Pain in your upper abdomen and back typically signals a problem with an internal organ in the affected area. The pain usually originates in the problematic organ and radiates to the back. Several medical conditions can elicit this pain pattern. The organs most likely to be involved include the gallbladder, pancreas, kidneys, stomach and small intestine.
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Sudden pain in the right upper abdomen that radiates to the back near the right shoulder blade might signal a problem with your gallbladder. Biliary colic describes gallbladder pain lasting less than 6 hours caused by temporary blockage of a duct that allows bile to drain from the gallbladder into the small bowel. Pain that lasts longer than 6 hours usually indicates acute cholecystitis, or inflammation of the gallbladder due to persistent blockage of the drainage duct. Repeated attacks of biliary colic or acute cholecystitis can lead to a condition called chronic cholecystitis. With each of these conditions, duct blockage usually occurs due to gallstones. Nausea, vomiting and low-grade fever often accompany upper abdominal and back pain during a gallbladder attack.
Pancreatic disease commonly elicits pain in the center of the upper abdomen with radiation to the back. Inflammation of the pancreas, or pancreatitis, is a possible culprit. With acute pancreatitis, steady severe pain develops suddenly or over a few days often accompanied by nausea, vomiting, clammy skin, and rapid heart and breathing rates. With chronic pancreatitis, the pain is typically less severe and occurs more intermittently, usually after meals. The pain episodes recur over time and might be accompanied by symptoms of failing pancreatic function, such as weight loss, fatigue, abdominal bloating, excess intestinal gas and greasy stools. Cancerous or noncancerous pancreatic tumors can also potentially cause central, upper abdominal and back pain.
Your kidneys reside behind the upper abdominal organs to either side of the spine, partially protected by the lower rib cage in the back. Kidney stones and infections can cause upper abdominal and back pain on the right or left, depending on which kidney is affected. With a kidney stone, the pain tends to be more sudden and severe than typically occurs with a kidney infection, or pyelonephritis. Fever, chills, increased urinary frequency and burning with urination commonly accompany upper abdominal and back pain with pyelonephritis. Additional signs and symptoms that might occur with a kidney stone include blood in the urine, clammy skin, and nausea with or without vomiting.
Peptic Ulcer Disease
With peptic ulcers disease, erosions develop in the lining of the stomach or the first part of the small intestine, the duodenum. Ulcers that erode through the wall of the stomach or duodenum and cause a hole, or perforation, characteristically cause intense pain in the central or left upper abdomen. This pain often radiates to the central or shoulder area of the back, depending on the site of the perforation. Ulcers that have not perforated often cause intermittent, gnawing upper abdominal pain but back pain is absent.
The conditions discussed represent some of the most common ailments associated with upper abdominal and back pain but other conditions might also provoke these symptoms. Examples include:
- Atypical presentation of a heart attack
- Inflammation of the sac around the heart, or pericarditis
- Tearing of the inner wall of the aorta, or aortic aneurysm dissection
- Atypical presentation of a lung blood clot, or pulmonary embolism
- Esophageal inflammation or cancer
- Spleen enlargement or injury
- Collection of pus in the liver, or a liver abscess
- Inflammatory bowel disease with associated spinal arthritis
Warnings and Precautions
Because upper abdominal and back pain can signal a potentially serious or life-threatening condition, contact your doctor right away if you develop these symptoms. Seek immediate medical care if your pain began after a blow to the chest, back or abdomen, is severe or worsening, or accompanied by any warning signs or symptoms, including:
- Chest pain, pressure or discomfort
- Jaw, neck or arm pain
- Shortness of breath or difficulty breathing
- Fever, chills or clammy skin
- Rapid heart and/or breathing rate
- Nausea and vomiting
- Dizziness, lightheadedness or fainting
- BMJ: Acute Cholecystitis
- Merck Manual Professional Version: Acute Pancreatitis
- Merck Manual Professional Version: Chronic Pancreatitis
- Merck Manual Professional Version: Peptic Ulcer Disease
- Surgery: Basic Science and Clinical Evidence, 2nd Edition; Jeffrey Norton, et al.
- American Family Physician: Evaluation of Acute Abdominal Pain in Adults