When Back Pain Is a Symptom of Lung Cancer

Pain often has characteristic features that set it apart

man holding his back and sitting on exam table
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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 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.

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 share 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 possibilities include:

  • The direct pressure a tumor can place on the structure of the back, more often than not, 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 

Symptoms That May Suggest Lung Cancer

The symptoms of back pain related to lung cancer are diverse but have certain tell-tale signs. If it involves the spine, it can mimic many of the symptoms of an upper back injury.

If it doesn't, the 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 (usually only on one side) or describe feeling like they've just had been "kidney punched."

Other red flags 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 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 tell-tale 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.

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 medications known as bisphosphonates (used to treat osteoporosis) usually provide significant pain relief.

In the end, there are many effective ways to 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.

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. 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.

Sources:

Henson, L., Gomes, B., Koffman, J. et al. Factors associated with aggressive end of life cancer care. Supportive Care in Cancer. 2016. 24(3):1079-89.

Xiong, J., and P. Zhang. Cauda equina syndrome caused by isolated spinal extramedullary-intradural cauda equina metastasis is the primary symptom of small cell lung cancer: a case report and review of the literature. International Journal of Clinical and Experimental Medicine. 2015. 8(6):10044-50.

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