Back pain is a common symptom that a lot of people experience. However, if you have an underlying lung disease, you may additionally experience worsened back pain when coughing. A painful lower back hurts during a coughing fit may signal a problem with the spine and related bones, muscles, or joints. Read on to learn more about back pain when coughing, what may cause your back to hurt when you cough, treatment options, and when it may be time to consult your doctor.

Causes of Back Pain When Coughing

When you cough, various muscles tighten and relax, putting strain on the bones they are attached to. Normally, this is painless. However, numerous conditions may cause back pain when you cough. Most commonly, it is due to problems with the parts that make up your spine – the bones, muscles, and joints. Here are some of the reasons why your back hurts when you cough¹:

• Strain or injury to your back muscles, ligaments, or tendons – Because the spine supports most of the body’s weight, it can be prone to a lot of stress. Coughing increases the pressure placed on the back, which can lead to pain and inflammation.
  
• Spinal stenosis – This condition involves narrowing of the spinal canal (the opening where the spinal cord runs through). Pressure and discomfort may arise due to this constriction. Because coughing adds to this already increased pressure, this may lead to aggravated back pain.
  
• Spinal disc herniation – The bones of the back (the vertebrae) are separated by discs that function to decrease the pressure on the spine. However, if these discs become compressed, they tend to herniate (bulge outward). This can lead to pain, numbness, tingling, and muscle weakness. Coughing can worsen this inflammation and discomfort.
  
• Costochondritis – This condition is due to inflammation of the cartilage that connects your ribs to the sternum (breastbone). Pain usually occurs after strenuous activities like exercise. When you cough, this causes friction and movement of the inflamed parts, which can worsen the pain.
  
• Sacroiliac joint irritation – The sacroiliac joint connects the lower spine to the pelvis (hip bone). It may become irritated due to frequent strain and improper posture, leading to lower back pain. Cough can worsen the underlying inflammation, and cause pain through juddering the spine and moving the sacroiliac joint.
  
• Pregnancy-related lower back pain – Women often experience numerous aches and pains during the course of their pregnancy. The fetus adds to the weight in front of the body, which in turn can stretch and strain the muscles of the back. This means the back muscles and structures have to work harder to support the growing weight. Hormones can also contribute to the instability of the lower back and pelvis. If the pregnant woman is coughing, this can also add to the discomfort.

Clearly, back pain when coughing can occur due to numerous causes. The common denominator is usually strain or injury of the back, which leads to inflammation and pain. Coughing adds to this negative mix due to the movement involved in tensing and relaxing muscles around the lungs, causing further discomfort. Having an idea of these causes can lead to better insight into your condition and also provide important clues for your healthcare provider later on. It is important then to take note of your symptoms, when and where they arise, and any other symptoms associated with your back pain when coughing.

Treatments for Back Pain When Coughing

Back pain when coughing can be a disruptive nuisance in everyday life. Here are some home remedies you can try to relieve the discomfort²³:

• Apply a warm compress for 10–15 minutes several times a day on the affected area.
• Take pain relievers like ibuprofen or acetaminophen to alleviate discomfort.
• Low-impact activities, such as walking or swimming, can help reduce tension in the back and relieve inflammation.
• Practice “bracing” techniques, such as putting a pillow over the stomach during a cough, to reduce the pressure and movement that causes pain.
• Use lumbar support to reduce injury to the lower back – Lumbar chair support can help keep the back stable and promote good posture. Adding a pillow under your knees while you sleep also reduces arching of the back and lessens muscle strain.
• Avoid prolonged rest – While it may be tempting to avoid movement due to discomfort, it is important to stay active to improve overall circulation to the body and facilitate healing.
• Replace your mattress, especially if it is old or sagging – Improved back support can make all the difference when it comes to back pain.
• Stress management is important, as physical and emotional stress can compound any existing conditions in the body – Try breathing exercises, journaling, yoga, and mindfulness techniques to combat stress.
• Wear appropriate shoes – Ill-fitting shoes can negatively impact your whole body, including your back. Choose footwear with proper arch support, that fits you well, and has adequate cushions to reduce impact.

