What Causes Pain Around the Ribs and Back?

Pain around the ribs and back may be accompanied by other symptoms, depending on the cause. 

Symptoms that may accompany pain around the ribs and back due to a bruised or broken rib may include:

• Intense pain in the chest area
  • Pain may be worse when inhaling, coughing, or sneezing
• Swelling or tenderness around the affected ribs
• Bruising on the skin

Symptoms that may accompany pain around the ribs and back due to costochondritis and Tietze's syndrome may include:

• Localized pain and tenderness in the front of the chest that may:
  • Be variable, often sharp
  • Be confused with heart pain
  • Last from hours to weeks
  • Cause difficulty sleeping 
• Redness, tenderness, and warmth
• Tietze's syndrome also causes swelling over the ribs and cartilage near the breastbone (sternum)

Symptoms that may accompany pain around the ribs and back due to pleurisy (pleuritis) may include:

• Chest pain
  • Most common symptom 
  • Can range from sharp, stabbing pain, to a dull ache, or a burning sensation
  • Usually worse when inhaling deeply, sneezing, coughing, or moving 
  • Less when taking shallow breaths or lying on the painful side 
• Cough
  • May be dry or may contain sputum or blood
• Shortness of breath
• Shallow, rapid breathing
• Fever (depends on the cause)

The cause of pain around the ribs and back is diagnosed with a patient history and physical examination. Depending on the suspected cause, tests may include:

• X-ray
• Computerized tomography (CT) scan
• Electrocardiogram (ECG)
• Echocardiogram (“echo”)
• Pulse oximetry 
• Thoracentesis: removal of fluid from around the lung
• Blood tests to check for infection or certain proteins that could indicate a heart attack

Treatment for pain around the ribs and back depends on the cause. 

Most of the time, a bruised or broken rib will heal on its own within two to six weeks. Home remedies to help relieve pain and speed healing of pain around the ribs and back due to broken or bruised ribs include: 

• Rest 
• Stop activity that causes pain
• Protect the injured area
• Ice the affected area regularly to reduce swelling
• After two to three days, if swelling is gone, use a heating pad on low
• Take over-the-counter (OTC) pain medicines
• Sleep sitting up for the first few nights if possible
• Breathe normally
• Walk around and move the shoulders to help you breathe 
• Cough when you need to 
• Avoid:
  • Wrapping the chest with a bandage which could stop the lungs from properly expanding
  • Straining or lifting heavy objects
  • Sports or exercise that causes or worsens pain
  • Lying down or staying still for long periods
  • Smoking

Treatment for pain around the ribs and back due to costochondritis and Tietze's syndrome may include: 

• Rest
• Stop activity that causes pain
• Protect the injured area
• Ice the affected area regularly to reduce swelling
• Take over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs)
• Local lidocaine analgesic patch (Lidoderm) application
• Cortisone injections

Treatment for pain around the ribs and back due to pleurisy (pleuritis) includes: 

• Over-the-counter (OTC) and prescription pain relievers 
• Corticosteroids 
• Antibiotics to treat bacterial infections that cause pleurisy
• Blood thinners to dissolve blood clots that cause pain
• Thoracentesis to drain pleural fluid from around the lungs
• Chest tube to drain the air in a pneumothorax or to drain infection
• Stopping medication that is causing the pain
  • Never stop taking a prescribed medication without first talking to your doctor