Chest or Back Pain: Causes and treatment options!

pain in middle of chest and back
Medically reviewed by Dr. Ola Tarabzuni


Pain in the middle of your chest and back can be like a tricky puzzle. Sometimes, it’s your heart or stomach causing trouble, like when you feel heartburn or chest pain. But don’t forget about your muscles and spine—they can also be culprits, especially if you’ve strained something or your back is out of whack. Stress, too, can sneak in and make things uncomfortable, adding another layer to the discomfort. So, when you’re dealing with pain in this area, it’s like untangling a web where your heart, stomach, muscles, spine, and stress all meet. Taking care of your health means not just looking at one thing but understanding how everything connects, leading to the symptoms. This blog explains all possible causes of pain in the center of the chest and back and under what conditions you should see your doctor.

What causes pain in the center of the chest and back? 

Pain in the center of the chest and back can stem from various causes, ranging from mild to severe. Here’s a detailed exploration of potential causes:

Heart attack

When the blood flow to the heart’s muscles is cut off, a heart attack occurs. Consequently, chest pain that radiates to the neck, shoulders, and back is a common symptom of a heart attack.

Other signs and symptoms to be aware of:

  • Chest stiffness or pressure, as well as chilly sweats, breathing difficulties, dizziness, or slight nausea.
  • Back or jaw discomfort associated with a heart attack is more common in women than in males. It’s also crucial to remember that some heart attack sufferers may show very little or no symptoms at all.


Angina is a pain that develops when insufficient blood flow to the heart tissue. People who have coronary artery disease are more likely to experience it. It frequently occurs when you’re pushing yourself.

  • Angina can cause discomfort that radiates to the shoulders, back, and neck, much like heart attack agony does.
  • Men and women can experience angina symptoms differently. Women may experience pain in addition to chest pain in the back, neck, or abdomen.

Additional signs of angina include:


Pleurisy is caused by inflammation of the membranes lining the lungs and chest cavities.

In a normal state, these membranes glide past one another. They may rub against one another when irritated, which can cause pain.

  • Numerous disorders, such as malignancies, autoimmune diseases, and infections, can result in pleurisy.
  • The more you cough or breathe deeply, the greater the pleurisy pain gets. It may also extend to your back and shoulders.

Other signs that may manifest are:

  • Coughing up 
  • Breathlessness
  • Fever and chills
  • Inexplicable drop in weight


The little organ known as the gallbladder holds bile, a digesting fluid. When this liquid inside your gallbladder solidifies and forms stones, gallstones happen.

There are various locations where gallstones can cause pain, including the upper right section of the belly, directly below the breastbone, and the space between the shoulder blades on your right shoulder. Back and chest pain after eating is one of the symptoms.

Gallstones may cause pain that lasts anywhere from a few minutes to several hours. Moreover, symptoms like nausea and vomiting are possible.

Your chance of gallstones can be increased by several risk factors, such as being female, pregnant, overweight, or obese.

Peptic ulcer disease:

Peptic ulcer disease involves ulcers in the stomach or duodenum, often causing abdominal pain that can radiate to the chest and back. The pain may be described as burning or gnawing and can worsen when the stomach is empty or after eating certain foods. Factors such as infection with Helicobacter pylori bacteria, long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), or excessive alcohol consumption can contribute to the development of peptic ulcers. 


Your heart’s pericardium runs over its surface—an inflammation of the pericardium results in pericarditis. An autoimmune disease or infection may be the cause. It may also occur following heart surgery or an assault of the heart.

Sharp chest pain is a symptom of pericarditis. Lying down, swallowing, or heavy breathing may make this pain worse. Pericarditis-related pain can also be experienced in the neck, back, or left shoulder.

Other signs to watch out for are:

  • Dry cough
  • Weariness
  • Anxiety
  • Breathing difficulties while in a lying position
  • Lower extremity swelling

Musculoskeletal pain

Occasionally, upper back and chest pain might be brought on by muscle issues. Chest, back, or chest wall aches can result from overusing or repetitively using several muscular groups, as in rowing exercises. Stem cell therapy can also be effectively used for advanced treatment methods and pain relief options.

You can also have twitching, stiffness, and weariness in your muscles.

Aortic aneurysm

The aorta is the largest artery in your body. An aortic aneurysm forms when the aorta weakens in a particular area. From time to time, this area of weakness may rip and cause possibly lethal bleeding. This is known as aortic dissection.

An aortic aneurysm frequently develops with few or no symptoms. On the other hand, some persons could have chest pain or tenderness. Back pain can also happen occasionally.

