Although 39 percent of all adults experience back pain each year, according to a 2019 study, the cause of that pain is rarely cancer. The far more likely culprits are arthritis, disc deterioration, inflammation, muscle knots, or injury.
So how do you determine whether there is cause for concern?
How does back pain caused by cancer differ from non-cancerous back pain?
It is often impossible to tell the difference between back pain caused by cancer and that caused by other sources because swelling from either a tumor in the vertebra or general inflammation exerts pressure on the nerves of the spine, producing the same type of pain. The difference is in the duration of the pain, the accompanying symptoms, and what types of activities trigger the pain.
When the cause is caused by cancer, the pain often:
- Doesn’t seem to be related to movement
- Occurs mostly at night or early morning and gets better during the day
- Persists even after physical therapy or other treatments
- Is accompanied by fatigue, sudden weight loss, or other symptoms depending on the type of cancer.
Which cancers are most likely to produce back pain?
Back pain can be a symptom of any cancer that has metastasized (spread) to the bones of the spine, but several cancers can also cause back pain before they spread. The most common are:
Lung cancer: Approximately 25 percent of all people with lung cancer experience back pain. In many cases, it’s the first symptom of the disease. A tumor in the lungs can produce back pain without spreading when it puts pressure on the nerves of the spine or directly grows into the bones and nerves in the chest wall or spine.
When back pain is caused by lung cancer, it is often accompanied by one or more of the following symptoms:
- A cough that persists for more than two weeks
- Difficulty breathing
- Pain when breathing
- Recurrent chest infections
- Coughing up blood
Colon cancer: Cancer of the colon — as well as other parts of the gastric system such as the stomach and rectum — can cause back pain when the tumor infiltrates nerves near your spine and causes pain that radiates from the site of the tumor to the back. When colon cancer is the cause of back pain, it is often accompanied by a change in your bowel habits including diarrhea, constipation, cramps, or blood in your stool. Other symptoms include fatigue or sudden weight loss.
Spinal cancer: Tumors in the spine are not always cancerous, but even non-cancerous tumors can cause back pain when they pinch nerves or expand to the point that they fracture vertebrae. The vast majority of spinal cancers begin in other parts of the body and metastasize (spread) to the bones of the spine. Unlike other types of back pain, which can be quite sudden, pain from a cancerous tumor usually develops gradually. It doesn’t improve with rest and often intensifies at night. Once established, it can flair up as shooting pain in the neck, arms, or lower back and legs.
Breast cancer: Although back pain is a rare symptom of breast cancer, it can cause back pain if the cancer metastasizes to the lymph nodes near your spine or into the vertebrae next to the spinal cord
Testicular cancer: Testicular usually doesn’t cause back pain unless it metastasizes to the lymph nodes in the back part of your pelvis or abdomen, near your spine. More typical signs of testicular cancer include swelling of either testicle, a feeling of heaviness in the scrotum, a dull ache in the lower belly or groin, or testicular pain.
Can cancer treatment cause back pain?
Yes. Some people who had no back pain at the time of diagnosis develop back pain as a result of certain cancer treatments, especially chemotherapy. For example, trastuzumab (Herceptin), a hormone therapy used to treat some breast and gastric cancers, can cause back pain that begins from the time of treatment to weeks later.
Back pain may also be a lasting issue for cancer survivors. Back pain does not necessarily mean the disease has spread, but it is still good to check with your doctor if you experience any new issues. If the pain is from cancer in your spine that was treated, but not eliminated, your oncology team can still work with palliative care experts, who focus on symptom relief, to try to alleviate your back pain. They are likely to try opioid or non-opioid medications, certain antidepressants, physical therapy, braces, acupuncture, yoga, meditation, relaxation, nerve blocks, or surgery. Often, back pain not from active or treated cancer lessens with regular exercise, stretching, and maintaining a normal weight.
It is important to remember that wanting to control pain is not a sign of weakness. It is a way to help you feel better and stay active.
About the Medical Reviewer
Dr. Abrahm is a national leader in the field of palliative care and a professor at Harvard Medical School. She received her MD from the University of California at San Francisco, completed her internship and residency at the Massachusetts General Hospital, and served as a chief resident at Moffitt Hospital of UCSF. After completing her fellowship in hematology/oncology at the Hospital of the University of Pennsylvania, she stayed on to work there for twenty years. In 2001, Dr. Abrahm joined Dana-Farber Cancer Institute, as a fulltime palliative care physician, founding the Adult Palliative Care service there and at Brigham and Women's Hospital. Since 2008, she has been part of a research team now focused on developing an electronic, rule-based clinical decision support system (CDS) for EHRs that leverages national clinical practice guidelines to improve the evaluation and management of symptoms during and following cancer treatment. The 4th edition of her book, "Comprehensive guide to Supportive and Palliative Care in Cancer Patients" will be published in 2022.