There are many possible causes of chest and back pain. Some are relatively benign, while others can be much more serious. The type and location of a person’s pain can be a useful tool in helping diagnose the underlying cause.

This article will outline some of the different causes of chest and back pain, as well as their associated symptoms.

It also provides information on diagnosis and when to seek emergency medical treatment.

Causes by location

Many causes of chest and back pain are benign.
The exact location of a person’s chest and back pain can provide a clue as to its underlying cause.

The following sections will discuss possible causes of pain by location in the body.

Pain on the left side
Pain in the center to left side of the chest and back could be a symptom of one of the heart conditions below.

Stable angina

Stable angina is a predictable type of chest pain that occurs when the blood flow to the heart is restricted.

Angina usually causes a feeling of pressure, fullness, or tightness in the chest. A person may also experience related discomfort or pain in other areas, including:

• the shoulder or arm
• the neck
• the jaw

With stable angina, the above symptoms usually occur when the heart requires a greater supply of blood. This may be during physical activity or when a person is experiencing strong emotions.

Heart attack

Pain in the center to left side of the chest and back could indicate a heart attack. A heart attack occurs when blood to the heart is cut off or severely reduced and the heart muscle is injured.

According to the American Heart Association (AHA), the most common symptoms of a heart attack include:

• pain, tightness, or a squeezing feeling in the middle of the chest
• pain in the back, neck, or jaw
• pain in one or both arms or shoulders
• nausea or vomiting
• cold sweats
• shortness of breath
• lightheadedness

Though many people associate heart attacks with pain in the left side of the upper body, pain can occur on either or both sides.

Anyone experiencing symptoms of a heart attack needs immediate medical attention.

Pain on the right side
A dull, sharp, or cramping pain in the upper right abdomen or right side of the back may indicate an issue with the gallbladder.

Sometimes, mineral deposits can form in the gallbladder. This can lead to a painful blockage. The pain may last anywhere from 15 minutes to a few hours.

Other common symptoms include:

• nausea
• vomiting
• yellowing of the skin, or jaundice

Causes by trigger
Another way to identify the cause of chest and back pain is to identify the factors or situations that trigger the pain.

The following sections will discuss some potential triggers of this type of pain.

Pain while breathing or coughing
Pain while breathing or coughing could be a symptom of one of the conditions below.

Issues with the ribs

The muscles between the ribs may become overstretched or partially torn as a result of overuse or injury. This may lead to chest pain and difficulty breathing.

A bruised or broken (fractured) rib could also cause pain in the chest or mid-to-upper back, particularly when a person breathes in. Some other symptoms include:

• feeling or hearing a crack before the onset of rib pain
• swelling or tenderness around the affected rib
• bruising on the skin

Pneumothorax

Pneumothorax is a condition in which the lung partially collapses due to air or gas entering into the chest cavity and pressing over the lungs. This results in the following symptoms:

• chest pain in the side of the collapsed lung
• pain when breathing
• shortness of breath

Pneumothorax generally occurs as a result of injury to the chest or as a complication of a chronic lung condition.

Pleurisy

Pleurisy refers to inflammation of the membrane that covers the lungs. The condition may cause a sharp pain in the chest that worsens when breathing deeply, coughing, sneezing, or moving around.

Other possible symptoms include:

• shoulder pain
• shortness of breath
• a dry cough
• Pleurisy usually occurs as a result of a viral infection. Such cases usually go away without medical treatment within a few days.

However, people who develop severe or persistent symptoms should see their doctor.

Pulmonary embolism

A pulmonary embolism is a blood clot that has become lodged in an artery within the lungs. This can cause chest and back pain and a range of other symptoms, including:

• a cough that may produce blood
• shortness of breath
• a rapid heart rate
• excessive sweating
• lightheadedness or dizziness
• blue discoloration of the lips or nails

A pulmonary embolism is a medical emergency. Without prompt treatment, the condition can be fatal.

Pericarditis

Pericarditis refers to inflammation of the sac of tissue that surrounds the heart. The condition can occur as a result of an infection or an underlying heart condition.

Pericarditis typically causes a sharp pain in the chest that gets worse when a person breathes in or lies down. Sitting up and leaning forward tends to alleviate the pain.

Some additional symptoms of pericarditis include:

• a fast heartbeat
• a fever
• shortness of breath

In some cases, pericarditis can lead to a condition called cardiac tamponade. This occurs when fluid builds up, creating pressure that prevents the heart from filling with blood.

Cardiac tamponade can be fatal if a person does not receive treatment for it. Anyone who experiences symptoms of pericarditis should therefore seek emergency medical treatment.

Lung cancer

Lung cancer may cause chest pain that worsens when a person breathes deeply, coughs, or laughs. If the cancer has spread to other areas, it may also cause bone pain in the back.

Other potential symptoms of lung cancer include:

• a persistent or worsening cough
• wheezing
• coughing up blood
• a hoarse voice
• shortness of breath
• persistent or recurrent chest infections, such as bronchitis or pneumonia
• a loss of appetite
• unexplained weight loss
• fatigue or weakness

A person who experiences any of the above symptoms should see their doctor as soon as possible.

