Chest and Back Pain

What is chest and back pain?

Chest pain can radiate to your back, and back pain can radiate to your chest. It’s common to have pain in your chest and back together because the nerves that communicate back and chest pain run so close together. Sometimes the signals get crossed in your brain. Healthcare providers call this referred pain.

It can be hard to tell where pain in your upper body started from because of the way it can move and spread. To make things more complicated, upper abdominal pain may also radiate to your chest or upper back. There are many possible causes to consider when you have upper back and chest pain.

Healthcare providers will try to narrow down the source of your pain by asking questions about it, like:

• Is it on the left side or right side?
• Did it start in one place and then move or spread to another?
• Is it constant or does it come and go?
• Do you feel it more when you move, breathe or cough?
• What does it feel like? Is it dull, sharp, throbbing or tearing?
• Do you have any other symptoms?

Why do my chest and back hurt?

Many different conditions can cause chest and back pain, some more serious than others. Healthcare providers will often start by considering the vital organs in your chest cavity — your heart and lungs. Issues with your heart or lungs are among the most serious possible causes of chest and back pain.

Heart conditions

Pain in your heart can radiate through your chest and back. The most common type of pain related to heart disease is called angina. It happens when your heart muscle isn’t getting enough blood flow (myocardial ischemia). Angina is a kind of chronic pain that comes and goes and may worsen over time.

Angina

Angina can feel like:

• Tightness or squeezing in your chest.
• Heavy, crushing pressure in your chest.
• Uncomfortable fullness with a burning quality, like indigestion.
• Pain that moves or spreads from your chest to other parts of your upper body.

Angina pain may spread from your chest to your:

• Back.
• Belly.
• Neck.
• Jaw.
• Shoulders.
• Arms.

Other symptoms besides pain might include:

• Shortness of breath.
• Sweating.
• Nausea.
• Dizziness.
• Fatigue.
• Anxiety.

Angina can be a precursor to a heart attack. A heart attack is essentially a severe episode of angina. It happens when blood flow to your heart stops for long enough to damage your heart muscle. The symptoms of both conditions are the same. If you experience these symptoms, seek immediate medical care.

Pericarditis

Infection or inflammation of the protective sac around your heart (your pericardium) can cause a different type of chest pain. This condition is called pericarditis. It usually develops suddenly and lasts a few weeks to months. Occasionally, it lasts longer, or it comes back after going away the first time.

Pericarditis might feel:

• Dull and sore sometimes, sharp and stabbing at other times.
• Worse when you cough, swallow, breathe deeply or lie down.
• Better when you sit up and lean forward.
• Like your heart is beating harder or irregularly.

The pain might spread from your chest to your:

• Back.
• Neck.
• Shoulders.
• Belly.

Other symptoms might include:

• Fever and chills.
• Trouble breathing when you’re lying down.
• Joint pain.
• Swelling in your legs and feet.

Pericarditis is usually a temporary condition related to a passing viral infection. But occasionally, when it’s more severe, it can lead to serious complications. It’s always best to see a healthcare provider about pain that feels like it involves your heart, or pain that matches the description of angina or pericarditis.

Lung conditions

Your lungs are in the back of your chest cavity, just in front of your spine. Pain in and around your lungs can involve your chest and back. The most common causes are infections, like pneumonia and bronchitis. Infections cause inflammation of the lining of your lungs, and sometimes, a build-up of fluid.

Chest infections

Pain related to chest infections can feel:

• Sharp and stabbing.
• Tight and constricting.
• Worse when you breathe or cough.
• Worse when you lie in bed longer.

It can spread from your chest to your:

• Back.
• Shoulders.

Other symptoms might include:

• Dry cough.
• Wet cough.
• Coughing up blood.
• Shortness of breath.
• Fever.
• Fatigue.

A cough is a strong clue that you have an infection. If it’s severe enough to cause chest and back pain, it’s worth a call to your healthcare provider. You might need antibiotics to prevent it from worsening. If you don’t have a cough, you could have inflammation in your lungs for another, more serious reason.

