Signs Your Upper Back Pain Is Serious

Backaches can be an annoyance—or they can sideline you for days. Here’s how to tell if upper back pain is run-of-the-mill or an emergency.

It may be your desk job

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Slouch much? “Upper back pain is most commonly from poor posture,” says Irene Tien, MD, an emergency medicine physician in Newton, Massachusetts. Sitting and staring at a computer “shortens chest muscles and pulls on the muscles in the upper back. A lot of people get a muscle spasm between the shoulder blades as a result,” she explains. Back pain can also be caused by everyday habits.

It could also be stress

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Along with sub-par posture, strain in the muscles around the neck and shoulders or between the shoulder blades can be multi-factorial, says Kaliq Chang, MD, an interventional pain management specialist at the Atlantic Spine Center in West Orange, New Jersey. Most notably: stress, strenuous exercise, and sleeping with your neck in a weird position.

What you can do

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“A typical episode of muscle strain usually lasts only a few days,” explains Dr. Chang. Staying comfortable during this time is key. He suggests resting, icing, taking anti-inflammatory medications like ibuprofen or naproxen, or trying a few of these effective home remedies for upper back pain relief.

When to go to the doctor

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You can’t always assume the discomfort is no big deal. “If pain lingers for more than a few days or requires regular pain medications” you should be evaluated by your physician, says Leda Ghannad, MD, assistant professor of orthopedic surgery and physical medicine and rehabilitation at Rush University Medical Center in Chicago. Another sign: if the pain limits your abilities in your day-to-day life, like you have to call off work to stay in bed. Following are signs you need to get medical help, pronto.

The ache won’t go away

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You’ve tried the DIY treatments, gotten massages, and maybe even bought a new mattress. If your upper back pain is persistent hurting, it may—very rarely—be a sign of a lung tumor. The American Cancer Society points out that advanced lung cancer may contribute to bone pain. Weight loss, chest pain, and weakness are also signs of lung cancer. If your back pain hasn’t gone away and wakes you up at night, see your doctor.

You were in a car accident

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If you’re able to walk away from a rear end crash and feel OK, you may decide not to get checked out by a doctor. However, whiplash—a violent backward-and-forward jerk of the head—can create “tears and inflammation of the muscles and ligaments in the neck and upper back,” explains Dr. Chang. See your doctor if you suspect whiplash, especially if you have other symptoms like fatigue, dizziness, and pain in your neck.

You feel pain in the side, too

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Anyone who’s had a kidney stone knows they’re quite agonizing—and they may cause upper back pain, says Dr. Ghannad. It’s unlikely that this is the only kidney stone symptom you’ll notice though. You may also feel severe pain in your side and back below your ribs, the Mayo Clinic notes. Discomfort while peeing or red- or brown-hued urine may be other clues. The best advice? “If pain is severe and persistent, it’s a good idea to be evaluated by a physician,” says Ghannad. Feel pain on your right side, under the shoulder blade? You may have a gallbladder issue, and need to see your doctor.

You have a fever

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The flu may be going around—but this isn’t any old illness. In certain instances, severe back pain with an accompanying fever or numbness or tingling in your arms can be from a spinal infection, points out Dr. Tien. This condition is very rare, but some risk factors are if you’re immunosuppressed, have cancer or diabetes, or are obese. If your doc thinks you may have a spinal infection, they may order an X-rays, CT, or MRI scan to help make the diagnosis. You’ll need to go to a hospital for intravenous antibiotics.

The pain is searing through your chest, too

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Numbness or weakness in your arms can be one sign of a stroke—or it may also be an indication of a tear in the wall of the aorta, the largest blood vessel in your body that runs in the back of your chest, says Dr. Tien. She adds that you’re especially at risk if you have uncontrolled high blood pressure over a long period of time. “This can cause a tearing mid-chest and/or back pain,” she describes. Just like a stroke, this is an emergency that requires immediate medical care.

You’re really fatigued

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The myth of the heart attack victim clutching their chest and collapsing has long been busted. It pays to listen up to subtler signs of a heart attack like nausea, shortness of breath, extreme fatigue, and back pain, says Dr. Tien.

Your legs are weak

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It’s time to think about a possible slipped disc (also called a herniated disc), which can happen if you lift something heavy using your back instead of your legs. If you feel upper back pain along with numbness or weakness in your arms or legs, it may be a sign of a neurologic injury from a slipped disc, says Dr. Chang. Your doc can make the diagnosis with a physical exam. You may also want to check for signs your upper back pain is actually arthritis.

A deep breath hurts

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Take a deep breath: how does that feel? If “extremely painful” is your answer, get checked out. One emergency-worthy cause is a pulmonary embolism, says Dr. Tien. “Blood clots can break off from a deep vein in the leg or arm and travel to the lung, wedging in blood vessels, causing poor blood flow, inflammation, and death of lung tissue,” she explains. A telltale sign is if you have sharp pain and trouble breathing after a long car or plane trip, or after surgery. If your back pain gets worse with a deep breath, you’re short of breath, you’re coughing up blood, or you feel faint, call 911. Here’s what you should do if you find yourself waking up with back pain.

You’re short of breath

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Rarely, upper back pain may be due to a punctured lung, which can be caused by an injury. While it is less likely to be the cause of your discomfort, a punctured lung is something you need to know the signs of so you can take the right action. “If the pain is accompanied by shortness of breath or severe pain taking a deep breath, seek urgent medical care,” advises Dr. Chang.

Pain intensifies when you move

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You had a recent fall, but you didn’t think your back would hurt this much! “If you had a traumatic injury, like a heavy object lands on your back or you slip on the ice and fall with your back striking the edge of a step, you can break a vertebral bone or a rib,” notes Dr. Tien. (Depending on where you broke it you may feel upper left back pain, or it may appear on your right side.) The pain can be moderate to severe, but it will get worse when you move. Talk to your doctor, especially after any bad injury. Here are 10 more reasons your back is in pain.