Middle Back Pain Red Flags

Middle back pain may not be as common as neck or lower back pain, but still impacts many people at some point in adulthood. But, when is middle back pain a simple matter of muscle tension or overuse and when does it point to a serious medical issue?

In this article, we’ll help you decipher between the two with middle back pain red flags. Keep in mind that while we can provide general information, middle back pain differs from patient to patient. So, when in doubt, reach out to your doctor. 

Table of Contents

What Disease Causes Middle Back Pain?

Many diseases can cause middle back pain, including osteoporosis, fibromyalgia, scoliosis, kidney diseases, pancreatitis, and spinal diseases.

  • Osteoporosis occurs when bone tissue weakens, or your body produces less bone tissue than usual. An estimated 10 million people in the U.S. have osteoporosis, making it a prevalent bone disease. It can cause middle back pain by weakening the vertebrae and causing spinal compression fractures. 
  • Fibromyalgia is a chronic disease that triggers far-reaching musculoskeletal pain, fatigue, disrupted sleep, and even memory and mood problems. It can cause middle back pain and tenderness.  
  • Scoliosis is an abnormal, sideways spinal curvature. It can result from genetics, spinal disc degeneration, osteoarthritis, or osteoporosis. Scoliosis often causes back pain, including mid-back pain, as the spinal curve increases pressure on the spinal structures and back muscles. 
  • Kidney diseases, such as kidney stones, cysts, and infections, are a possible cause of middle back pain. Kidney pain may also be felt just under the ribs or in your sides. The pain is typically accompanied by other symptoms, such as nausea and vomiting. 
  • Pancreatitis is characterized by inflammation in the pancreas, and it’s most often caused by gallstones or consuming alcohol in excess. Along with stomach pain, nausea, vomiting, fever, rapid heartbeat, and fluid buildup in the belly, pancreatitis can cause middle back pain. 
  • Spinal diseases like spinal stenosis, osteoarthritis, and herniated discs can cause middle back pain. 

Pain in the Center of the Back

Pain in the center of the back can result from muscle strains, poor posture, arthritis, a herniated disc, scoliosis, spinal stenosis, fibromyalgia, kidney issues, or pancreatitis. 

  • Muscle strains in the center of the back can strike after heavy lifting, twisting, or bending. They tend to cause mid-back pain, stiffness, and back muscle spasms. Thankfully, most muscle strains are mild and resolve with at-home care. 
  • Poor posture, like hunching forward or sitting in twisted positions, can place significant stress on the center of the back, leading to pain. 
  • Arthritis is a category of conditions involving joint pain and inflammation. The most common type of arthritis, osteoarthritis, can affect the facet joints of the spine. This may lead to dull, achy pain and stiffness anywhere in the back, including the center. 
  • Herniated discs occur when the disc exterior develops a crack, allowing the soft, jelly-like interior to protrude into the spinal canal. If a herniated disc develops in the middle of the spine and presses on nearby nerve roots, you may develop pain in the center of the back. 
  • Scoliosis is a common deformity involving a sideways spinal curvature. The abnormal curve can place excessive stress on certain areas of the spine, including the center. This can lead to a painful, achy mid-back, among other symptoms. 
  • Fibromyalgia is a chronic condition that causes pervasive body pain, tenderness, and fatigue. With fibromyalgia, you may experience a deep, achy pain in the center of the back. 
  • Kidney issues like kidney stones and infections can cause pain that radiates to the back. Many people feel it in the area of the back that’s just under the rib cage. Kidney pain can feel like a dull ache that worsens with pressure or a sharp, stabbing pain that occurs in waves. 
  • Pancreatitis refers to pancreas inflammation, and it can be acute or chronic. While pain from pancreatitis usually occurs in the center of the abdomen, it can radiate to the center of the back. Other symptoms include nausea, vomiting, and unexplained weight loss. 

Mid Back Pain on the Right Side

Mid back pain on the right side can be caused by soft tissue injuries, spinal conditions, or organ-related issues involving the kidney, gallbladder, pancreas, or appendix. 

  • Soft tissue injuries can affect the muscles, ligaments, tendons, and discs in the middle of the back. Resulting from a sudden trauma, like a car accident, or repeated overuse, these injuries can cause mid-back pain on either or both sides. Minor soft tissue injuries typically heal with rest and home care, while more severe cases require professional care. 
  • Spinal conditions including spinal stenosis, spondylolisthesis, osteoarthritis, and bone spurs can affect any part of the spine, including the middle. These conditions often cause persistent back pain and stiffness. If nerve impingement is involved, you may also experience neurological symptoms like tingling, numbness, and weakness. 
  • Certain organ conditions can cause mid-back pain on the right side, including:
    • Kidney conditions like kidney stones and infections can cause mid-back pain on the right side if the right kidney is affected. 
    • Gallbladder problems, like gallstones, can trigger pain in the upper right portion of the abdomen. However, this pain can radiate and some people report feeling it on the right side of the back. 
    • Pancreas conditions including pancreatitis and pancreatic cancer can cause mid-back pain on the right side. With pancreatic cancer, the pain typically feels dull and occurs when the developing tumor presses on nearby nerves. 
    • Appendicitis occurs when the appendix, a small pouch-like organ that protrudes from the colon, is infected and inflamed. It usually causes pain that starts close to the belly button and shifts down to the right. This pain can radiate to the back on the right side. 

