Many people experience pain in the ribs of the back at some point. The pain may be sharp or dull and mild or severe. Mild injuries can cause pain in this area and may improve over time, with or without treatment.

However, this pain can sometimes indicate a more serious medical condition that requires specialist care. This is more likely if the pain is intense or there are other symptoms.

This article looks at some common causes of pain in the back of the ribs, as well as the associated symptoms and typical treatments.

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Injuries can cause back rib pain. Common rib-related injuries include:

If pain after an injury is lasting or severe, the cause may be a broken rib. To diagnose this injury, a doctor may use an X-ray or MRI.

Treatment options vary. Many people with broken ribs just need rest and pain relief medication. Surgical intervention is sometimes necessary, but only in severe cases.

An intercostal muscle strain is an injury to the muscles between the ribs. A strain occurs when these muscles tear, often due to strenuous physical activity.

Common symptoms of an intercostal muscle strain include:

  • sharp, severe pain in the upper back or ribs
  • stiffness and tension in the upper back muscles
  • spasms in the intercostal muscles

To treat this type of strain, doctors often recommend pain medication and physical therapy.

Costochondritis is inflammation of the cartilage that holds the ribs together. It is a common condition, particularly in adults aged 40–50, and it causes pain in the chest wall, sometimes at the back of the ribs.

The pain may be strong and sharp, and it may get worse when the person takes a deep breath. It may also worsen with movement.

Treatment may involve:

  • heat therapy
  • local or oral pain medications
  • capsaicin cream
  • physical therapy

For many people with costochondritis, the issue improves in a few weeks. However, because the symptoms can be similar to those of a heart condition, it is vital to speak with a doctor.

Preexisting conditions, such as osteoporosis, can weaken the ribs so that they break more easily, often during less intensive activities.

Osteoporosis causes the bones to lose the minerals that they need to stay strong. With a low mineral density, bones can fracture spontaneously or when the person is coughing. It is a common condition in older adults, especially in females.

The Centers for Disease Control and Prevention (CDC) report that 12.6% of adults over 50 had osteoporosis in 2017–2018. The figure for females only was 19.6%.

The symptoms of osteoporosis include soreness and pain. Healthcare professionals often diagnose the issue with X-rays. They may also test a person’s kidney and thyroid function.

Some treatment options for osteoporosis include:

  • doing gentle strength training
  • reducing alcohol consumption and cigarette smoking, if applicable
  • taking calcium and vitamin D3 supplements
  • taking medications that reduce the risk of fractures

Fibromyalgia causes widespread pain in the muscles and bones. People may also have specific tender points. Researchers are unsure what causes it, but it is more common in females than in males.

Beyond the pain, fibromyalgia often occurs with:

Because fibromyalgia has such diverse symptoms, doctors may recommend a variety of interventions, including:

Gallstones are hardened deposits in the gallbladder. They sometimes cause no symptoms, but they can also move and block the ducts of the gallbladder, leading to problems.

Gallstones can cause pain, especially when they block ducts. The classic presentation is pain in the upper right part of the stomach, under or around the ribs. Some people also feel the pain in their back, such as between their shoulder blades.

The pain may be intense, though it is mild for some people. It usually develops shortly after a meal and lasts for a few hours. A person may also have nausea and vomiting or jaundice. This yellowing of the eyes and skin signals that the gallstones are affecting the liver. It may also cause dark urine.

A blocked gallbladder duct can become a medical emergency. Anyone with gallstones should receive prompt medical attention for any intense abdominal pain, especially if there is jaundice.

A pulmonary embolism occurs when a blood vessel in a lung is blocked, often by a blood clot. A person may initially notice pain and swelling in one leg when the clot blocks a blood vessel there. If the clot breaks loose, it can travel to the lungs.

Pulmonary embolisms are serious and relatively common. Research shows that they are responsible for around 100,000 deaths per year in the United States, and this figure is rising.

Aside from pain in the back of the ribs, a pulmonary embolism can cause the following symptoms:

  • coughing, which may bring up blood
  • sweating
  • headaches and lightheadedness
  • shortness of breath
  • rapid breathing
  • anxiety
  • an irregular heartbeat

A pulmonary embolism is a life threatening emergency that requires immediate treatment.

Typically, treatment involves blood thinning medication, which makes it harder for clots to form. A person who cannot tolerate this approach receives a different medication that prevents the blood from clotting.

Certain health conditions that affect the lungs can also cause back rib pain.

For example, pleurisy, or inflammation of the lining of the lungs, can cause pain in the chest, shoulders, and back ribs. Researchers know that several underlying issues can cause pleurisy. For this reason, the treatments are varied.

Lung cancer can also cause pain in the chest and ribs. It is life threatening and a leading cause of cancer-related death in the U.S.

Other symptoms of lung cancer include coughing, which may bring up blood, and shortness of breath.

The best course of treatment depends on the cancer’s type and stage, as well as factors specific to each individual. A person may need to undergo surgery, chemotherapy, and radiation therapy.

A person should contact a doctor about back rib pain if:

  • The pain worsens.
  • It remains after a few days of home treatment.
  • It limits the ability to move.
  • It occurs with a fever, chills, vomiting, nausea, or other symptoms.

People who think that they may have gallstones should call a healthcare professional and ask if their symptoms are signs of an emergency. But anyone with intense gallstone pain should go to an emergency room.

In general, seek emergency treatment if:

  • The pain is so severe that it limits the ability to function.
  • It occurs with jaundice.
  • It occurs with trouble breathing, shortness of breath, or chest pain.
  • The person feels very sick.
  • Any symptoms rapidly worsen over several hours.

Minor injuries can cause pain in the back ribs. These injuries are not usually dangerous, and they often heal on their own.

However, this pain can also stem from a more serious health condition. This is especially likely if the pain is very intense, comes on suddenly, with no clear cause, or occurs with other symptoms. Prompt treatment can prevent serious complications and death.

Anyone with persistent or severe back rib pain should contact a healthcare professional.