Pain when lying down or at rest
Chest and back pain that occurs while lying down or at rest may be a symptom of one of the following conditions.

Gastrointestinal reflux disease

A tight or burning pain in the middle chest and upper abdomen that occurs while lying down may be a symptom of gastroesophageal reflux disease (GERD).

This occurs when the contents of the stomach, including stomach acid, back up into the esophagus.

Some additional signs and symptoms of GERD include:

• a feeling of food moving back up into the mouth or throat
• pain when swallowing
• a bitter or sour taste in the mouth
• bad breath
• trapped gas
• nausea
• vomiting

In GERD, the above symptoms may occur at any time, but they are more common after eating.

Hiatal hernia

A hiatal hernia occurs when the top section of the stomach pushes up through the opening of the lower esophagus in the diaphragm and into the lower chest.

The symptoms of a hiatal hernia are similar to those of GERD. They may also worsen when a person lies down.

Pancreatitis

Pancreatitis refers to inflammation of the pancreas.

Pancreatitis causes pain in the mid-to-left upper abdomen, and this generally gets worse when a person lies flat. The pain can be excruciating and may radiate into the person’s back.

Some other potential symptoms include:

• a swollen and tender abdomen
• a fever
• a fast heart rate
• nausea
• vomiting
• diarrhea

People who experience severe symptoms should seek immediate medical attention. Severe symptoms can sometimes indicate a serious infection or a blockage in the main pancreatic duct or the common bile duct.

Unstable angina

Unstable angina and stable angina share the same symptoms. However, the symptoms of unstable angina generally come on suddenly and unexpectedly, even when a person is resting.

Anyone who experiences symptoms of angina while resting should contact the emergency services. Unstable angina can quickly lead to life threatening complications such as heart attack and cardiac arrest.

Pain during or after eating
Chest and back pain that occurs during or after eating may be a symptom of one of the following digestive conditions:

• GERD
• hiatal hernia
• gallbladder issues
• pancreatitis
• If a person develops any signs or symptoms of one of the above conditions, they should make an appointment with their doctor.

Other causes
The following conditions can also cause pain in the chest and back.

Panic attacks

A panic attack is a sudden episode of overwhelming or debilitating fear and anxiety. This can lead to physical symptoms such as:

• chest pain
• rapid breathing
• a rapid heart rate
• sweating
• nausea
• shortness of breath
• lightheadedness
• dizziness

The symptoms of a panic attack come on suddenly and usually reach their peak within 10 minutes. They rarely last for longer than an hour.

Shingles

Shingles is a viral infection that causes a painful rash to develop on the body.

Often, a person who is about to develop shingles will feel a band of burning or tingling pain beneath the skin before the rash appears. The pain and subsequent rash most commonly occur on the chest and abdomen on one side of the body.

Diagnosis
To diagnose the cause of chest and back pain, a doctor will ask about a person’s symptoms and medical history. They will also perform a physical examination.

In some cases, a doctor may also order medical imaging tests, such as a plain film X-ray, CT scan, or MRI study. This should highlight any irregularities inside the chest.

If the doctor suspects a heart condition, they may order a 12-lead electrocardiogram (to check the function of the heart) or a coronary artery angiogram (to check the blood vessels within the heart).

Treatment
The type of treatment a person receives will depend on the underlying cause of their chest and back pain.

Avoiding foods that may trigger GERD or gallbladder attacks — such as fatty, greasy, and spicy foods — may help alleviate digestive causes of chest and back pain.

Chest infections may require treatment with antibiotic or antiviral medications.

Severe lung infections or other lung problems will likely require specialized treatment, which may include surgery.

Treatments for angina and other heart conditions typically consist of making the following lifestyle changes

• quitting tobacco smoking
• quitting or reducing alcohol consumption
• eating a healthful, nutrient-rich diet
• exercising daily
• reducing stress
• Depending on the type of heart condition and its cause, surgical treatment may also be necessary.

People who experience regular panic attacks may receive medications or cognitive behavioral therapy to help reduce the frequency and severity of the episodes.

If cancer is the cause of a person’s chest and back pain, a doctor will coordinate a specialized treatment plan.

When to see a doctor
A person should see a doctor if their chest and back pain is severe or persistent, or if it worsens over time. It is also important to see a doctor if the pain is accompanied by other symptoms.

Anyone experiencing symptoms of a heart attack or other major cardiac event needs emergency medical treatment.

Outlook
Chest and back pain can be a cause for concern, especially if a person has an underlying condition such as heart disease or cancer.

Some other possible causes of chest and back pain include infections, digestive conditions, and injuries to muscle, bone, or other tissues within the chest.

Anyone who experiences severe, persistent, or worrying symptoms should see a doctor for a diagnosis and appropriate treatment. Treating certain conditions early can help prevent the risk of further complications.

Back Pain