The sensation of sharp pain in the upper back that intensifies with breathing is an alarming symptom. This pain, often called pleuritic or mechanical pain, signals that a structure in the chest or back is being compressed, stretched, or irritated by respiration. While this symptom can indicate serious underlying conditions involving the lungs or heart, it is far more frequently rooted in less severe, localized issues involving the muscular and skeletal framework of the chest wall. Understanding the source of the pain is important for determining the appropriate course of action.
Understanding Musculoskeletal Triggers
The most common sources of sharp upper back pain related to breathing involve the muscles and joints surrounding the thoracic spine and rib cage. A sharp, localized pain that worsens with movement, coughing, or deep inhalation often points to a muscular strain. The intercostal muscles, which run between the ribs and assist in expanding and contracting the chest cavity, are susceptible to strain from forceful activities like heavy lifting or persistent coughing.
The rhomboid muscles, located in the upper back between the shoulder blades and the spine, can also be strained. Overuse, poor posture, or sudden movements can cause these muscles to spasm or tear, and the resulting inflammation is aggravated every time the muscle stretches during a deep breath. When pain radiates from the front of the chest through to the upper back, costochondritis—the inflammation of the cartilage connecting the ribs to the breastbone—may be the cause. This inflammation makes the rib cage sensitive to breathing movements and is often described as a sharp, stabbing pressure.
Causes Originating in the Lungs and Chest Cavity
Sharp pain triggered by breathing can be a direct result of pathology within the lungs or the surrounding chest cavity. The most recognized cause is pleurisy, a condition where the pleura, the two thin layers of tissue lining the lungs and chest wall, become inflamed. Normally, these layers glide smoothly, but when inflamed, they rub against each other, causing a distinct, sharp pain that is exacerbated by deep breaths, sneezing, or coughing.
Pleuritic pain frequently radiates from the chest wall to the upper back or shoulder. This inflammation is often secondary to an underlying infection, such as pneumonia or bronchitis, where the infection has spread to the pleural lining. The pain from pneumonia can also be compounded by severe, persistent coughing that strains the surrounding back and rib muscles.
A more acute cause is a pneumothorax, commonly known as a collapsed lung, which occurs when air leaks into the space between the lung and chest wall. This buildup of air creates pressure that prevents the lung from fully expanding, leading to a sudden onset of sharp, one-sided chest pain that often extends to the back. The immediate shortness of breath that accompanies this severe pain is an important distinguishing characteristic.
Pain Referred from Other Areas
Upper back pain may be a form of referred pain, where discomfort originates in an internal organ but is perceived in the back due to shared nerve pathways. Issues with the spine itself, such as thoracic radiculopathy, involve a compressed or irritated nerve root in the upper-to-mid back region. When a disc or bone spur presses on a thoracic nerve, the pain can be sharp or burning and may follow the path of the nerve around the rib cage to the chest, often worsening with coughing or straining.
Digestive issues like gastroesophageal reflux disease (GERD) can also cause pain felt between the shoulder blades. The irritation of the esophagus caused by the backflow of stomach acid can activate the same sensory nerves that supply the upper back, leading to a burning or aching sensation. This referred pain may be noticeable after large meals or when lying down.
Although less common, severe upper back pain can be an atypical presentation of a cardiac event, such as angina or a heart attack. The nerves carrying pain signals from the heart converge with nerves from the upper back and arm, causing the brain to misinterpret the source of the discomfort. This presentation is seen more frequently in women, where the pain may be described as a pressure or tightness across the upper back.
Identifying Red Flags and Seeking Care
While many causes of upper back pain when breathing are minor, certain accompanying symptoms require immediate medical attention. Any sharp pain that is sudden, severe, and accompanied by shortness of breath, especially if the breathlessness occurs at rest, is a medical red flag. The presence of fever, chills, or a persistent cough that produces bloody or discolored phlegm suggests a serious infection like pneumonia or a pulmonary embolism.
Sudden, crushing pain in the chest or upper back, combined with sweating, lightheadedness, nausea, or a feeling of impending doom, should be treated as a medical emergency to rule out a heart attack. If the pain persists for more than a week without improvement, or if it is accompanied by numbness, tingling, or weakness in the limbs, a medical evaluation is warranted. A healthcare professional can perform a targeted examination to determine if the pain is musculoskeletal, pulmonary, or referred from another internal source.