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What Causes Upper Back Pain When Breathing?

What Causes Upper Back Pain When Breathing?
Laura Castricone, CRT

Deep breathing is a wonderful exercise for the lungs. However, if the process of breathing causes pain in the upper chest, it may be something to be concerned about. Deep breathing is a way to increase oxygenation in the bloodstream and decrease the amount of carbon dioxide that may be harbored in our lungs. If pain is present when taking deep breaths, what would be most disconcerting would be sharp stabbing pain, prolonged pain that doesn't resolve, or persistent coughing due to deep breathing.  

So, what kind of conditions can cause upper back pain?   

Causes For Upper Back Pain When Breathing

Causes For Upper Back Pain When Breathing

1. Heart Attack: First and foremost, if upper chest pain is persistent and also causes shortness of breath or pain that radiates down the left arm or into the neck, you should call 911 or go to the hospital emergency department immediately. Sometimes these symptoms will be accompanied by diaphoresis, which is profuse sweating, a feeling of extreme anxiety or impending doom, and lightheadedness or dizziness. In situations like this, time is of the essence. If any of these symptoms are present, do not try to guess if you are having a heart attack; assume that you are and take the appropriate measures. It's better to be safe than sorry! 

2. Pleurisy: This is a condition where the lining of the lungs, also called the pleura, becomes inflamed and no longer moves smoothly. Infections such as the flu and some medications can cause pleurisy. The most common symptom of pleurisy is sharp chest pain when you breathe. The upper back pain may worsen when you cough and can become so debilitating that you only want to take shallow breaths. If pleurisy is not treated, the lungs cannot expand in the way they should, and a condition called atelectasis may develop. This is when some of the small air sacs become blocked or closed. This impairs the ability to breathe and causes drops in oxygen levels due to the blocked air sacs.  

3. Fracture of Vertebra: In older patients, this can happen without them realizing it, especially if they have a history of osteoporosis or any bone issues. Fractured vertebrae can cause pain when deep breathing. The pain usually does not subside and may radiate to the neck, back or arms. This pain will also be exacerbated by movement. The treatment for a vertebral fracture can range anywhere from physical therapy or steroid injections to surgery.  

4. Asthma and COPD: The conditions of asthma, chronic bronchitis, or COPD may cause upper chest pain. This pain is mostly caused by persistent inflammation of the lungs or coughing. Inflammation of the lungs can be due to lung irritants such as pollen, smoke, pet dander, and dust - to name a few common culprits. Upper back pain with COPD or asthma can also be muscular in nature due to chronic coughing. The use of bronchodilators and inhaled steroids are the main course of treatment for these conditions.  

5. Anxiety Disorders: Having chest pain with an anxiety disorder is very common. When someone is in a state of high anxiety, they may become very short of breath or start to hyperventilate. This can cause chest pain. Chest pain with anxiety can mimic the chest pain you would have with a heart attack. That's why it's important if you have severe chest pain to call 911 or present to the ED to have it checked out immediately.  

6. Pulmonary Embolism: A pulmonary embolism is also known as a blood clot in the lungs. This can develop due to many different conditions and can become dangerous if it gets lodged in the lungs or a blood vessel. A person who has PE usually presents with stabbing chest pain. They may have bloody phlegm when they cough, and they may also have an irregular heartbeat and difficulty breathing. A pulmonary embolism is a medical emergency and requires the person to call 911 or present to the ER for treatment. Treatment for a pulmonary embolism will require hospitalization and may include blood thinners, oxygen, or even mechanical ventilation.  

7. Deformities Of The Spine: Kyphosis and scoliosis are two common deformities of the spine and can cause persistent upper chest pain due to changes in bone and muscle structure. Both conditions will change the shape of the rib cage, putting stress on the lungs restricting their ability to inflate and deflate properly, and causing chest pain. Treatment for these conditions requires bracing or surgery.  

To summarize, any upper back pain when breathing is severe, sudden, or persistent and disturbs your ability to breathe properly or function should be brought to the attention of a doctor. You should go to the emergency room or call 911 if you think you are having a heart attack or you might have a pulmonary embolus. For these conditions, time is of the essence. 


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HPFY Laura Castricone, CRT

Laura Castricone, CRT

LinkedIn Profile My name is Laura Castricone and I am a Certified Respiratory Therapist. I have been practicing in the state of Connecticut since 1992. I have worked in several aspects of respiratory ...

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