- Lower Right Back Pain from Internal Organs
- Less Common Causes of Lower Right Back Pain
- Middle Back Pain
- What is middle back pain?
- What other symptoms might occur with middle back pain?
- What causes middle back pain?
- What are the risk factors for middle back pain?
- What are the potential complications of middle back pain?
- Sharp Back Pain: What to Know
- When to Go to the ER for Back Pain
- Types and causes of pain
Lower Right Back Pain from Internal Organs
There are numerous possible sources of lower right back pain in the organs of the mid-back, abdominal, or pelvic regions. Pain may start following inflammation or irritation of an internal organ, or may be a sign of infection. These conditions will usually produce other symptoms with lower right back pain that more specifically narrow down the source.
Several common internal causes of lower right back pain include:
Kidney problems. Symptoms of kidney stones and a kidney infection can be very similar. Both conditions can cause low back pain on one side, as well as pain with urination and nausea and/or vomiting. Difficulty urinating is typically felt as a kidney stone moves in the kidney, through the ureters, and into the bladder and urinary tract, and a patient may notice blood in the urine. An infection in the right kidney can cause fever, local inflammation, and tenderness in the lower right back around the kidney.
Ulcerative Colitis. This inflammatory bowel disease is characterized by persistent inflammation in the large intestine, also called the colon. Frequent abdominal cramping from ulcerative colitis can cause lower right back pain. Other symptoms includes chronic digestive problems such as diarrhea, rectal pain, weight loss, and fatigue.
Appendicitis. The appendix is located in the lower right hand side of the abdomen. If the appendix becomes inflamed, starts leaking or ruptures, it may cause symptoms that include lower right back pain. Symptoms vary, and there is debate about gradual onset or chronic appendicitis, but anecdotal evidence suggests that it is possible for an appendix to present chronic symptoms of lower right quadrant pain. A typical presentation is sudden-onset abdominal pain with a focal point in the lower right abdomen, with possible additional symptoms of fever, nausea and vomiting, and/or lower right back pain.
Gynecological disorders. In women, various reproductive organs located in the pelvis may lead to lower right back pain. For example, endometriosis is a common condition that may create sporadic, sharp pain in the pelvic area that may radiate to the lower right back. Fibroids, or tissue masses that grow in and around the uterus, may cause lower right back pain as well as other symptoms such as abnormal menstruation, frequent urination, and/or pain with intercourse.
Pregnancy. Lower right back pain, and low back pain in general, is common during pregnancy as the baby develops. Many women find different pain management methods helpful, which may include rest, exercise and stretching, and complementary therapies.
See Back Pain in Pregnancy
A variety of other internal conditions may also cause low back pain concentrated on the right side, so it is important to be aware of one’s symptoms when consulting with a doctor to obtain an accurate diagnosis and effectively plan treatments.
View Slideshow: 7 Ways Internal Organs Can Cause Lower Back Pain Slideshow
In This Article:
- A Guide to Lower Right Back Pain
- Lower Right Back Pain: Tissues & Spinal Structures
- Lower Right Back Pain from Internal Organs
- Causes of Lower Back Pain Video
Less Common Causes of Lower Right Back Pain
The following conditions may be common in the population, but are less likely to cause lower right back pain than pain in other areas, such as in the abdomen.
Lower right back pain may be an early symptom of the following:
- Gallbladder inflammation. Gallbladder inflammation or dysfunction is typically marked by severe indigestion, particularly following meals. Gallbladder dysfunction typically causes upper right abdominal pain and right-sided back pain.
- Liver problems. Pain related to the liver may be caused by inflammation (hepatitis), an abscess, liver scarring (cirrhosis), or an enlarged or failing liver. Symptoms of liver problems include pain in the upper right abdomen and/or back, fatigue, nausea or lack of appetite, and jaundice. Liver problems are relatively rare in persons not already at risk.
If the above conditions are the suspected cause of troubling symptoms, seeking prompt medical attention is advised.
Middle Back Pain
What is middle back pain?
Middle back pain is any type of pain or discomfort in the area between your upper and lower back. Healthcare professionals refer to this area as the lower thoracic area or lower thoracic spine. The upper thoracic area or upper thoracic spine makes up part of the upper back. The lumbar spine makes up part of the lower back.
The middle back consists of the spine (spinal column), spinal cord, nerves, discs, muscles, blood vessels, ligaments, and tendons. Any of the structures in the spine or back area can become irritated or inflamed in response to a variety of mild to serious conditions. Middle back pain causes include sports injuries, poor posture, arthritis, muscle strain, and car accident injuries. Middle back pain is not as common as lower back pain because the thoracic spine does not move as much as the spine in the lower back and neck.