These are simple but effective ways to help manage back pain when coughing. Taking these small measures can alleviate discomfort and promote better health and improved quality of life in the long run.

Medications for Back Pain When Coughing

There are numerous medications⁴ that can help alleviate back pain when coughing. Over-the-counter pain relievers like ibuprofen and acetaminophen are good options to help relieve back pain. If these do not sufficiently relieve the pain, it may be prudent to consult your doctor for a prescription.

Stronger medications include non-steroidal anti-inflammatory drugs (NSAIDs). Muscle relaxants may also lessen the tension of the lower back muscles and relieve pain. For chronic pain, antidepressants like amitriptyline and duloxetine are now being considered viable options⁵. Steroid injections may also be administered to the affected parts to relieve pain quickly but may not be for everyone. They are also associated with several side effects like bleeding and infection. Lastly, topical creams and patches may be applied to the affected areas to numb the pain and provide relief.

Consult your doctor for the most appropriate medication for your back pain when coughing. 

Alternative Treatments for Back Pain When Coughing

Physical Therapy

Physical therapy⁶ is a good long-term treatment option and can provide effective relief. Physical therapy is usually given through sessions with a physiotherapist, who generally provides an appropriate exercise regimen that will not only strengthen the muscles supporting the back but also give recommendations on how to maintain proper posture.

Acupuncture

Acupuncture is also another treatment option, which involves fine needles that are used to stimulate the body. This leads to improved circulation and may reduce muscle spasms, stiffness, and pain, although the evidence is mixed⁷⁸⁹.

Transcutaneous Electrical Nerve Stimulation (TENS)

Lastly, transcutaneous electrical nerve stimulation (TENS) is a treatment modality that physical therapists use to reduce muscle tension and pain via electrodes that send mild electric currents to your body. There is currently some evidence that TENS can relieve acute pain¹⁰, such as from injury, but there is currently not much evidence for its effect on chronic pain¹¹.

Surgery

In cases where back pain when coughing is not relieved by more conservative measures, surgery may become a treatment option. There are several surgeries available to address back pain, depending on the cause of the pain and the side effects of the surgery. These include¹²:

• Laminectomy – The lamina (roof of the vertebrae) is removed in this procedure. It aims to relieve pressure on the spinal cord and nerves.
• Spinal fusion – Misalignments in the spine can be corrected by fusing joints of two or more vertebrae by using metal rods and screws. 
• Diskectomy – This surgery removes the bulging or herniated disc that is causing pain and discomfort in the lower back.
• Artificial disc replacement – This is a minimally invasive surgery where an artificial disk is used to replace one of yours with the goal of relieving pressure on the lower back.

While there are numerous treatment options, the decision will ultimately depend on your age, health condition, and severity of symptoms. You and your doctor will have a comprehensive discussion on the pros and cons of each treatment until you decide which option would suit you best. It is important to keep your long-term health in mind and choose what is best for your quality of life. 

When to Go to The Doctor

Back pain when coughing that lasts longer than two weeks could signal a more serious underlying condition. Here are signs and symptoms that should prompt you to consult your doctor immediately¹³:

• Constant pain that worsens at night
• Fever
• Loss of bladder and bowel control
• Numbness, weakness, or tingling of the lower extremities
• Pain resulting from trauma, like a fall
• Throbbing pain in the abdomen
• Unintentional weight loss

These are signs that there could be multiple factors at play that are compounding your condition. The sooner you consult your doctor when these symptoms arise, the earlier they can be managed.

Summary

Back pain when coughing can be due to multiple conditions, usually associated with problems in alignment or strain of the parts of the back, whether it’s the muscles, bones, or joints. Coughing compounds back pain by causing movement and friction of the already inflamed and painful parts. Home remedies can provide simple solutions to troubleshoot back pain in the day-to-day. Long-term solutions include physical therapy, acupuncture, and TENS. Lastly, if the back pain when coughing does not respond to these, surgery may become an option. Work closely with your doctor to determine the cause of your back pain when coughing and the best treatment option for you.

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Mikaela Millan

Mikaela is a dentistry clinician at the University of the Philippines.