Dorsal pain is a common presentation in primary healthcare clinical practice. Compared to lumbar and cervical spine, the thoracic spine has received less attention in terms of clinical, genetic and epidemiologic research, yet pain experienced in the thoracic spine can be equally disabling and imposes similar burdens on the individual, community and work-force. Pain may be referred to the upper thoracic spine from visceral structures and cervical spinal structures or it may arise in the thoracic interspinous ligaments, paravertebral muscles and zygapophyseal joints. Clinicians should be alert to the potential for rare, serious conditions presenting as acute thoracic spinal pain; however, most cases of thoracic pain are of mechanical origin. The patient’s medical history helps to differentiate sources of thoracic spinal pain and to identify the features of potentially serious conditions; however, it carries little diagnostic weight.