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Pain in the middle of the back may be either short lived or chronic, which is defined as lasting more than three months. Middle back pain may be described as a dull, annoying ache or a sharp, acute pain. The pain can radiate, or spread, to other areas of your body. The converse is also true; pain that is caused by a problem somewhere else in your body can radiate to your middle back.
In some cases, acute back pain can resolve with basic self-care measures within a few weeks, but it can also persist and lead to more serious problems over time.
Prompt diagnosis and treatment of middle back pain can help control symptoms and reduce the risk of complications, such as disability. Seek prompt medical care if your pain is severe, is persistent, or causes you concern. In some cases, the underlying cause of middle back pain can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have middle back pain accompanied by chest pain, difficulty breathing, loss of bladder or bowel control, or numbness or paralysis in the arms or legs.
What other symptoms might occur with middle back pain?
Middle back pain symptoms depend on the underlying disease, disorder or condition. For instance, if your back pain is due to arthritis, you may experience pain in other joints of your body. Back pain due to a pinched nerve can cause loss of bladder control. Back pain is often a major symptom of fibromyalgia, which is characterized by fatigue and sleep problems.
Other symptoms that may accompany middle back pain include:
Morning back stiffness
Redness, warmth or swelling of the back
Shoulder, neck or hip pain
Serious symptoms that might indicate a life-threatening condition
In some cases, middle back pain may occur with other symptoms that might indicate a serious or life-threatening condition, such as heart attack or cauda equina syndrome (a syndrome in which nerves in the spinal cord of the lower back are compressed or paralyzed, cutting off sensation and movement). Seek immediate medical care (call 911) if pain in your middle back occurs with any of the following symptoms:
Chest pain, tightness or pressure
Difficulty breathing or shortness of breath
Loss of bladder or bowel control
Severe abdominal pain
Weakness, paralysis or numbness in the legs
What causes middle back pain?
The middle back consists of the thoracic spine (bony structures called vertebrae surrounding the nerves of the spinal cord). Between the vertebrae are spongy sacs of cartilage called discs that act as cushions and provide a range of motion to the back. Muscles, tendons and ligaments provide additional support. Any of these structures in the back can become irritated or inflamed in response to a variety of mild to serious conditions.
A common cause of mild to severe pain in the thoracic spine is a sudden movement during sports activities or home improvement projects. People who normally lead a relatively sedentary lifestyle are at increased risk of these types of strains and sprains.
Middle back pain can also be due to more serious conditions, such as fibromyalgia, spondylitis (infection or inflammation of the spinal joints), or a herniated disc. A bulging disc can put pressure on the nerve roots coming out from the spine, resulting in middle back pain.
In addition, a problem in another part of the body, such as the heart or digestive organs, can radiate to the middle back. This is called referred middle back pain.
Diseases and disorders that can cause middle back pain
Middle back pain can be due to diseases and disorders of the bones and tissues in the back including:
- Osteomyelitis (infection or inflammation of the bones)
- Osteoporosis (thinning and weakening of the bones)
- Paget’s disease (abnormal bone tissue loss and reformation)
- Spinal degeneration (degenerative disc disease, also called spondylosis)
- Spinal stenosis (narrowing of the spinal canal, creating pressure on the spinal cord or nerves)
- Spondylitis (infection or inflammation of the spinal joints)
Structural causes of middle back pain
Middle back pain can be due to injury or misalignment of the bones and tissues in the back including:
- Herniated disc
- Kyphosis (abnormal curving of the upper spine and humpback)
- Muscle spasm
- Scoliosis (sideways curve of the spine)
- Spinal tumor or cancer (the tumor can be noncancerous, also known as benign)
- Spine fracture
- Sprains and strains due to overuse or injury
Other possible causes of middle back pain
Middle back pain can also be due to systemic problems or problems affecting other body systems, which can be serious or life threatening in some cases. These include:
- Aortic aneurysm (life-threatening bulging and weakening of the wall of the aortic artery that can burst and cause severe hemorrhage)
- Gastric ulcer (with or without perforation)
- Heart attack
- Kidney stones (pain is usually below the rib cage in the flank area)
- Multiple myeloma (bone marrow cancer)
What are the risk factors for middle back pain?