If you suspect that your back pain is coming from an organ problem, seek immediate medical care.  

What Are the Red Flags of Back Pain?

The red flags of back pain include pain that doesn’t improve with treatment, occurs at night or at rest, wakes you up at night, or is accompanied by symptoms like fever, unexplained weight loss, or incontinence. 

Back Pain That Doesn’t Improve with Treatment

If back pain doesn’t improve with several weeks or months of treatment, it could point to a chronic or more severe condition. Your physician may recommend a different course of treatment or more invasive methods. Sometimes, surgery is necessary to resolve back pain that doesn’t improve with conservative treatment. 

Back Pain That Occurs at Night or at Rest

Back pain that occurs at night or at rest is a red flag. While it may simply be due to poor posture or a muscle strain, nighttime back pain and pain that doesn’t improve with rest are possible symptoms of spinal tumors. Other potential spinal tumor symptoms include:

  • Abnormal gait
  • Generalized mid-back pain
  • Bladder or bowel incontinence
  • Numbness, weakness, or tingling
  • Paralysis  

Back Pain That Wakes You Up at Night

Middle Back Pain Red Flags

Back pain that wakes you up at night is a red flag of serious nerve impingement, spinal infections, spinal fractures, and spinal tumors. It can also point to ankylosing spondylitis, a form of arthritis.

If your back pain consistently makes it difficult to stay asleep, reach out to your doctor for an evaluation. 

Back Pain with Other Symptoms

Back pain that occurs with certain other symptoms can indicate a serious health condition or severe nerve compression. If you experience back pain with any of these symptoms, reach out to your doctor immediately. You may need emergency medical attention. 

Symptoms that are considered red flags with back pain include:

  • Fever
  • Nausea
  • Vomiting 
  • Unexplained weight loss
  • Lost bowel or bladder control
  • Numbness and tingling in the inner thighs, genitals, or buttocks
  • Difficulty standing or walking
  • Abrupt leg weakness

Why Am I Getting Back Pain in the Middle?

You may be getting back pain in the middle because of poor posture, overuse, stress, a sudden impact, an organ condition, or a spinal condition. 

  • Poor posture keeps your spine out of proper alignment, increasing the impact on spinal structures. It also causes muscle tension. These factors are a recipe for pain in the middle, upper, and lower back. 
  • Overuse can cause back sprains, strains, pinched nerves, and even vertebral stress fractures. These conditions can often be resolved with rest and at-home care, but more severe cases require physical therapy and medications. 
  • A sudden impact on the spine, like a car accident injury, can cause middle back pain. 
  • Organ conditions, like kidney problems and pancreatitis, can cause middle back pain. While back pain is more likely to result from a musculoskeletal issue than an organ problem, it’s important to contact your doctor if you experience other symptoms with mid-back pain, like nausea, vomiting, and unexplained weight loss. 
  • Spinal conditions, spinal stenosis, spondylolisthesis, osteoarthritis, and herniated discs, can cause back pain in the middle. These conditions have the potential to cause chronic pain and disability. So, visit your doctor for an exam if you experience middle back pain that doesn’t resolve with at-home care. 

Can Stress Cause Middle Back Pain?

Yes, stress can cause middle back pain. This is because stress contributes to back muscle tension and inflammation. 

When you’re feeling stressed, you tend to tense your muscles – especially the muscles of your back. Muscle tension places more stress on the spine, often leading to back pain and stiffness. Try to pay attention to your muscles, relaxing them and breathing deeply when you’re experiencing stress. 

Prolonged stress can increase inflammation throughout the body and worsen back pain. This is because chronic stress can make your body less sensitive to cortisol, the primary stress hormone. Inflammation can exacerbate pain from poor posture, sprains, strains, and various spinal conditions.

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How Do You Fix Middle Back Pain?

You can fix middle back pain with rest, lifestyle adjustments, physical therapy, medications, or surgery, depending on its cause. 

The best way to fix middle back pain will come down to the cause and extent of your pain. Your physician may also recommend your occupation, age, and lifestyle in determining the best treatment path for your needs. 

To fix middle back pain as quickly as possible, don’t hesitate to see your doctor. Early intervention is the most effective way to achieve relief without the need for invasive procedures or prolonged recovery periods.