Gastroesophageal reflux disease (GERD), or acid reflux, occurs when stomach acid frequently flows back into the esophagus. This happens because the lower esophageal sphincter, a muscle at the bottom of the esophagus, weakens or relaxes inappropriately, allowing stomach contents to escape. While heartburn is the classic symptom, acid reflux can manifest in less obvious ways, including referred pain felt in the back.
The Reflux-Back Pain Connection
Acid reflux can lead to back pain through several physiological mechanisms. Referred pain is one primary reason, where internal discomfort is felt elsewhere. The esophagus and back share nerve connections, especially through the vagus and spinal nerves. Irritated esophageal lining sends pain signals to spinal nerves, leading to discomfort perceived in the upper or middle back.
Chronic acid exposure can also irritate the diaphragm. The diaphragm shares nerve pathways with parts of the back, and when irritated by persistent reflux, discomfort can extend to the back. This irritation can also contribute to muscular tension and postural strain.
Esophageal spasms, uncoordinated muscle contractions, are another way reflux can cause back pain. These spasms may cause chest pain that radiates to the neck, arm, or back. Often, the pain is felt between the shoulder blades. Additionally, chronic inflammation from ongoing acid exposure in the esophagus can contribute to generalized discomfort or pain, which may extend to the back.
Distinguishing Reflux-Related Back Pain
Reflux-related back pain is identified by its association with other typical reflux symptoms. This type of back pain is frequently accompanied by classic signs such as heartburn, regurgitation, or a sour taste in the mouth. Other accompanying symptoms might include difficulty swallowing, a chronic cough, or hoarseness.
The timing and triggers of the back pain also offer clues. Reflux-related back pain often worsens after eating, especially large meals, or after consuming specific trigger foods such as spicy, fatty foods, caffeine, or alcohol. The pain might also intensify when lying down, bending over, or at night, as gravity no longer helps keep stomach acid in place.
Back pain is typically in the upper or mid-back, often felt between the shoulder blades. While acid reflux can sometimes contribute to lower back pain, upper and mid-back discomfort is more common. Temporary improvement after antacids or reflux medications suggests a connection to acid reflux. If these characteristics are absent, or if the pain is persistent without other reflux symptoms, other causes of back pain require professional evaluation.
Managing Reflux and Alleviating Back Pain
Managing acid reflux and associated back pain involves lifestyle adjustments and medication. Dietary changes are a common starting point, including identifying and avoiding trigger foods like spicy dishes, citrus fruits, chocolate, caffeine, and fatty or fried foods. Eating smaller, more frequent meals instead of a few large ones can reduce pressure on the lower esophageal sphincter, minimizing reflux episodes.
Lifestyle Modifications
Lifestyle modifications can provide relief. Avoiding eating within two to three hours before lying down allows the stomach to empty, reducing the likelihood of acid backflow. Elevating the head of the bed by 6 to 9 inches can use gravity to prevent nighttime reflux. Maintaining a healthy weight can reduce abdominal pressure that contributes to reflux, and avoiding tight clothing around the waist can help. Quitting smoking and reducing alcohol intake are beneficial, as both can weaken the lower esophageal sphincter and increase stomach acid production.
Medications
Over-the-counter (OTC) medications can help manage reflux symptoms. Antacids provide quick relief by neutralizing stomach acid, but they are generally for occasional use. Histamine-2 blockers (H2 blockers) reduce stomach acid production and offer longer relief than antacids. Proton pump inhibitors (PPIs) are stronger acid reducers that can also help heal esophageal tissue.
Consult a healthcare professional if symptoms are persistent, OTC medications are ineffective, or new/worsening symptoms appear. A doctor can diagnose, rule out other back pain causes, and recommend treatment, including prescription medications.