Although anyone can experience middle back pain, there are certain risk factors that make you more likely to experience it. Middle back pain can occur at any age, but it most often begins between 30 and 50 years of age. The activities associated with this age group, along with the increasing age of the spine and associated tissues, are the most influential factors in back pain. Risk factors include:
- Advanced age
- Congenital (present at birth) or acquired back deformities (such as kyphosis, an abnormal curving of the upper spine and humpback)
- Family history of back pain or disease (such as degenerative disc disease)
- Poor posture
- Sedentary lifestyle
- Stress and anxiety
- Weak abdominal (core) muscles
What are the potential complications of middle back pain?
The complications associated with middle back pain depend on the underlying disease, disorder or condition. For example, middle back pain resulting from a degenerative condition, such as spondylosis, can lead to inactivity and its associated complications.
You can best treat middle back pain and minimize the risk of complications by following the treatment plan you and your health care professional design specifically for you. In many cases, this may include physical therapy and basic self-care measures, such as rest and nonprescription pain relievers.
In some cases the degree and duration of your pain may become overwhelming and affect your everyday living. Treatment and pain management for all types of back pain is an area of ongoing research. Contact your doctor to learn about your treatment options.
Over time, middle back pain can lead to complications including:
- Absenteeism from work or school
- Chronic pain
- Permanent nerve damage (due to a pinched nerve) including paralysis
- Poor quality of life
Sharp Back Pain: What to Know
Ouch! A sudden sharp pain in your back can stop you in your tracks. Unlike the dull ache of sitting too long at a computer or the gradual neck stiffness from too much driving, the cause of a sudden sharp pain in your back (also known as acute back pain) is not always obvious.
In fact, there are a number of common and less-common causes for acute back pain, and they are both mechanical and medical in nature.
Diagnosing Sharp Back Pain: Common Causes
Acute, sharp back pain caused by a mechanical problem within the back (meaning a problem with the bones, disks, ligaments, or muscles of the back) is one of the most common types of back pain. Some specific causes of acute, sharp back pain include:
- Muscle spasm. A muscle spasm is a prolonged contraction or stiffening of the back muscles, which can be triggered by trauma or repetitive strain. The back muscles spasm to protect the spine from further injury. A spasm can produce sharp back pain in either the upper or lower back.
- Herniated disk. A herniated disk — also called a bulging disk, slipped disk, ruptured disk, or pinched nerve — can also cause sudden, sharp back pain. It can result from the improper lifting of heavy objects or overly strenuous activity. Sharp back pain that shoots down through the buttocks into the legs, called sciatica, is a common symptom of a herniated disk.
- Compression fracture. This term refers to a fracture of the spine bones (vertebrae). It can be caused by trauma (a fall or car accident) or by weakened bones (osteoporosis), and the pain is often very sharp.
- Infection. Sometimes the vertebrae themselves can become infected in a rare condition known as osteomyelitis. With infection, back pain is usually accompanied by fever and other symptoms.
In between your vertebrae are rubbery cushions called spinal discs. These discs, which act as shock absorbers, are a little bit like jelly donuts. They have a softer inside with a tougher exterior. There are also a number of ligaments attached to your spine, connecting those stacking vertebrae to each other and to other bones. Beyond that, there are tendons attaching bones to surrounding muscles. Then there are the muscles of your back themselves.
Because there are so many parts in your back, lower back pain could be coming from a variety of sources. With that said, experts name the following issues as some of the most likely to result in lower back pain.
1. If your back pain is dull and persistent, it could be poor posture.
Working a sedentary job can do a number on your body. “Sitting at your desk all day long with a poor ergonomic workstation is one of the worst things for your general health overall, including your lower back,” Dr. Oberle says.
An ergonomic workstation is designed to put the least amount of stress on your body. For the purposes of lower back comfort, that includes using an office chair that supports the curve of your spine, according to the Mayo Clinic. Objects you use often, like your telephone and notepad, should be comfortably within reach so you don’t have to strain each time you need them. And your computer monitor should be right in front of you, with the top of the screen either at or slightly below eye level so you don’t need to hunch over as you work.
Setting up an ergonomic work space might seem like a pain, but it’s better than the soreness you might experience without one. Sitting in a slumped or unsupported position puts a lot of pressure on your back, especially the lower region, Alpesh Patel M.D., the director of orthopedic spine surgery at Northwestern University’s Feinberg School of Medicine, tells SELF. Over time, that pressure can lead to a dull, persistent ache. Plus, sitting all day can shorten your hip flexors, causing them to pull on your lower back. This might make your lower back and butt feel tight and sore, Dr. Patel says.
If you can’t set up an ergonomic workstation, Dr. Oberle recommends taking regular breaks to stretch and move around. Though this of course varies by individual, she suggests doing so every 15 minutes. (This is her recommendation for generally healthy people—if you have health issues that don’t make this feasible, check in with your doctor for specific guidelines.) Even if you can’t actually move this often, you should be checking your posture regularly and adjusting accordingly.
