Gastroesophageal Reflux Disease (GERD), or acid reflux, is a digestive condition where stomach acid frequently flows back into the esophagus, the tube connecting the mouth and stomach. This backwash happens because the lower esophageal sphincter, a ring of muscle at the bottom of the esophagus, either weakens or relaxes when it should not. This allows harsh stomach contents to irritate the sensitive esophageal lining. While most people associate acid reflux with symptoms like heartburn or regurgitation, the irritation can sometimes manifest as pain between the shoulder blades. This connection between a digestive issue and back discomfort is rooted in how the body’s nervous system processes pain signals from internal organs.
Understanding Referred Pain
The back pain experienced during a reflux episode is an example of referred pain, which occurs when the brain misinterprets the origin of a sensory signal. Internal organs, or viscera, share nerve pathways with certain areas of the skin and muscles, a concept known as viscerosomatic convergence. When the esophagus is inflamed by stomach acid, its pain signals travel along the same nerve routes that carry sensation from the upper back, specifically the area between the shoulder blades.
The irritation can extend to the Vagus nerve, which is the primary sensory pathway for the esophagus. Signals from the irritated esophageal lining travel to the spinal cord, where they converge with nerves that innervate the thoracic region of the back. The brain receives this signal but lacks the precision to pinpoint the exact source within the chest cavity, instead perceiving the pain as originating from the more familiar somatic structures of the upper or middle back. This misinterpretation causes the discomfort to be felt specifically in the interscapular region. Because the pain is not muscular or skeletal in origin, it often feels deep, burning, or squeezing, and is not relieved by movement or stretching.
Identifying Reflux Related Back Pain
Reflux-related back pain has distinctive characteristics that help differentiate it from common musculoskeletal issues. This discomfort is frequently described as a burning or tightening sensation that spreads from the chest or upper stomach and radiates into the upper or middle back. Unlike muscle strain, the pain is often cyclical and directly tied to digestive activity.
A key indicator is the timing of the discomfort, which typically begins shortly after eating, especially following large or fatty meals that trigger acid production. The pain can feel significantly worse when the body is in a position that encourages acid backflow, such as lying flat or bending over. Conversely, sitting upright or taking an antacid may provide some relief, a pattern not typically seen with a strained back muscle.
Furthermore, back pain caused by acid reflux is rarely an isolated symptom. It is usually accompanied by classic GERD symptoms like heartburn, regurgitation (the sensation of liquid or food coming back up), a sour taste in the mouth, or difficulty swallowing. The presence of these simultaneous digestive symptoms strongly suggests the back pain is a referred signal from the irritated esophagus.
Other Sources of Pain Between the Shoulder Blades
While acid reflux can be the source, the area between the shoulder blades is a common site for pain originating from numerous other causes. The most frequent culprits are musculoskeletal issues resulting from daily activities. Poor posture from prolonged sitting, especially at a desk or while looking at a mobile device, can strain the rhomboid muscles located in this area.
Muscle strain can also occur from lifting heavy objects improperly or from repetitive overhead movements, leading to spasms or a dull, persistent ache. Problems with the thoracic spine, such as bulging or herniated discs, can compress nerves and cause pain that is felt between the shoulder blades. This discomfort is often aggravated by specific movements or body positions.
Pain in this specific location can also be referred from other internal organs besides the esophagus. For instance, certain conditions affecting the gallbladder or peptic ulcers can sometimes cause pain to be felt in the upper back. Crucially, sudden, severe pain in the upper back or between the shoulder blades can sometimes signal a medical emergency, such as a heart attack or an aortic dissection. Any back pain accompanied by shortness of breath, dizziness, sweating, or pain radiating to the jaw or arm requires immediate medical attention.
Treating Acid Reflux and Related Symptoms
Effective management of the referred back pain begins with treating the underlying acid reflux. Lifestyle adjustments are generally the first line of defense and can significantly reduce the frequency of acid backflow episodes.
Dietary and Positional Changes
Eating smaller, more frequent meals helps prevent the stomach from becoming overly full and putting pressure on the lower esophageal sphincter. Avoiding known trigger foods is also a foundational step, as items like spicy foods, caffeine, chocolate, fatty foods, and alcohol tend to relax the sphincter muscle or increase acid production. To reduce nighttime symptoms and prevent acid from rising while sleeping, the head of the bed should be elevated by six to eight inches, often achieved using a foam wedge or blocks under the bedposts. Weight management and not lying down for at least three hours after eating are further modifications that decrease abdominal pressure and minimize reflux.
Medications
When lifestyle changes are insufficient, several medications can help manage acid levels. Over-the-counter antacids offer quick, temporary relief by neutralizing existing stomach acid. For more persistent symptoms, medications that reduce acid production, such as H2 blockers and proton pump inhibitors (PPIs), are often used. H2 blockers decrease the amount of acid the stomach produces, while PPIs provide stronger, long-term acid suppression. A healthcare provider should be consulted before starting long-term use of any acid-reducing medication or if back pain persists after treatment.