Other signs and symptoms to watch out for are:

Spinal problems

Pain may occasionally spread to the chest region and maybe even the limbs due to a pinched nerve in the upper back.

You might also have muscle stiffness and spasms in the afflicted area of your spine, which could limit your range of motion and pain.

Furthermore, there are case studies where pain in the chest or chest wall was brought on by a herniated disc in the upper part of the spine.

Lung cancer

Lung cancer can also cause symptoms such as back and chest pain. While back pain is a typical sign of lung cancer, 25% of patients with the disease also experience chest pain, according to the Dana-Farber Cancer Institute.

When pressure from a lung tumor starts to build up on the spine, back discomfort from lung cancer may result. Coughing, laughing, or heavy breathing may exacerbate lung cancer pain.

Other symptoms of lung cancer, in addition to chest and back pain, can include

  • A persistent cough that may involve blood in the cough
  • Hoarseness
  • Shortness of breath or wheezing
  • Feeling weak or exhausted
  • Inexplicable drop in weight
  • Recurring pneumonia and other lung illnesses

Anxiety or panic attacks:

Anxiety or panic attacks trigger physiological responses like increased heart rate and muscle tension. These can cause chest tightness or discomfort, often felt in the back too. Hyperventilation during panic episodes may lead to changes in breathing patterns, exacerbating these sensations. Heightened sensitivity to physical symptoms can intensify the experience. Psychological factors, including fear of severe medical conditions, can further amplify these symptoms, creating a cycle of anxiety.


Costochondritis is characterized by cartilage inflammation that connects a rib to the breastbone (sternum), leading to chest pain. This pain is typically sharp and may worsen with movement, deep breathing, or pressing on the affected area. While the pain is usually localized to the chest, it can also radiate to the back in some cases. 

“Chest and back pain is a medical puzzle, and the differential diagnosis is broad and multifaceted, ranging from benign musculoskeletal etiologies to potentially life-threatening cardiac conditions. Understanding the intricate interplay of factors such as patient history, physical examination findings, and diagnostic modalities is paramount in discerning the underlying cause,”

says Dr. Rhichard Honekar
Experiencing persistent chest and back pain, don’t delay it could be a serious health issue. Consult now

How can I relieve chest and back pain?

The underlying reason for your chest and upper back pain will determine how it is treated.

Heart attack

Heart attack treatment typically involves immediate medical intervention to restore blood flow to the heart muscle. These include oxygen therapy, nitroglycerin to increase blood flow, and aspirin to reduce blood clotting. Then, unclotting drugs, which aid in dissolving blood clots, might be administered. Emergency procedures such as angioplasty and stent placement or coronary artery bypass surgery may be performed to open blocked arteries and restore blood flow.

Any arteries discovered to be blocked or narrowed can be helped to open up via a treatment known as percutaneous coronary intervention (PCI). A tiny balloon connected to a catheter compresses plaque or clotted blood against the damaged artery wall and restores blood flow.

Other potential treatments can include:

  • Prescription drugs (ACE inhibitors, blood thinners, beta-blockers) to help avoid another heart attack; lifestyle modifications (eating a heart-healthy diet, boosting). 
  • Heart bypass surgery


One can be administered a range of drugs to help treat angina. These drugs may widen blood arteries, reduce angina discomfort, or prevent blood clots. Medications for angina include, for example:

  • Beta-blockers
  • blockers of calcium channels
  • blood thinners
  • Nitrates 
  • the statins

Procedures like heart bypass surgery and PCI may be required if lifestyle modifications and medicines are unable to treat the condition adequately.


Many over-the-counter (OTC) drugs can treat heartburn. Antacids, proton pump inhibitors, and H2 blockers are some examples. Your doctor may recommend more vital medication if over-the-counter remedies don’t relieve your symptoms.


Pleurisy, an inflammation of the pleura surrounding the lungs, is treated by addressing its underlying cause, including infections, pneumonia, or other conditions. Pain relief with over-the-counter medications like ibuprofen or acetaminophen is essential, along with rest and hydration. Management of pleural effusion, if present, may involve draining excess fluid through procedures like thoracentesis. Anti-inflammatory medications like corticosteroids can help reduce inflammation, while respiratory support with supplemental oxygen may be necessary in severe cases. Additionally, follow-up care is crucial to monitor progress and adjust treatment as needed.