2. If your back pain is sharp and you have muscle spasms or stiffness, it could be improper workout form or over-exercise.
If your lower back hurts the day after you exercise, it could be delayed onset muscle soreness (DOMS). This kind of post-workout pain happens as a normal result of your body repairing muscle fibers you tear during exercise. It typically sets in 12 to 24 hours after you’ve exercised and lasts for a maximum of 72 hours, according to the American College of Sports Medicine. But if your pain lasts beyond that or is more extreme than your usual post-exercise soreness, your workout could be doing your back more harm than good.
There are any number of reasons your upper and middle back can hurt. Strain or injury to the muscles and ligaments that support your spine is sometimes the problem. This can come from overuse.
You might also have poor posture. When you sit, try to keep your shoulders back. When you stand, try to keep your back as straight as possible and your weight evenly placed on your feet.
Other possible causes include:
- A pinched nerve. This could happen in your spine near your ribs.
- A fractured vertebra
- A herniated disc. When the area around the disc is damaged, the cushioning material pushes out between your vertebrae and can press on spinal nerves.
- Osteoarthritis. Cartilage that protects your bones might wear down, leading to pain. Bone spurs can press on spinal nerves. This condition can hit many parts of the body, but the spine is among the most commonly affected.
- Myofascial pain syndrome. This is an ongoing (or “chronic”) pain disorder. It’s usually triggered after a muscle has contracted over and over. Sometimes, it’s related to your job or a hobby that requires the same repeated motion.
- Gallbladder issues. Gallstones can cause pain between your shoulder blades or around your right shoulder.
- Elbow Arthritis
- Elbow Bursitis / Olecranon Bursitis
- Little League Elbow
- Ankle Tendinitis
- Ankle Arthritis
- Ankle Bursitis
- Ankle Instability
- Ankle Ligament Damage
- Foot Arthritis
- Plantar Fasciitis
- Wrist Bursitis
- Wrist Tendinitis
- Back Injury
- Neck Injury
- Shoulder Injury
- Knee Injury
- Hip Injury
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When to Go to the ER for Back Pain
While many people tolerate occasional aches and pains in their back, severe back pain may indicate a larger problem. But how do you know if your back pain, or that of a loved one, has reached the point that it requires an emergency department visit?
If at any point you feel that your condition is serious enough that it can’t wait for a visit with your primary care physician, you should visit the emergency department. However, if you’re not sure whether your back pain deems emergency care, consider these guidelines.
If You Have These Symptoms, You May Require Emergency Care
Lower back pain, which can occur anywhere from your rib cage to your buttocks, is often the result of lifting, reaching, twisting and stretching. Upper and middle back pain, in most cases, does get better with time and rest. If your back pain is unrelenting and not relieved by rest, you should immediately visit the closest emergency department. If the pain is accompanied by any of the following symptoms, you should also seek emergency care.
- Bladder or bowel incontinence (loss of control)
If You Have These Medical Conditions, You May Require Emergency Care
For individuals with certain medical conditions, back pain may signify a more serious issue. If you have any of these medical conditions and are experiencing severe or chronic back pain, you should visit an emergency department.
- History of cancer
- Recent immunosuppression, either from surgery or prescribed drugs
- Any recent injury or trauma, especially in the elderly
- Prolonged use of steroids
- Intravenous drug use
North Suburban has three ERs in the North Denver area. All are open 24/7 and are staffed by board-certified emergency physicians and experienced nurses. Please see the map below for locations, addresses, and phone numbers.
Lower-back pain, or pain in the part of the back between the ribs and the legs, is one of the most common complaints of discomfort. It is the most common cause of job-related disability and a major reason for missed work. While most back twinges go away on their own after a few days, many people suffer from chronic back pain.
About 80 percent of people in the United States experience at least one bout of lower-back pain in their lives, according to the National Institute of Neurological Disorders and Stroke. The back can get out of whack very easily because it supports most of the body’s weight. People ages 30 to 50 tend to be more likely to suffer from back pain, possibly because they spend large amounts of their day sitting, with the occasional too-vigorous workout that can cause injury.
Types and causes of pain
Most back pain is one of four types, said Dr. Christopher Maher, director of the musculoskeletal division at the George Institute for Global Health at the University of Sydney in Australia.
One form of back pain, called sciatica, occurs when nerves in the spinal column are pinched.
