Back pain on its own does not cause chills, but the combination of back pain and chills together is a well-recognized clinical signal that something more than a muscle strain may be going on. In most cases, the link between the two symptoms is an infection or inflammatory process affecting the spine, kidneys, or nearby structures. That pairing deserves attention because some of the conditions behind it, particularly spinal infections, can deteriorate quickly if missed.
Why These Two Symptoms Show Up Together
Chills are your body’s response to a rising internal temperature. When an infection triggers a fever, your brain resets your thermostat upward, and the shivering and chill sensations are the body’s way of generating heat to match the new set point. Back pain enters the picture when the source of infection or inflammation happens to involve the spine itself, or sits in an organ that refers pain to the back. So it is not that back pain “causes” chills in any direct sense. Instead, a single underlying process produces both symptoms at the same time.
The most common culprits fall into a few categories: infections within or around the spinal column, infections in organs whose pain pathways overlap with the back, and systemic inflammatory diseases that involve the spine. Each has a different level of urgency, and the distinction matters for how quickly you need to be evaluated.
Spinal Infections
Among the most serious conditions that produce both back pain and chills are infections directly involving the spine. A spinal epidural abscess is a collection of pus that forms in the space surrounding the spinal cord. The classic presentation includes back pain, fever, and progressive neurological problems such as weakness or numbness in the limbs.1PubMed Central. Spinal epidural abscess: common symptoms of an emergency condition. A case report Chills and rigors often accompany the fever. This condition can progress from pain to paralysis within hours or days if the abscess compresses the spinal cord, making it a genuine emergency.
A related infection, spondylodiscitis, involves the vertebral bones and the discs between them. Bacteria or fungi settle in the vertebral body, usually after traveling through the bloodstream from another infection site. The pain tends to be constant, worsening over days to weeks, and the accompanying fever and chills can be intermittent rather than dramatic. One documented case involved a patient who developed progressive back pain and bilateral leg weakness after a spinal injection, ultimately diagnosed with fungal spondylodiscitis and osteomyelitis with spread into the surrounding muscle.2PubMed Central. Candida Spondylodiscitis After Transforaminal Epidural Steroid Injection: A Case Report The slow onset is what makes vertebral infections tricky. Unlike a broken bone or a herniated disc, where the pain is immediate, these infections build gradually, and people often attribute the worsening back pain to a pulled muscle until the fever and chills make it clear something else is happening.
Kidney Infections and Other Organ Sources
The kidneys sit against the back wall of your abdomen, tucked just below the lower ribs. When a kidney infection develops, the pain is typically felt in the flank, the area between the lower ribs and the hip on one side, and it can easily be mistaken for a back problem. Fever, chills, nausea, and painful urination usually accompany the flank pain, but the urinary symptoms are not always obvious, especially early on. A kidney infection that goes untreated can spread to the bloodstream, so the combination of back or flank pain with chills warrants a urine test at minimum.
Other abdominal organs can refer pain to the back as well. A severe pancreatic infection, for instance, produces deep, boring pain that often wraps around to the mid-back. Abscesses that form behind the abdominal cavity after surgery or as a complication of another infection also cause back pain alongside systemic signs like fever and chills. In all these scenarios, the back pain is not coming from the spine at all. It is the brain misinterpreting where the pain signal originates because internal organs and back muscles share overlapping nerve pathways.
Inflammatory Conditions That Mimic Infection
Not every case of back pain with chills points to an infection. Certain autoimmune and inflammatory diseases affecting the spine can produce fever and chills without any bacteria or virus being involved. Ankylosing spondylitis, a chronic inflammatory condition that targets the joints of the spine and pelvis, occasionally presents with unexplained fevers. One case report described a young man who experienced intermittent fevers, significant weight loss, muscle pain, and joint pain for a full year before clinicians identified inflammation of the sacroiliac joints consistent with ankylosing spondylitis, along with inflammation of the aorta.3PubMed Central. A case of ankylosing spondylitis presenting with fever of unknown origin diagnosed as aortitis: A case report
The key difference between inflammatory and infectious causes is the tempo. Infections tend to escalate over days to a couple of weeks, with the chills feeling like clear illness. Inflammatory conditions more often produce low-grade fevers and intermittent chills that come and go over months, blending in with fatigue and general malaise. That subtlety means inflammatory spinal diseases often go undiagnosed for a long time, as clinicians initially look for and rule out infections.