Gallstone or cholelithiasis treatment typically involves managing symptoms and preventing complications. Options include lifestyle changes such as a low-fat diet to minimize gallbladder stimulation, medications like ursodeoxycholic acid to dissolve smaller stones, and pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs) or prescription pain medications during gallstone attacks. For more severe cases, surgical procedures such as laparoscopic cholecystectomy to remove the gallbladder, or less commonly, endoscopic retrograde cholangiopancreatography (ERCP) to remove stones from the bile ducts, may be necessary. Treatment choices depend on factors like the size and number of stones, the presence of symptoms, and the individual’s overall health.


NSAIDs and other pain and inflammation relievers can be used to treat pericarditis. Your doctor might recommend a more potent anti-inflammatory drug if these don’t work.

You may also be offered an antifungal or antibiotic medicine if an infection is causing your disease.

You could occasionally require a procedure to drain fluid. Your heart’s pressure may drop as a result.

Musculoskeletal pain

Rest and pain inflammation-relieving drugs, including NSAIDs, can help cure muscle problems that cause upper back and chest pain.

Heating the afflicted area could be beneficial as well. Physical treatment might be suggested in more severe situations.

Aortic aneurysm

Your doctor may occasionally advise using imaging technologies, including CT or MRI scans, to monitor your aneurysm. To assist in reducing blood pressure or cholesterol, your doctor may also prescribe drugs like statins, beta-blockers, and angiotensin II receptor blockers.

Individuals who have many giant aortic aneurysms may need surgery for repair. Endovascular or open surgery can be used to accomplish this. When an aortic aneurysm bursts, immediate surgery is required.

Spinal problems

The severity of a spinal condition determines how it should be treated. It may entail lowering your amount of exercise and using drugs to treat pain or inflammation, such as NSAIDs and muscle relaxers. Additionally, physical rehabilitation activities could be suggested.

Surgical intervention may be necessary to repair more severe situations.

Lung cancer

Lung cancer can be treated using different methods. The type of lung cancer and the extent of metastasis determine which type is employed. Together, you and your physician will design an appropriate course of care.

Chemotherapy, radiation therapy, and targeted therapy are among the available treatment options. Surgery might also be suggested to remove the cancerous tissue.


Treatment for chest pain related to anxiety or panic attacks often involves techniques like deep breathing exercises and cognitive behavioral therapy to address underlying psychological factors. Medications such as antidepressants or anti-anxiety drugs may be prescribed in some cases. Lifestyle changes like regular exercise, stress management, and limiting caffeine intake can also help manage symptoms. It’s important to consult with a healthcare provider to develop a personalized treatment plan and to rule out any other potential causes of chest pain.


Treatment often involves rest, over-the-counter pain medications, and applying heat or ice to the affected area. A healthcare provider may recommend physical therapy or corticosteroid injections to alleviate symptoms in severe or persistent cases.

Whether it’s a dull ache or sharp discomfort, chest and back pain should never be ignored. Consult now

What are the 4 signs of an impending heart attack?

For your heart to work, your blood must be rich in oxygen. The blood flow to the heart might be stopped if plaque of fat, cholesterol, and other materials accumulates in the arteries.

The more damage is done to your heart, the longer it is without blood flow. However, there are four common warning signs that individuals should be aware of are 

Chest pain, pressure, fullness, or discomfort

Periodically, sudden, intense pain can be a sign of a heart attack and should be immediately treated. What happens, though, when it isn’t?

The majority of heart attacks genuinely only cause moderate chest pain around the middle. You might also experience fullness, squeezing, or pressure. Usually starting slowly, these symptoms can go away and then reappear.  

This can get complex because these symptoms could be connected to anything less significant, like heartburn. But your body is the one you know best. You should see a doctor or even go to the emergency department if you believe something is wrong. 

Discomfort in other areas of your body

Your entire body is affected by a heart attack; its consequences are not limited to your heart. However, this can make recognizing a heart attack difficult. 

  • You could feel pain or discomfort in one or both of your arms.
  • Neck Back, Jaw or Stomach

Individual differences may exist in these symptoms. Some patients, for instance, say that the agony in their back after a heart attack feels like a rope being tied around them. There could be an intense pressure on your back as well. Pay attention to any of these less visible heart attack warning signals if you believe you are experiencing any of them. 

Difficulty breathing and dizziness 

It may indicate that your heart isn’t pumping enough blood to the rest of your body if you feel you’ve just finished a marathon but just walked up the stairs. Breathlessness is a frequent symptom of a heart attack and can occur with or without chest pain.