In spinal stenosis, the open spaces in the spine narrow, which can also put pressure on spinal nerves. Others experience back pain due to infections, fractures or serious diseases such as cancer. In total, about 50 to 60 rare diseases can cause back pain, Maher said.
But the most common form, which accounts for about 90 percent of all cases, is what’s called “common nonspecific back pain,” which means “we’re not sure what causes the pain,” Maher told Live Science.
Twisting or lifting a heavy load the wrong way can sprain or strain the muscles and ligaments in the back, causing acute back pain. In addition, the cushiony discs between the backbones, or vertebrae, tend to disintegrate with age, reducing how much shock absorption they can provide, though doctors don’t agree on how much this causes back pain.
There are several risk factors associated with chronic back pain. Smoking, being physically inactive or being overweight can all increase the risks of back pain, Maher said. People who frequently lift heavy objects are also at risk.
People who report a lot of psychological distress due to a stressful work environment or poor social support also tend to feel more chronic back pain, he said.
Back pain may also be linked to a person’s chance of death according to a 2017 study published in the European Journal of Pain. Those in the study ages 70 and older that reported having back or neck pain were 13 percent more likely to die when compared with people who didn’t have back pain.
Treating back pain is tricky. For minor aches and pains or twinges after an injury or strain, it’s usually sufficient to take a pain reliever — either acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory such as ibuprofen (Advil) — and continue normal activities. A July 2014 study by Maher and his colleagues and published in the journal in The Lancet found that taking acetaminophen doesn’t help people recover sooner from back pain.
Prescription opioid medications, such as oxycodone (OxyContin), may relieve pain, but doctors are typically reluctant to prescribe them because people rapidly develop a tolerance and the drugs can be diverted for illicit use in the community, Maher said.
Sometimes a fake cure can help. A 2016 study published in the journal PAIN involving 100 people found that those with a placebo added to their normal medication reported pain and disability scores about 30 percent lower than their scores at the beginning of the study. In an interesting twist, those who were taking the placebo still felt better, even though they knew the drug was a fake from the very beginning of the study.
Though it can be tempting for people to put their feet up or lie in bed when back pain flares up, that’s actually the worst thing they can do, Maher said. Studies in dogs, sheep and pigs show that loading the joints and muscles in the back can speed tissue recovery after an injury, he said.
The discs and cartilage in the back don’t have a very good blood supply, so they rely on the compression and movement of daily activity to force healing nutrients and chemical factors in the tissue, Maher said.
People with really stubborn back pain may need more active treatment, such as physical therapy. A 2002 study in the journal Spine found that back exercises could significantly reduce pain in patients who had pain due to an unspecified cause.
Certain forms of talk therapy may also help. A 2014 study in the Journal of Back and Musculoskeletal Rehabilitation and another in The Clinical Journal of Pain found that people receiving cognitive behavioral therapy (CBT), a type of talk therapy, in conjunction with physical therapy reported greater reductions in pain than those treated with physical therapy alone.
People who are more anxious, fearful or depressed about their pain can take longer to recover, Maher said, so CBT may work by helping them reframe how they think about the pain.
“People are taught to challenge unhelpful believes and replace them with more helpful beliefs that will help them recover,” Maher said.
Acupuncture, yoga and massage can improve chronic back pain, although the evidence for those interventions is weaker, according to the American College of Physicians’ U.S. guidelines for the diagnosis and treatment of chronic low-back pain.
Spinal manipulation therapy (SMT) that uses compression on the spinal joints may also be a treatment consideration. A 2015 study published in the journal Spine found that this type of therapy works for some, but not all. Typically, SMT is performed by chiropractors and physical therapists. It has been controversial, with some medical experts claiming that it works, while others claim that it doesn’t. “The big finding is that both sides have been right all along,” said Greg Kawchuk, a professor of rehabilitation medicine at the University of Alberta and co-author of the study.
Surgery and lumbar injections of medicines such as steroids have not been demonstrated to work consistently, Maher said.
“All forms of surgery are a last resort,” Maher said.
For people with degenerative disc disease, for instance, spinal fusion therapy has only modest benefits, and those benefits may be no greater than rehabilitation and cognitive behavioral therapy, according to a 2009 study in the journal Spine. And a 2014 study in the New England Journal of Medicine found that injections of a painkiller and a steroid into the spine did not improve pain any more than injections of the painkiller alone.
Additional reporting by Alina Bradford, Live Science Contributor.
This article is for informational purposes only, and is not meant to offer medical advice.
- Mayo Clinic: Back Pain
- National Institutes of Health: Back Pain
- Stanford Back Pain Study