What could be the causes of pain in the middle of the back?

Reviewed by Yoshinori Abe, MD

Internal Medicine

Middle back pain is most often caused by muscle strain or a bone-related issue in the spine, such as poor posture, injury, or degenerative changes. Less commonly, mid-back pain can signal a problem with internal organs, including the stomach, pancreas, kidneys, or aorta. Because the causes range from minor and self-limiting to potentially serious, identifying the source of your pain is important for choosing the right next steps.

If you're unsure what's behind your middle back pain, take a free, instant, online symptom check to get personalized insight into possible causes and guidance on when to see a doctor. It only takes a few minutes, requires no sign-up, and can help you approach your care with clarity and confidence.

Reviewed for medical accuracy: 07/14/2026

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Discover causes of your middle back pain See if middle back pain needs care Find out what’s causing your back pain Compare OTC relief for middle back pain Find a doctor for back pain Understand home remedies for middle back pain Check if back pain could be serious

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Explanation

There are instances where back pain is caused by the muscles or bones around the back, and cases where the cause is caused by deeper internal organs.

Muscle and bone problems

Achy muscles or bones can be a result of injury, overexertion, or long-term wear-and-tear.

Internal organs near the back

Issues with the stomach (ulcer, acid reflux), pancreas (inflammation), kidneys (stones, infection), or aorta can also lead to pain in the middle of the back. For example, in a disease called an aortic aneurysm, the aorta swells like a lump. This leads to pressure on the middle of the back and causes pain when it becomes large or is about to burst. This is very uncommon in young, healthy populations but should be considered in older people or those with many cardiovascular risk factors. If you're experiencing persistent middle back pain and want to understand what might be causing it, try our free AI symptom checker to get personalized insights based on your specific symptoms.

(References)

Johansson MS, Jensen Stochkendahl M, Hartvigsen J, Boyle E, Cassidy JD. Incidence and prognosis of mid-back pain in the general population: A systematic review. Eur J Pain. 2017 Jan;21(1):20-28. doi: 10.1002/ejp.884. Epub 2016 May 5. PMID: 27146481.
Casiano VE, Sarwan G, Dydyk AM, et al. Back Pain. [Updated 2023 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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