Dizziness or lightheadedness can happen, and you could even faint. Males and females can have this commonly, although women are more likely than males to do so. Be careful to get checked out if you’re experiencing difficulty with things that weren’t previously challenging, like walking the dog or making the bed. This could be a subtle symptom of a heart attack. 

Nausea and cold sweats

Feeling queasy, throwing up, and waking up in a cold sweat can all be markers of a silent heart attack or flu.

You may have experienced the flu before, so you may know what it feels like, but pay attention to your intuition if it signals that these flu-like symptoms are something more serious. These symptoms could be much more severe than the illness, stress, or feeling under the weather. Don’t write them off as such.

Chest pain can be a sign of a heart attack. Consult now

When should I worry about upper back and chest pain?

Upper back and chest pain can sometimes be benign and temporary, but it’s essential to pay attention to certain warning signs that may indicate a more severe condition. Here are situations in which you should be concerned about upper back and chest pain:

Sudden and severe pain

If the pain is intense and comes on suddenly, especially if it feels like pressure, squeezing, or a tight band around your chest, it could be a sign of a heart attack. Seek immediate medical attention.

Pain with other symptoms

A heart attack or another significant medical problem may be indicated if the pain is accompanied by dizziness, nausea, vomiting, pain radiating to your arms, neck, jaw, or shoulder blades, or shortness of breath. Pay attention to these symptoms; get medical assistance as soon as possible.

Chronic or recurring pain

If you experience persistent or recurrent chest and upper back pain, significantly if it worsens over time or is not relieved by rest, it’s essential to see a doctor to determine the underlying cause.

Pain after Injury

If the pain follows an injury or trauma to your chest or back, such as a fall or car accident, it could indicate a fracture, muscle strain, or other serious injury that requires medical evaluation.

Pain with Breathing Difficulty

If the pain is accompanied by difficulty breathing, coughing up blood, or a rapid heartbeat, it could be a sign of a pulmonary embolism, pneumonia, or other respiratory problem requiring immediate medical attention.

Pain with Risk Factors

If you have risk factors for heart disease, such as a family history of heart problems, high blood pressure, smoking, diabetes, obesity, or a sedentary lifestyle, you should take chest pain more seriously and seek medical evaluation, even if the pain is mild or intermittent.

See a doctor

Chest pain demands serious attention, as it can signal potentially life-threatening conditions like a heart attack. Seek emergency medical assistance immediately if you encounter sudden or unexplained chest discomfort, especially if it’s severe or accompanied by breathing difficulties or pain spreading to your jaw or arm. If over-the-counter remedies fail to alleviate symptoms or if they worsen, recur, or persist, it’s crucial to schedule a consultation with a doctor. Utilize Your Doctors Online service to connect with a nearby physician for prompt evaluation and personalized care.

FAQs about pain in the middle of chest and back

What part of the back hurts with heart issues?

Back pain, especially in women, may indicate a heart attack. Upper back pressure or tightness may be experienced. It could manifest as a dull pain that comes and goes.

Which is the best painkiller tab for chest and back pain?

For mild to moderate chest and back pain, acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are commonly used. 

How do you know if chest pain is muscular or heart?

Distinguishing between muscular and heart-related chest pain involves considering factors like location, duration, and accompanying symptoms. Muscular pain is often localized, aggravated by movement, and may feel like a dull ache or sharp pain. Heart-related pain typically involves pressure or tightness in the chest, may radiate to the arms or jaw, and is often accompanied by shortness of breath, nausea, or sweating. If unsure, seek medical evaluation promptly to rule out severe conditions.

Your Doctors Online uses high-quality and trustworthy sources to ensure content accuracy and reliability. We rely on peer-reviewed studies, academic research institutions and medical associations to provide up-to-date and evidence-based information to the users.

  • Shiba, Hiroshi, and Tsuneaki Kenzaka. “Straight Back Syndrome Presented with Chest and Back Pain: A Case Report.” International Medical Case Reports Journal (2022): 611-614.
  • Fam, Adel G., and Hugh A. Smythe. “Musculoskeletal chest wall pain.” CMAJ: Canadian Medical Association Journal 133.5 (1985): 379.
  • Yelland, Michael J. “Back, chest and abdominal pain: how good are spinal signs at identifying musculoskeletal causes of back, chest or abdominal pain?.” Australian Family Physician 30.9 (2001): 908-912.
  • Wendling, Daniel, et al. “Anterior chest wall pain in recent inflammatory back pain suggestive of spondyloarthritis. data from the DESIR cohort.” The Journal of Rheumatology 40.7 (2013): 1148-1152.

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