Acid reflux, also known as gastroesophageal reflux (GER), is a common digestive issue where stomach acid flows back into the esophagus. While the primary symptom is a burning chest sensation called heartburn, the discomfort can sometimes manifest in surprising locations. Acid reflux can cause pain between the shoulder blades, especially when the condition progresses to the chronic form, Gastroesophageal Reflux Disease (GERD). This seemingly unrelated back pain is an example of how a problem in one organ can be mistakenly felt in a distant part of the body.
The Mechanism of Referred Pain
The back pain felt during a reflux episode is not a muscle or bone problem, but rather a phenomenon called referred pain. Referred pain occurs because the nerve pathways carrying signals from internal organs (visceral afferents) share connections in the spinal cord with nerve pathways from the skin and muscles (somatic afferents). The esophagus, the tube connecting the throat to the stomach, is located just in front of the spine in the chest cavity.
When stomach acid irritates the lining of the esophagus, it generates a pain signal that travels to specific segments of the thoracic spinal cord. These segments also receive sensory input from the upper back and the interscapular region (the space between the shoulder blades). Because the brain is more accustomed to receiving pain signals from the somatic structures of the back, it misinterprets the visceral signal from the esophagus as originating from the back muscles.
This convergence of nerve fibers on the same neurons in the spinal cord is the physiological basis for the pain referral. The resulting sensation can be felt anywhere along the upper and middle back, particularly between the shoulder blades. The brain projects the discomfort onto the body surface corresponding to the shared nerve roots, creating a neurological “short-circuit.” This mechanism explains why an issue with an internal organ can feel like a sharp, muscular ache in the back.
Characteristics of Reflux-Related Interscapular Pain
Pain caused by acid reflux in the interscapular region presents with specific qualities that distinguish it from musculoskeletal pain. The discomfort is often described as a generalized burning, a deep ache, or a squeezing pressure. It may also manifest as shooting pains originating from the center of the upper back.
The timing of the pain often correlates directly with activities that trigger acid reflux. The pain frequently appears shortly after consuming a large meal, especially one high in fat or acid, or when lying down soon after eating. Bending over or straining can also precipitate the back pain, as these actions push stomach contents upward toward the esophagus.
The pain may lessen or resolve completely with the use of antacids or medications designed to reduce stomach acid production. If the back discomfort is consistently accompanied by classic reflux symptoms like heartburn, a sour taste in the mouth, or a chronic cough, it suggests a digestive origin. When the pain is episodic and linked to dietary or positional triggers, it is likely a manifestation of GERD.
Alternative Causes of Pain Between the Shoulder Blades
While acid reflux is a possible cause, interscapular pain is common and can stem from many sources. Musculoskeletal causes are the most frequent, often related to poor posture from prolonged sitting or working at a computer. Muscle strain in the rhomboids or trapezius can cause a persistent dull ache. Cervical spine issues, such as a herniated disc or osteoarthritis in the neck, can also irritate nerves that radiate pain into the upper back.
Other conditions cause referred pain to this area, particularly those involving the chest cavity. Pulmonary issues, such as an infection or inflammation of the lining of the lungs, can refer pain to the upper back. Gallbladder disease is another potential source, causing pain in the right upper abdomen that radiates to the right shoulder blade or the central back.
Severe interscapular pain can occasionally be a symptom of a serious cardiac or vascular event. Conditions like a heart attack, especially in women, or an aortic dissection can present with sudden, crushing pain between the shoulder blades. Due to the wide range of potential causes, a medical professional is required to accurately diagnose the source of the discomfort.
When to Seek Urgent Medical Evaluation
While back pain from acid reflux is not an emergency, certain accompanying symptoms are serious warning signs requiring immediate medical attention. Any sudden onset of severe pressure or crushing pain in the chest or upper back must be treated as an emergency, particularly if not relieved by antacids. This is true if the pain radiates into the jaw, neck, or down one or both arms, as these can be signs of a heart attack.
Other red flag symptoms include:
- Shortness of breath
- Unexplained dizziness
- Excessive sweating
- A feeling of lightheadedness
Gastrointestinal symptoms demanding prompt evaluation include difficulty swallowing (dysphagia) and unexplained weight loss. Vomiting blood, or passing dark, tarry stools, indicates active internal bleeding and necessitates immediate emergency care. If the back pain is accompanied by a fever or does not resolve after several weeks of over-the-counter treatment, a comprehensive medical workup is warranted.