Mid-back pain is felt in the thoracic spine region (T5 to T12) and is usually caused by muscle strain or spinal issues. However, internal organs in the chest and abdomen share nerve pathways with this area, leading to referred pain. When an organ is irritated, inflamed, or damaged, the brain interprets the signal as coming from the back muscles or skin. Understanding this distinction helps determine if the discomfort is musculoskeletal or a sign of an internal health issue.
Differentiating Organ Pain From Muscle Pain
The characteristics of the pain provide important clues to its origin. Musculoskeletal (somatic) pain typically feels sharp, localized, and changes significantly with movement, posture, or physical activity. This type of pain often eases with rest or specific positional changes.
In contrast, organ-related (visceral) pain is often described as a vague, deep, and dull ache that is difficult to pinpoint precisely. Visceral pain tends to be constant, persisting even when resting, and generally does not change when you move your spine. It is also frequently accompanied by systemic symptoms such as fever, chills, nausea, vomiting, or changes in bowel or urinary habits, suggesting an internal cause for the discomfort.
Referred Pain from Upper Abdominal Organs
Several organs located in the upper abdomen commonly refer pain to the mid-back region. The pancreas, situated behind the stomach, can cause a deep, boring pain across the middle of the back when inflamed, a condition known as pancreatitis. This pain is often felt shortly after eating fatty meals and typically worsens when lying flat on the back. Patients frequently find that leaning forward or sitting up helps alleviate the discomfort.
The gallbladder, located under the liver, can cause referred pain, typically in the right mid-back or beneath the right shoulder blade. This pain is often sharp, sudden, and occurs within an hour after consuming a high-fat meal, frequently due to gallstones blocking bile ducts. Liver inflammation or enlargement can cause a dull ache in the right upper back. Peptic ulcers (sores in the stomach or small intestine lining) can also cause a burning or gnawing pain that radiates through to the mid-back, often between the shoulder blades.
Kidney and Urinary Tract Pain
The kidneys are positioned deep in the abdomen against the back muscles, below the rib cage. Kidney pain, often called flank pain, is typically felt higher and deeper in the back, usually on one side, and does not improve with positional changes or rest. The nature of the pain helps distinguish the specific issue within the urinary tract.
A kidney stone passing through the ureter tubes causes a sharp pain that fluctuates in intensity and location as the stone moves. This pain can radiate from the flank down to the groin or lower abdomen. Conversely, a kidney infection (pyelonephritis) usually presents as a dull, constant ache in the flank. This is accompanied by systemic symptoms like fever, chills, and painful or frequent urination. The presence of blood, cloudiness, or a strong odor in the urine suggests a kidney or urinary tract origin.
Vascular and Thoracic Considerations
Less common but serious causes of mid-back pain can originate from the vascular system or the chest cavity. The aorta, the largest artery in the body, runs close to the spine through the chest and abdomen. A tear in the inner layer of the aorta, known as an aortic dissection, is a medical emergency. It presents as sudden, severe pain in the chest or upper back, often described as a tearing or ripping sensation, requiring immediate medical attention.
Conditions affecting the lungs and their lining, such as pleurisy or pneumonia, can also cause mid-back pain. Pleurisy involves inflammation of the lung lining, resulting in a sharp, stabbing pain exacerbated by deep breathing, coughing, or sneezing. Pneumonia, an infection causing fluid buildup in the lungs, can cause similar back or chest discomfort, especially when accompanied by a persistent cough, fever, and shortness of breath.