Pain felt between the shoulder blades upon swallowing is known as odynophagia. This discomfort is an example of referred pain, occurring because the esophagus and the upper back share nerve pathways. Sensory nerves from the esophagus converge with nerves from the upper back at the spinal cord level. When the esophagus is irritated or contracts abnormally, the brain misinterprets the signal as originating from the back. This neural crossover explains why a problem in the chest can feel like an ache in the shoulder blade area.
Common Gastroesophageal Causes
The most frequent source of this type of pain originates from the esophagus itself, often involving issues with either acid exposure or muscle function. A common and intensely painful cause is the presence of esophageal spasms, which are uncoordinated or overly forceful contractions of the muscle lining the esophagus. These spasms can be so powerful that they mimic the chest pain of a heart attack, often causing a severe, squeezing sensation that radiates directly into the back. In some cases, these contractions are consistently strong, a condition known as “jackhammer esophagus.”
Gastroesophageal Reflux Disease (GERD) is another frequent culprit, where stomach acid flows back up into the esophagus, leading to irritation and inflammation called esophagitis. This acid-induced inflammation activates the shared nerve pathways, causing the familiar burning sensation to be felt as back pain between the shoulder blades.
A specific type of localized inflammation is known as pill esophagitis, which results from certain medications lodging in the esophagus and dissolving there. Drugs like some antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), or bisphosphonates can cause ulcers or erosions in the lining. The resulting tissue damage and inflammation create a localized source of pain that is then transmitted as referred pain to the posterior chest wall. This irritation is directly linked to the act of swallowing, as the pill transit initiates the inflammatory process.
Less Frequent and Urgent Considerations
While most causes are esophageal, structural or systemic issues may present with similar symptoms, some of which require urgent attention. Structural problems within the esophagus, such as a stricture or a Schatzki ring, can cause severe pain and difficulty in swallowing (dysphagia). These narrowed areas impede the passage of food, causing it to become temporarily stuck, which leads to painful stretching of the esophageal wall.
Infectious esophagitis is a less common cause, typically occurring in individuals with weakened immune systems due to conditions like HIV or organ transplantation. This involves infections from organisms such as Candida (thrush), Herpes simplex virus, or Cytomegalovirus, which create painful sores and inflammation in the esophageal tissue. The pain from these infections is often intense and can easily be referred to the back during swallowing.
The most serious consideration is cardiac pain, as heart issues frequently refer pain to the back, shoulder, or jaw. Conditions like a heart attack or pericarditis (inflammation of the sac around the heart) can present with chest pain that radiates to the shoulder blade area. Any sudden, severe chest pressure accompanied by shortness of breath, sweating, or light-headedness requires immediate medical attention to rule out a cardiac event.
Medical Investigation and Diagnosis
Investigating the cause of swallowing-related back pain begins with a detailed patient history, where a doctor will ask about the pain’s nature, triggers, and associated symptoms. This initial evaluation helps distinguish between muscle-related, acid-related, and potentially cardiac causes. The diagnostic process then moves to specialized tests designed to examine the esophagus and its function.
A common procedure is an Upper Endoscopy (EGD), where a flexible tube with a camera is passed down the throat to visually inspect the lining of the esophagus, stomach, and duodenum. This allows the physician to identify signs of esophagitis, ulcers, strictures, or take tissue samples (biopsies) to check for infection or other diseases. The visual evidence gathered during an EGD is often the most direct way to confirm acid damage or structural abnormalities.
To evaluate the mechanical function of the esophagus, specialized tests are used. An Esophageal Manometry involves passing a thin tube to measure the strength and coordination of muscle contractions when the patient swallows water. This test is the primary tool for diagnosing motility disorders like esophageal spasms. A Barium Swallow, or esophagram, involves the patient drinking a contrast liquid while X-rays are taken. This procedure clearly outlines the shape of the esophagus to reveal strictures, rings, or abnormal muscle movement.
Relief and Management Options
Treatment for the pain depends entirely on the underlying diagnosis. For pain caused by GERD, management involves lifestyle changes and medications aimed at reducing stomach acid production. Proton pump inhibitors (PPIs) and H2 blockers are commonly prescribed to decrease acid, allowing the inflamed esophageal lining to heal.
Lifestyle modifications also play a significant role in GERD management, including avoiding trigger foods, eating smaller meals, and elevating the head of the bed to prevent nighttime reflux. When the pain is caused by esophageal spasms, the focus shifts to relaxing the hyperactive smooth muscles. Medications such as calcium channel blockers or nitrates are used for their ability to relax smooth muscle tissue.
In cases of severe spasms that do not respond to medication, specialized procedures may be considered, such as the injection of botulinum toxin (Botox) into the esophageal muscles. For structural issues like strictures, an endoscopic dilation procedure may be performed. This involves using a balloon or dilator to gently stretch the narrowed area, allowing food to pass more easily.