Modern medicine explains these observations through the concept of referred pain, where internal organ issues manifest as pain in completely different areas. Back pain caused by digestive system disorders is a frequent complaint, arising from our neurological complexity.
Our nerves can be broadly divided into two types: somatic nerves, which handle sensations from the skin, muscles, and joints, and visceral nerves, which process sensations from internal organs like the stomach, heart, and lungs. These two types of nerves converge at certain points in the spinal cord. When pain signals from visceral nerves mix with signals from somatic nerves and travel to the brain, the brain can misidentify the true origin of the pain. This is why a stomach problem can feel as if the back muscles are hurting.
Several specific conditions illustrate this process.
First are conditions such as reflux esophagitis and gastritis. When the esophagus or stomach is irritated by inflammation, these pain signals can travel along the spinal nerve to the chest and back. Particularly in reflux esophagitis, pain originating in the esophagus can appear not only in the epigastrium, but also as stiffness or burning between the scapulae or in the mid-back (the T4-T8 thoracic ganglion region). With gastritis, epigastric pain often spreads to the inside of the left scapula or the mid-back. This occurs because the pathways of sympathetic nerves distributed across the stomach and esophagus connect to those segments of the spinal cord.
Next, cholelithiasis and cholecystitis can also induce back pain. When the gallbladder becomes inflamed or a gallstone blocks the biliary tract to trigger pain, it usually appears in the right upper abdomen, but it commonly radiates to the right shoulder or back, especially beneath the right scapula. This happens because pain signals from the gallbladder travel through the phrenic nerve and link with cervical nerves C3-C5 and the thoracic spinal nerve (T5-T9).
A more serious example is pancreatitis. Pancreatitis characteristically begins in the epigastrium and presents as severe pain across the entire back, particularly above the waist. The pain can be severe enough that leaning forward tends to relieve it. The pancreas sits behind the stomach and connects closely with the thoracic spinal nerve (T5-T10), causing strong referred pain toward the back.
Back pain stemming from such digestive disorders is easily mistaken for simple muscle pain or a spine problem. Many patients feel frustrated when they visit a clinic for back discomfort, undergo magnetic resonance imaging or an x-ray, and are told everything is normal. In reality, it is not a structural back issue, but a signal sent from within the digestive system.
Furthermore, chronic stress affects the autonomic nervous system, worsening stomach function and lowering the intestinal pain threshold, which can make referred pain feel even more severe. This is also described through the gut-brain axis: stress impairs gastrointestinal motility and reduces digestive secretions, causing chronic dyspepsia, which then feeds into a vicious cycle leading back to back pain. Back pain is often not simply an isolated back issue, reflecting how intricately the body is connected.
