When Back Pain Is a Symptom of Lung Cancer

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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 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.

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 a 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 back rather than lower back.
  • A malignancy can irritate the nerves servicing the lining of the lungs and chest wall, triggering a sharp and sometimes chronic nerve pain.
  • Cancer spread (metastasis) from the lungs to the spine and bones is an occurrence shared by upwards of 30% of people with lung cancer.
  • Metastasis of cancer to the adrenal glands (occurring in 40% of people with lung cancer), can cause localized pain due to its location right above the kidney.

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.

It's important to note that back pain may be the first symptom not only of lung cancer, but of multiple myeloma, breast cancer, and others. For example, back pain is the presenting symptom (first symptom) for roughly 1% of people diagnosed with breast cancer.

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 breath, unintentional weight loss, chronic fatigue, or the coughing up of blood may further support the likelihood of lung cancer.

It's important to note, however, that the "typical" symptoms of lung cancer are less likely to be present with lung adenocarcinoma, and currently the most common symptoms are fatigue and shortness of breath with exercise (that can easily be dismissed as due to age or inactivity).

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% of people. The most common sites of spread are the spine (occurring in at least 50%) and large bones of the legs.

Cancer which has 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 that occurs with only minimal trauma.

Treating Back Pain

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, targeted therapy, immunotherapy, 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.

When Back Pain Requires Emergent Treatment

In some people who have metastases to their spine, a condition called malignant spinal cord compression may develop. The symptoms include worsening back pain, weakness of 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.

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 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.

Even in those who will ultimately be diagnosed with metastatic cancer, early diagnosis and treatment can help prevent fractures that can lead to disability. And given that the life expectancy for stage 4 lung cancer has been increasing (one recent study found that the median survival for people with stage 4 lung cancer with a particular genetic change was 6.8 years compared with roughly 1 year in the past ) quality of life is extremely important.

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