Back pain from pneumonia

Back pain is a common symptom of pneumonia. In the last 15 years, I have personally treated thousands of patients hospitalized with pneumonia. Many of them had back pain. I am writing this article based on my personal experience as well as a review of relevant medical journals.

In this article, I will describe:

  1. How pneumonia may cause back pain
  2. What back pain from pneumonia feels like
  3. What can you do for back pain with pneumonia
  4. When you need to be concerned about your back pain while recovering from pneumonia

If you would like to read about different types of pneumonia and their symptoms, click here.

If you would like to read about hospitalization for pneumonia, click here.

How does pneumonia cause back pain?

To understand how pneumonia causes back pain, you need to understand the nerve supply in your lungs. It is important to understand that there are virtually no pain receptors inside your lungs. You may have pneumonia without any chest pain at all.

A diagram showing that pneumonia away from the outer lining causes no pain, but pneumonia near the outer lining causes pain.
A diagram showing how the location of pneumonia leads to pain or no pain

As you can see in the picture, your lungs are covered by 2 layers of membrane-like lining, the inner lining and the outer lining. The inner lining goes in-between the fissures of your lungs. It doesn’t have any pain receptors. Pain receptors are only found in the outer lining of the lungs. The outer lining is attached to your chest wall, both in the front and in the back.

Pneumonia does not not cause any pain if it doesn’t lead to direct irritation of the outer lining of the lungs. When inflammation caused by pneumonia is closer to the surface, near your back, the outer lining at that spot may get irritated. This pain-sensitive outer layer is the reason you get back pain from pneumonia.

Inflammation from pneumonia must be closer to the outer lining of your lungs for you to have back pain.

What does back pain from pneumonia feel like?

Back pain from pneumonia is a pleuritic-type chest pain. Pleura is the medical name for the lining of the lungs. The pain is sharp because the outer pleura is very sensitive to pain. It gets worse anytime the outer lining gets stretched, which happens with coughs, deep breaths, and movement. Back pain from pneumonia feels like a deep-seated sharp pain in the back, usually on one side, unless you have pneumonia on both sides. The pain gets worse whenever you cough or take a deep breath.

What to do with back pain from pneumonia?

You need to control the back pain. It is not just a matter of comfort. Uncontrolled back pain from pneumonia makes it difficult to recover and also makes you vulnerable to more complications. You can start by taking some Tylenol. Ibuprofen or Naproxen can be taken on top of the Tylenol. The goal is to make your pain tolerable enough to be able to cough and take deep breaths regularly. If over-the-counter pain medications are not enough, you may have to ask your doctor for prescription pain medications to enable you to cough and take deep breaths comfortably. However, it is best to avoid opioids. They can make you drowsy and suppress your cough reflex.

When you have a severe, sharp pain in your back from pneumonia, you may avoid taking deep breaths. If you don’t take deep breaths, the lower part of your lungs may collapse. A collapsed lung can worsen your pneumonia and make you more short of breath.

Coughs are a very important weapon against pneumonia. They help expel dust, bacteria, phlegm, and dead cells out of your airway. When you have uncontrolled back pain, it hurts more when you cough. If you don’t cough, you can’t clear your airway. Some people take cough-suppressing medications when they have back pain from pneumonia. That is the wrong approach. You need to control the pain so that you can cough normally, not the other way around. If you don’t cough out your phlegm, it may go back down your air pipes and block them. Blocked air pipes will cause the collapse of more areas of the lungs, worsening your breathing.

Taking deep breaths and coughing normally are two very important things to help you recover from pneumonia.

When do you need to be concerned about back pain while recovering from pneumonia?

Back pain may be common with pneumonia, but not all back pain is normal or expected. Back pain may suggest new complications or problems that may need urgent medical attention.

Here are a few things you need to look out for:

  1. New back pain: If you develop a new back pain a few days after being diagnosed with pneumonia, it might not be normal.
  2. Sudden worsening of sharp back pain: If you had mild sharp back pains while breathing when diagnosed with pneumonia, but now it is suddenly worse, you need to be concerned.
  3. Back pain with worsening shortness of breath
  4. Back pain that makes you dizzy or lightheaded

The main complications you need to worry about with a new or worsening back pain while recovering from pneumonia are:

  1. A new air leak
  2. Formation of an abscess
  3. Fluids in the lungs
  4. A new blood clot in the lungs

In conclusion, back pain while coughing or taking a deep breath is a common symptom from pneumonia. It is important to control the pain so that you can keep coughing regularly and keep taking deep breaths to avoid complications.