Reactive arthritis and psoriatic arthritis can also involve the spine and produce systemic symptoms including fevers, though these are less common than ankylosing spondylitis in this context. If you have persistent back stiffness that improves with movement rather than rest, especially if it wakes you at night, and you’ve had low-grade fevers or chills on and off, mention all of those details to your doctor. The combination points away from a simple mechanical problem.
Can Severe Pain Itself Trigger Chills
This is the question most people are really asking when they search for the connection between back pain and chills: can the pain alone make you feel chilled? The honest answer is that intense pain can trigger autonomic nervous system responses that feel like chills, even without a fever. When pain is severe, your body mounts a stress response that includes changes in heart rate, blood pressure, sweating, and skin blood flow. Vasoconstriction, the narrowing of blood vessels near the skin, can make you feel cold and shivery even though your core temperature hasn’t changed.
Research on nerve-related pain adds another layer. In animal models of disc herniation, exposure of nerve tissue to disc material triggered heightened sensitivity not just to pressure and heat but also to cold, a phenomenon called cold allodynia.4Global Spine Journal. Experimental Noncompressive Disc Herniation Neuropathy Elicits Sustained Peripheral Hypersensitivity to Subthreshold Stimuli Mediated by Heightened TRPV1 Receptor Activity Cold allodynia means that mildly cool temperatures, ones that wouldn’t normally register, start feeling uncomfortably cold or even painful. If something similar happens in a person with an inflamed disc pressing on a nerve root, it could explain why some people with acute sciatica or radiculopathy report feeling chilled in the affected limb or more generally. This is not the same as infection-related chills, but it can be hard to tell the difference from the inside.
Spinal cord injuries provide an even more striking example. People with high-level spinal cord injuries lose the autonomic pathways that regulate body temperature below the level of the injury, leaving them vulnerable to swings in body temperature even in mild environments.5PubMed Central. Thermodysregulation in persons with spinal cord injury: case series on use of the autonomic standards While this is an extreme scenario far removed from typical back pain, it illustrates how deeply the spine is involved in temperature regulation. Disruptions in spinal nerve signaling, even less severe ones, can plausibly interfere with how warm or cold your body feels.
Who Faces Higher Risk of Spinal Infections
Spinal infections are uncommon in the general population, but certain groups face a meaningfully elevated risk. People who inject drugs are disproportionately affected. One prospective study found that half of patients treated for primary spinal infections were intravenous drug users, with a mean age of 43. Many had co-existing infections: hepatitis C was present in the majority, nearly half had HIV, and patients were often using multiple substances.6PubMed. Primary pyogenic infection of the spine in intravenous drug users: a prospective observational study The route of entry is typically a skin break from injection, which allows bacteria to enter the bloodstream and seed in the spine’s rich blood supply.
A separate analysis found that people who use drugs and develop spinal epidural infections tend to be younger, averaging 48 years old, compared to 64 for patients without a drug use history. They also had higher rates of drug-resistant bacteria, specifically methicillin-resistant Staphylococcus aureus, which was found in about a third of cases among people who use drugs versus roughly one in eight among other patients.7PubMed Central. Microbes Causing Spinal Epidural Infection in Patients Who Use Drugs Drug-resistant infections are harder to treat and may require longer courses of intravenous antibiotics, which underscores why early detection matters.
Beyond injection drug use, other risk factors for spinal infections include diabetes, immunosuppression from medications or illness, recent spinal surgery or injections, and advanced age. People on dialysis and those with indwelling catheters are also at increased risk. If you fall into any of these groups and develop new or worsening back pain accompanied by fever or chills, the threshold for seeking evaluation should be lower than for someone without those risk factors.
Infections After Spinal Procedures
Spinal injections and surgeries are common and generally safe, but any procedure that breaks the skin near the spine introduces a small risk of infection. Epidural steroid injections, widely used for disc-related pain and sciatica, occasionally serve as the entry point for bacteria or fungi. In one documented case, a patient developed Candida spondylodiscitis at the L1-L2 vertebral level after a transforaminal epidural steroid injection, presenting with worsening back pain and leg weakness over a period of weeks.2PubMed Central. Candida Spondylodiscitis After Transforaminal Epidural Steroid Injection: A Case Report The patient initially received antibiotics at an emergency department without improvement, and the correct diagnosis was not made until more than two months after the injection.
