When Back Pain Is a Symptom of Lung Cancer

Pain often has characteristic features that set it apart

It is not uncommon for people to experience back pain with lung cancer or even to have back pain as their first symptom. While it may seem an unusual association—linking the back to the lungs—there are defining features that are as telling as they are unique. Chief among them are the location and types of pain experienced, which are quite different from your typical, chronic back ache.

All told, around 25 percent of people with lung cancer will report back pain as a symptom at some point in their disease.

when is back pain a symptom of lung cancer
​Illustration by Emily Roberts, Verywell

How Lung Cancer and Back Pain Are Linked

When we think about back pain, usually the last thing that comes to mind is cancer. Instead, we associate it with things like physical trauma (such as a muscle strain or ruptured disc) or a degenerative disease (such as arthritis or osteoporosis). 

While back pain caused by lung cancer shares commonalities with many of these disorders, it also has its distinct difference. Much of these relate to how and where the cancer causes pain, both directly and indirectly. Some of the possible ways in which lung cancer can produce back pain include:

  • The direct pressure a tumor can place on the structure of the back, more often than not, is in the mid to upper rather than lower back
  • The way in which a malignancy can irritate the nerves servicing the lining of the lungs and chest wall, triggering a sharp and sometimes chronic nerve pain 
  • The spread (metastasis) of malignancy from the lungs to the spine and bones, an occurrence shared by upwards of 30 percent of people with lung cancer
  • The metastasis of cancer to the adrenal glands (occurring in 40 percent of people with lung cancer), causing localized pain due to its location right above the kidney 

Don't dismiss the possibility of lung cancer if you've never smoked.

At the current time, the majority of people who develop lung cancer are non-smokers (they are either never smokers or former smokers), and lung cancer is increasing in young women and men who have never smoked. In fact, due to the location of the type of lung cancer (lung adenocarcinoma) most common in non-smokers, the typical symptoms most people associate with lung cancer are often absent. These tumors are also more likely than other kinds of lung cancer to spread to bones.

Symptoms That May Suggest Lung Cancer

The symptoms of back pain related to lung cancer are diverse and overlap significantly with back pain caused by other conditions. If it involves the spine, it can mimic many of the symptoms of an upper back injury. Lung cancer related back pain may be generalized like a muscle ache or sharp like a pinched nerve. People with adrenal gland involvement may sometimes complain of "kidney pain" on one side of their back, or describe a feeling like they've just been "kidney punched."

That said, back pain related to lung cancer may have certain telltale signs. Red flags that back pain may be due to lung cancer include:

  • Back pain that is present at rest
  • Back pain that is worst at night
  • Back pain that occurs without any activity
  • Back pain that worsens the longer you lie in bed
  • Back pain that gets worse when you take a deep breath
  • Back pain that doesn't respond to physical therapy or other medical interventions

Moreover, back pain accompanied by other telltale signs such as a persistent cough, shortness of breathunintentional weight loss, chronic fatigue, or the coughing up of blood may further support the likelihood of lung cancer.

Back pain related to a spinal fracture should also make your doctor think of lung cancer. With metastatic lung cancer, bone metastases occur in around 40 percent of people. The most common sites of spread are the spine (occurring in at least 50 percent) and large bones of the legs. Cancer which as invaded the vertebrae results in brittleness and weakness of the bone and compression fractures may commonly occur. Fractures that occur in a bone weakened by cancer are referred to as pathologic fractures. A sign that suggests that a compression fracture in the spine is related to lung cancer (instead of osteoporosis) is a fracture which occurs with only minimal trauma.

Treating Back Pain in People With Lung Cancer

The treatment of back pain in people with lung cancer depends largely on the underlying cause. If the pain is related to pressure caused by a tumor, treatments may include surgery, chemotherapy, or radiation therapy to reduce its size. If bone metastases are present, combining radiation therapy with bone-modifying medications known as bisphosphonates (used to treat osteoporosis) or the drug denosumab usually provide significant pain relief (and reduce the risk of fractures through involved bone as well).

In the end, there are many effective ways to treat severe pain associated with lung cancer. Unfortunately, too many people try to hold out on pain control, either because they fear they'll get addicted or that the drugs will become less effective "when they really need it." Both of these fears are unfounded if the drugs are taken as prescribed.

A Word From Verywell

Research suggests that the time between the onset of symptoms and the diagnosis of lung cancer is around 12 months. Oftentimes, this is because a person may not recognize the symptoms or chooses to actively ignore them, hoping they'll go away. Yet, physicians may overlook the potential of lung cancer as a cause, especially in people who have never smoked. This is especially true when it comes to back pain, which many consider are simply facts of life we have to deal with.

However, if a back pain doesn't make sense to you, is getting worse, and doesn't respond to typical treatments, don't endure it. This is especially true if you are having pain in your mid or upper back. See a doctor and discuss any other symptoms you may be experiencing. If it is cancer, early diagnosis allows for early treatment, increasing your likelihood of a complete cure.

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