Pulmonary embolism (PE)

A pulmonary embolism (PE) is a blood clot in your lungs. This is another relatively common and serious cause of chest and back pain. A pulmonary embolism restricts the blood flow to your lungs and increases the blood pressure in your pulmonary arteries. It suddenly or gradually reduces the oxygen in your lungs.

Pulmonary embolism feels like:

• Sudden or gradually increasing shortness of breath.
• Sharp, stabbing chest pains, especially when you breathe in.
• Unexplained pain in your back, shoulders, arms, neck or jaw.
• Pain that worsens with exercise or stress.

PE can be fatal. If you have symptoms of a pulmonary embolism, seek immediate medical attention. 

Musculoskeletal conditions

Pain in your musculoskeletal system — your muscles, bones and joints — can sometimes extend from your chest to your back, or vice versa. An injury in your chest wall or back can cause muscle tension and spasms throughout the area. A compressed nerve can cause pain to spread along nerve pathways.

Possible causes of musculoskeletal pain in your chest and back include:

• Muscle strains. A traumatic injury or repetitive strain injury can tear muscle fibers in your chest wall or back. Neighboring muscles may spasm or may work harder to compensate for the injury.
• Rib fractures. A traumatic injury or repetitive stress can cause a rib fracture, which is very painful. Your ribs wrap around from your back to your chest, and pain can radiate throughout.
• Joint pain. Rheumatic diseases, like arthritis, cause chronic inflammation in your joints. Pain in the joints that connect your ribs to your spine can spread through your chest and back.
• Nerve compression syndromes. A herniated disk or bone spur in your thoracic spine might compress a nerve, causing pain to radiate. A displaced (subluxated) joint can do the same.
• Myofascial pain. Myofascial pain syndrome is chronic inflammation in your muscles and fascia (the connective tissue around your muscles). It causes achy pain in one area of your body.
• Fibromyalgia. Fibromyalgia is another chronic pain condition that affects your muscles, usually in a wide area. It commonly starts in your upper back and may spread to your chest from there.

Musculoskeletal conditions are usually not an emergency, but they still need care. If you have an injury, even one you weren’t aware of, it will need time and rest to heal. If you have a chronic pain syndrome, you might need to see a specialist, like a rheumatologist or orthopaedist, to diagnose and treat it.

Biliary pain

Your biliary system is the network of organs that pass bile and other digestive juices through your bile ducts. Most of these organs are in your upper abdomen, and mostly on the right side. Biliary pain will often radiate to your right ribcage, shoulder blade and back. Gallstones are the most common cause.

A gallstone that blocks one of your bile ducts or your pancreatic duct will cause inflammation and pain in your biliary system. The most common symptom is biliary colic, a pattern of pain that occurs in episodes, often after eating. It builds to a peak and then subsides. It’s intense and often accompanied by nausea.

Biliary pain may be more constant if it’s coming from one of your organs, like:

• Pancreatitis (pancreas inflammation).
• Cholangitis (bile duct inflammation).
• Cholecystitis (gallbladder inflammation).
• Hepatitis (liver inflammation).

Biliary pain is serious. If you experience an episode of biliary colic, even though it might go away, you still need treatment. Biliary colic will keep coming back until the blockage in your biliary system is removed. It’s also likely to get worse. If you develop a complete blockage, it will become an emergency.

How do you relieve chest and back pain?

You’ll need a healthcare provider to diagnose the cause of your chest and back pain and recommend the right treatment. Some of the possible causes of back and chest pain are emergencies that might need critical care. Other causes, like musculoskeletal conditions, might just need painkillers and time to heal.

When should I go to the ER for chest and back pain?

Head to the ER if your back and chest pain:

• Is severe and you don’t know the cause.
• Starts after an injury.
• Feels tight and squeezing or heavy and crushing.
• Is accompanied by shortness of breath.
• Is accompanied by nausea or sweating.
• Is accompanied by fever and coughing up blood.