The sudden onset of side pain when breathing can be a deeply unsettling experience, whether the sensation is a sharp, stabbing feeling or a dull, persistent ache. This pain is typically localized to the chest or rib cage area and worsens with inhalation, exhalation, or coughing. While this symptom can cause alarm, the underlying causes range widely, from common, easily managed issues to serious internal conditions. Understanding the mechanics of respiration and the potential sources of irritation helps determine the nature of the discomfort.
How Breathing Triggers Pain
The sensation of pain during breathing is a direct result of the mechanical action of the respiratory system on irritated or injured tissues. Breathing is powered by the rhythmic movement of the diaphragm, a large, dome-shaped muscle situated beneath the lungs that separates the chest cavity from the abdomen. During inhalation, the diaphragm contracts and flattens, expanding the chest cavity to draw air in.
The lungs are encased in two thin layers of tissue known as the pleura. One layer wraps around the lung surface, and the other lines the inner chest wall, with lubricating fluid between them. This fluid allows the two pleural layers to glide past each other as the lungs expand and contract. When inflammation, infection, or injury affects the pleura or surrounding muscles, the movement of the diaphragm and the rubbing of the membranes can painfully aggravate the site of irritation.
Musculoskeletal and Benign Causes
Many instances of pain when breathing originate in the chest wall, involving the ribs, cartilage, and muscles, and are typically not life-threatening.
Costochondritis
One of the most common causes is costochondritis, the inflammation of the cartilage connecting the ribs to the breastbone. This condition produces a sharp, localized pain that is often tender to the touch at the junction of the ribs and breastbone. It can be aggravated by deep breaths or movements of the upper body. The pain generally resolves on its own over a few weeks or months.
Muscle Strain
Another frequent source of pain is a strain of the intercostal muscles, the small muscles located between the ribs that assist in respiration. These muscle strains can occur from sudden, forceful movements, heavy lifting, or a prolonged bout of severe coughing. The discomfort is often worse with deep breathing and twisting motions. Treatment usually involves rest and over-the-counter anti-inflammatory medications like ibuprofen, along with applying heat or ice to the affected area.
Side Stitch
A temporary, non-serious cause commonly experienced during physical activity is the “side stitch,” or transient abdominal pain. While the exact cause is unclear, it is thought to be related to irritation of the parietal peritoneum, possibly due to repetitive torso movement or eating too close to exercise. This sharp, cramping pain usually resolves quickly by slowing down the activity, practicing deep, rhythmic breathing, or applying pressure to the painful spot.
Internal and Pulmonary Conditions
Pain triggered by breathing can also signal a condition originating within the lungs or adjacent internal organs, which often requires professional medical diagnosis.
Pleurisy and Pneumonia
Pleurisy, or pleuritis, is the inflammation of the pleural lining around the lungs, which causes a sharp, stabbing pain that intensifies when inhaling, coughing, or sneezing. This inflammation is frequently caused by viral infections, but it can also be a symptom of more serious conditions like pneumonia. Pneumonia is a serious lung infection that may also present with a cough, fever, chills, and shortness of breath, differentiating it from a simple muscle strain.
Pneumothorax
A sudden cause of pain is pneumothorax, or a collapsed lung, which occurs when air escapes the lung and fills the space between the lung and the chest wall. This condition is marked by a sudden onset of sharp pain and noticeable shortness of breath, necessitating immediate medical attention.
Referred Pain
Pain felt in the side or chest when breathing can also be referred pain originating from organs outside the respiratory system. Gastroesophageal reflux disease (GERD) can cause chest pain that mimics other issues. Conditions involving the stomach, such as a hiatal hernia, can cause pain or difficulty breathing due to mechanical irritation of the diaphragm. A medical evaluation is necessary to distinguish these referred pains from pulmonary or cardiac events.
Immediate Medical Attention
While many causes of pain when breathing are benign, certain accompanying symptoms indicate an emergency requiring immediate medical attention. Any sudden, severe, or crushing chest pain that lasts for more than a few minutes should prompt an emergency call. This is particularly true if the pain spreads from the chest to the arms, back, neck, or jaw, as these are signs associated with a heart attack.
A medical emergency is also indicated if the pain is accompanied by:
- Significant difficulty breathing, a rapid heart rate, or feeling lightheaded or confused.
- A high fever, shaking chills, or a cough that produces blood.
- Pain following a recent trauma or injury to the chest.
- Skin or lips appearing blue or very pale.