When Back Pain Is a Symptom of Lung Cancer

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Research suggests that the time between the onset of symptoms and a diagnosis of lung cancer is around 12 months. This is often because a person does not recognize the symptoms, or because they hope that they'll go away. Back pain is one such symptom.

It is not uncommon for people to have back pain with lung cancer, or even to have back pain as their first symptom. In fact, there are certain defining symptoms that point to cancer as the cause of back pain.

Chief among them are the location and types of pain, which may be quite different from your typical, chronic backache. All told, around 25% of people with lung cancer will report back pain as a symptom at some point in their disease.

This article looks at how back pain is linked to lung cancer, and how this pain differs from other kinds of back pain. It also explains why early treatment for back pain is so important.

back pain symptoms that may suggest lung cancer

Verywell / Hugo Lin

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 connect it to things like an injury, such as a muscle strain or ruptured disc. Or we may think it's because of a degenerative disease, like arthritis or osteoporosis.

Back pain caused by lung cancer shares some common features with many of these disorders. Yet it also has distinct differences. These may relate to how and where the cancer causes pain, both directly and indirectly.

Some possible ways in which lung cancer can produce back pain include:

  • A tumor can place direct pressure on the structure of the back, most often in the mid to upper back rather than lower back.
  • A tumor can irritate the nerves that serve the lining of the lungs and chest wall. This may trigger a sharp and sometimes chronic nerve pain.
  • Cancer spread (metastasis) from the lungs to the spine and bones happens in some 30% of people with lung cancer.
  • Spread of cancer to the adrenal glands occurs in 40% of people with lung cancer, and can cause pain right above the kidney.

Healthcare providers may overlook a possible lung cancer as the cause of back pain, especially in people who have never smoked. However, at the current time, most of the people who develop lung cancer are non-smokers, either never smokers or former smokers. Lung cancer cases are rising in young women and men who have never smoked.

In fact, due to the location of the type of lung cancer most common in these non-smokers, called lung adenocarcinoma, the typical symptoms most people think of with lung cancer are often missing. These tumors are also more likely than other kinds of lung cancer to spread to bones.

While back pain may be the first symptom of lung cancer in some people, it also may signal multiple myeloma, breast, and other cancers. For example, back pain is the first symptom for roughly 1% of people diagnosed with breast cancer.

Recap

Back pain affects roughly one in four lung cancer patients, but few people think of back pain as a symptom. It may actually be among the earliest symptoms, though it may differ from "classic" back pain. Back pain is often linked with the kind of lung cancer that nonsmokers get most often. 

Symptoms That May Suggest Lung Cancer

Symptoms of back pain linked to lung cancer may overlap with back pain caused by other conditions. If the cancer involves the spine, it can mimic many of the symptoms of an upper back injury.

Lung cancer-related back pain may feel dull like a muscle ache, or it may seem sharp like a pinched nerve. People with cancer that has spread to the adrenal glands may sometimes say they have "kidney pain" on one side of their back. They also may 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 happens 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 treatment

The back pain may come with other telltale lung cancer signs like a cough that won't go away or shortness of breath. Unintentional weight loss, chronic fatigue, or coughing up blood may further suggest lung cancer.

The "typical" symptoms of lung cancer are less likely to be present with lung adenocarcinoma, which often affects non-smokers. The most common symptoms with this type of cancer are fatigue and shortness of breath with exercise, which people may attribute to age or inactivity instead.

Back pain related to a spinal fracture should also make your healthcare provider think of lung cancer. With metastatic lung cancer, the cancer spreads to bones in around 40% of people. The most common sites of spread are the spine, in about half of all cases, and the large bones of the legs.

Cancer that invades the vertebrae of the spine may result in brittle, weak bones, and compression fractures often occur. These breaks that occur in a bone weakened by cancer are referred to as pathologic fractures.

One sign that suggests a compression fracture in the spine is related to lung cancer, rather than osteoporosis, is that it occurs with only minimal trauma.

Recap

Back pain due to lung cancer may feel sharp or dull. It tends to be present at rest and is worse at night, and it doesn't improve with physical therapy or other treatment. If the cancer spreads to the spine, it can cause fractures. Other lung cancer symptoms include fatigue, shortness of breath, unexplained weight loss, and a cough.

Treating Back Pain

The treatment of back pain in people with lung cancer depends largely on the underlying cause. If the pain is caused by pressure from a tumor, treatments may include:

If cancer has spread to the bone, combining radiation therapy with drugs called bisphosphonates, often used to treat osteoporosis, may help. The drug denosumab usually provides significant pain relief and reduces the risk of fractures in affected bone as well.

In the end, there are many effective ways to treat severe pain associated with lung cancer. Far too many people, though, will try to hold out on pain control 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.

When Back Pain Requires Immediate Care

A condition called malignant spinal cord compression may develop in some people who have lung cancer that spreads to the spine. These symptoms include worsening back pain, weakness in the legs, and sometimes loss of urinary or bowel control. This is a medical emergency, and immediate treatment is needed to prevent complications such as paralysis.

Summary

Back pain is a symptom of lung cancer far more often than people, even healthcare providers, may realize. It's common enough, though the pain itself is often different from "back pain" as we often think of it. For many people, it may even be a first symptom of lung cancer.

If you have back pain that doesn't make sense to you, see a healthcare provider. Be sure to share any other symptoms you may have. If it is cancer, early diagnosis allows for early treatment, increasing your likelihood of a better outcome.

Frequently Asked Questions

  • How does lung cancer cause chest and back pain?

    Lung cancer can cause back and chest pain by spreading to the spine or irritating nerves that line the lungs and chest wall. This can cause a sharp, sometimes chronic pain. If cancer spreads to the adrenal glands, it may cause pain above the kidney, which can be felt as chest pain.

  • What is usually the first sign of lung cancer?

    In some cases, the first sign of lung cancer is a chronic cough that lasts for several weeks. Many people don't seek help for symptoms until lung cancer has reached an advanced stage, which is why keeping an eye out for warning signs and receiving regular checkups with a doctor are vital for early diagnosis.

  • Is lung cancer painful?

    Yes. Pain is a common symptom of lung cancer, especially when cancer has reached advanced stages.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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