribs: common. Coughing briefly raises pressure around the spine and the nerve.
- The numbness is staying after the pain eased: numbness often fades more slowly than pain, sometimes over several months.
If it isn’t going to plan
It is week five. The waistband of your pants still burns along one side, and you have been lying still on the sofa most evenings, waiting for it to calm down. The thought in your head is that a pinched nerve needs to be left alone.
My advice is gentle, regular movement rather than stillness, because an irritated nerve root usually does better with it. Movement keeps the joints around it from stiffening and helps the nerve glide without strain. Long, still periods often leave the area stiffer and more sensitive.
If the pain has not eased by about 6 weeks, or you are unsure of the cause, I’d get it assessed by a doctor or physical therapist. These are the questions I’d ask:
- Could this be shingles, a rib joint or something other than a nerve?
- Is my numbness or strength being checked over time?
- Which movements should I build up, and which should I avoid for now?
- Would imaging or a different medicine change the plan?
When can I…
| Activity | Typical range |
|---|---|
| Sleep on that side | Often after 2 to 4 weeks; the other side or your back is usually easier at first |
| Drive | Once you can turn to check blind spots and are not drowsy from medicine, often 1 to 2 weeks |
| Reach overhead | Usually as comfortable within 2 to 6 weeks |
| Lift | Light loads close to the body within 1 to 2 weeks; heavier lifting often 6 to 12 weeks |
| Desk work | Often within days, with a change of position every 20 to 30 minutes |
| Manual work or sport | Often 6 to 12 weeks, longer for twisting or contact activities |
If you have had surgery, your surgeon’s protocol comes first.
Call your local emergency number or go to the emergency department if
- Spinal cord signs: new weakness, numbness or heaviness in both legs, unsteady walking, or loss of bladder or bowel control.
- Heart signs: chest pressure or tightness, breathlessness, sweating, nausea, or pain spreading to the arm or jaw.
- Sudden severe pain: sudden tearing pain through the back, or sharp pain on breathing with breathlessness.
See a doctor today if
- A rash appears: blisters or a red rash in the painful band, or a rash near the eye or on the forehead.
- Fever: back or rib pain with fever, chills or feeling generally unwell.
- Possible fracture: sudden pain after a minor fall, lift or cough with osteoporosis or long-term steroid use.
Get it checked soon if
- Slow progress: no clear easing after 4 to 6 weeks.
- Spreading numbness: the numb area is growing or new areas are affected.
- Night pain: constant pain at night that no position eases.
- Wider health: unexplained weight loss, diabetes, or a history of cancer.
More on this area: upper and mid back conditions.
A pinched nerve in the upper back usually settles with time and gentle movement, once shingles and other causes are ruled out.
Written and reviewed by Louise Yow, Neck & Shoulder Physio. More about me. These pages explain; they don’t examine you, and your doctor’s or surgeon’s plan comes first.