Published by PMR of NY & CT
Back pain is common, so when it shows up alongside a burning ache in your upper stomach, you may wonder whether the two are connected. Can ulcers cause back pain? Sometimes, although back pain is not the usual way an ulcer shows itself.
Peptic ulcers, often called stomach ulcers, are sores where acid has worn away part of the lining of the stomach or duodenum, the upper end of the small intestine. Most ulcer pain stays in the upper belly. Pain that spreads to the back is less common, and when it is sudden or severe it can signal a complication that needs emergency care. Back pain with stomach symptoms deserves a doctor's visit.
Can ulcers cause back pain? How it happens
When ulcer pain reaches the back, it often means the ulcer has gone deeper:
- Penetration: an ulcer on the back wall of the stomach or duodenum can burrow into the pancreas or another nearby organ. The pain tends to become steadier and more intense and is felt in the back.
- Perforation: an ulcer that breaks all the way through the wall causes sudden, severe belly pain that spreads across the abdomen and is sometimes felt in one or both shoulders. This is a surgical emergency.
The most common causes of peptic ulcers are infection with the bacterium Helicobacter pylori (H. pylori) and regular use of nonsteroidal anti-inflammatory drugs (NSAIDs).
Stomach or spine? Clues to the source
No checklist replaces an exam, but patterns help.
Pain may be coming from your stomach when it:
- Comes with a burning or gnawing upper belly ache, nausea or bloating
- Changes with meals, an empty stomach or antacids
- Isn't set off by lifting, bending or twisting
Pain is more likely to come from muscles, joints or discs when it:
- Started after lifting, twisting, a long drive or a new activity
- Flares with certain movements and eases with rest
- Travels down a leg with tingling, as with sciatica
Emergency warning signs
Call 911 or go to an emergency department if you have:
- Black, tarry or bloody stools
- Vomiting blood, or vomit that looks like coffee grounds
- Sudden, sharp belly pain that doesn't let up, especially with a hard, rigid belly
- Lightheadedness, fainting or a racing heartbeat with stomach pain
- Chest pressure or pain, trouble breathing, or pain moving into your arm, neck or jaw
- Sudden, severe tearing pain in your back or belly
See a doctor promptly for back pain with fever, ongoing upper belly pain, repeated vomiting, trouble swallowing or unexplained weight loss.
Other causes of belly and back pain together
Other conditions can also cause pain in both places:
- Pancreatitis: severe upper belly pain that bores into the back, often with vomiting
- Gallbladder problems: upper right belly pain that may spread to the right shoulder or between the shoulder blades, often after a heavy meal
- Kidney stones or infection: pain in the side and back, sometimes with fever or painful urination
- Heart attack: can feel like indigestion, with pain in the back, jaw or arms, especially in women, older adults and people with diabetes
When back pain medicine is part of the story
Often the link runs the other way. Many people with a sore back reach for NSAIDs such as ibuprofen, naproxen or aspirin, and taken regularly, these medicines can damage the stomach lining and lead to ulcers.
Your risk is higher if you are older, take them at high doses or for a long time, take blood thinners or steroids, or have had an ulcer before. Talk with your doctor about safer options, but don't stop a prescribed medicine, such as daily aspirin for your heart, on your own.
Who to see first
If back pain comes with stomach symptoms, start with your primary care doctor or a gastroenterologist. Testing may include a breath or stool test for H. pylori, or an upper endoscopy, a camera exam of the stomach. Antacids may ease symptoms for a while, but they don't treat the cause.
If your doctor rules out an internal cause, a musculoskeletal evaluation makes sense for pain that acts like a muscle or joint problem. Read about our care for upper back pain and lower back pain, or how our physiatry and pain management team coordinates care.
Frequently asked questions
Can ulcers cause back pain without stomach pain?
It is uncommon. Most people with ulcer-related back pain also have upper belly pain, indigestion or nausea. Back pain alone that flares with movement and eases with rest more likely comes from muscles, joints or discs. Some people, particularly older adults, have ulcers with few or no symptoms, though, so mention any digestive changes to your doctor.
What can I take for back pain if I have an ulcer?
Ask your doctor first. People with ulcers are usually told to avoid NSAIDs such as ibuprofen and naproxen, and acetaminophen is often suggested instead, used exactly as the label directs. If you need to keep taking an NSAID, your doctor may also prescribe an acid-reducing medicine. For low back pain, a 2017 American College of Physicians guideline recommends trying non-drug treatments first, such as heat, exercise, massage, acupuncture or spinal manipulation.
Can a chiropractor help with back pain from an ulcer?
Not if the ulcer is the source. Adjustments, massage and exercise don't heal an ulcer; that takes medical treatment. A chiropractor or physical therapist should watch for signs that back pain may come from an internal problem, such as indigestion, nausea, weight loss or pain that doesn't change with movement, and refer you to a physician. Black stools or vomiting blood need emergency care, not a back appointment.
Talk with our team
Once your physician has ruled out an ulcer or other internal cause, Physical Medicine & Rehabilitation of NY & CT (PMR) can help with back pain from muscles, joints and discs, using hands-on care, exercise and pain management. Request an appointment and our team will contact you to schedule your visit.
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