Fungal spinal infections are rarer than bacterial ones but tend to be more insidious. They progress slowly, so the connection between a procedure weeks or months earlier and worsening symptoms is easy to miss. If you’ve had a spinal injection or surgery in the past few months and notice back pain that is progressively getting worse rather than better, especially if accompanied by chills, low-grade fever, or night sweats, bring up the procedural history to your doctor. It changes the diagnostic workup considerably.
When Back Pain and Chills Demand Urgent Evaluation
Most back pain is mechanical and resolves on its own. Adding chills to the picture changes the calculation. Clinicians use “red flags” to identify which patients with back pain need urgent investigation rather than the usual wait-and-see approach.8PubMed Central. Red flags of low back pain The combination of back pain with fever or chills is itself a red flag, but certain additional features raise the urgency further:
- Neurological changes: New weakness, numbness, or tingling in a leg or foot, difficulty walking, or loss of bladder or bowel control. These suggest the spinal cord or nerve roots may be compressed and require imaging within hours, not days.
- High fever with rigors: Shaking chills with a temperature above 101°F (38.3°C) alongside back pain. This pattern points to bacteremia, meaning bacteria are circulating in the bloodstream, and can progress to sepsis.
- Recent procedure or injection: Any spinal injection or surgery in the preceding weeks to months, as discussed above.
- Immunocompromised state: Active cancer treatment, organ transplant medications, uncontrolled diabetes, or HIV raise the probability that back pain with chills reflects infection.
- IV drug use: Even if the back pain seems routine, the combination with chills in someone who injects drugs should prompt evaluation for spinal epidural abscess or vertebral osteomyelitis.
- Pain that worsens at rest: Mechanical back pain usually eases when you lie down. Infection-related back pain often worsens at night or at rest, and may wake you from sleep.
If none of these apply, the more likely explanation is something benign. A viral illness, for example, can cause body aches that concentrate in the back along with chills and low-grade fever, and it resolves on its own. The flu, COVID-19, and other systemic viruses are among the most common reasons people experience back pain and chills simultaneously. In these cases the back pain is a symptom of the infection rather than a sign that the spine itself is affected.
Sepsis and the Systemic Escalation
The worst-case scenario when infection is the underlying cause is progression to sepsis, the body’s overwhelming and life-threatening response to infection. In sepsis, the infection has spread beyond its original site, and the immune response itself starts damaging organs. Chills in this context are often dramatic, with uncontrollable shaking, and they may be accompanied by confusion, rapid breathing, a racing heart, and mottled or cool skin. Some patients develop hypothermia rather than fever, which is actually a more ominous sign. A study of septic shock patients found that those who presented with hypothermia had distinct clinical profiles, including differences in hemoglobin and heart rate, compared to those with typical fever presentations.9PubMed Central. Clinical characteristics associated with septic shock complicating hypothermia: a retrospective cohort study from the MIMIC-IV database
This matters because the popular understanding of infection is “fever equals sick.” In reality, a person with back pain who feels cold, has low body temperature, and looks unwell may be in a more dangerous position than someone with a high fever. If someone around you has back pain with chills but feels cold to the touch, seems confused, or has a low rather than high temperature, treat it as an emergency.
Sorting Through the Noise at Home
A practical challenge for most people is figuring out whether their combination of back pain and chills is cause for concern or just the overlap of a strained back and a mild cold. A few questions can help you sort through it. First, is the back pain new or different from your usual aches? Chronic back pain that feels the same as always is less concerning even if you happen to have chills from an unrelated virus. Second, is the pain getting worse over days rather than better? Mechanical pain usually peaks early and gradually improves. Infection-related pain tends to progress. Third, have you had any fever, even low-grade? If you own a thermometer, use it. The presence or absence of objective fever helps clinicians immensely. Fourth, do you have any of the risk factors or red flags listed above?
If the answer to those questions is mostly “no,” you are likely dealing with a coincidence of two common problems rather than a single dangerous one. Rest, over-the-counter pain relief, and time usually resolve it. But if the pain is worsening, you have a definite fever, or any neurological symptoms are appearing, err on the side of getting evaluated sooner. Spinal infections are uncommon but unforgiving when they are missed. The window for preventing permanent nerve damage can be narrow, and a few hours of “wait and see” in the wrong scenario can make a real difference in outcomes.