Updated May 18, 2023.
Among the many medical causes of pain between the shoulder blades, GERD or Acid reflux disease are likely reasons.
This article will explore the possible association between this type of pain and these common GI problems.
Additionally, I will also provide a brief overview of other medical issues that could possibly contribute to interscapular pain.
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What is shoulder blade pain?
Also known as interscapular pain, this type of discomfort is common in the general population.
People suffering from shoulder blade pain experience varying degrees of discomfort, including muscle spasms, limited range of motion, weakness of the arm closest to the affected shoulder blade, and aching, dull, or sharp pain specific to the area in question.
Depending on the cause, the upper back pain can be intermittent or constantly present.
Why does GERD or Acid reflux cause pain between the shoulder blades?
Before we discuss the relationship between shoulder blade pain and acid reflux and GERD, we need to define these GI problems clearly.
While most people use the terms GERD and acid reflux interchangeably, there are clear distinctions between both.
The lower esophageal sphincter, or LES, is a muscle ring separating the stomach’s contents from the esophagus (see image below).
Normally, the LES closes after food passes through it from the esophagus.
This keeps the stomach’s acidic contents from backing up and irritating the sensitive mucosal tissue lining the esophagus.
However, in about 15 million people in the United States, this sphincter does not close properly.
The resulting predominant symptom people feel is a burning sensation in the chest area. This is what is commonly referred to as “heartburn.”
Gastroesophageal reflux disease or GERD, is a severe form of acid reflux disease where people have regular, consistent symptoms of acid reflux with no relief.
Some other common symptoms of GERD include upper abdominal pain, difficulty swallowing, a sensation of a lump in your throat, a sour taste in your mouth after waking up, and bad breath.
With the constant backflow of acidic stomach contents, damage occurs to the lining of the esophagus.
So, put another way, GERD is chronic acid reflux disease. Heartburn is a symptom of acid reflux disease and GERD.
Now that we have defined these important health problems, let’s address the connection between them and interscapular pain.
Why do people feel pain in an area that does not seem to be directly related to the stomach?
The explanation is referred pain, which is pain that is perceived at a location other than the actual site of damage.
Due to the extensive network of nerves that interconnect various organs and tissues, the pain signal sensed and interpreted by the brain is felt in the tissue nearby.
Specifically, the sensory nerves in the esophagus share the same ascending signal pathway to the brain as the phrenic nerves that communicate pain in the diaphragm and abdominal area.
In other words, GERD or acid reflux do not cause back pain; rather, the intensity of heartburn is so marked that the pain felt in the chest and esophagus will radiate to the area between your shoulder blades.
How to treat acid reflux back pain
To manage interscapular pain associated with GERD or acid reflux, you must control the underlying GI problems.
If the heartburn is alleviated, then you have removed the cause of the radiating pain to your back.
Acid reflux and GERD can be treated with a combination of diet, lifestyle, and medication options.
Certain medications, trigger foods, and lifestyle choices can worsen acid reflux and GERD. Some examples are:
- Nonsteroidal anti-inflammatory drugs (NSAIDS – ibuprofen, naproxen, etc)
- Tomatoes or food products containing tomatoes
- Spicy foods
- Eating large meals instead of spreading out food intake
- Tight-fitting clothing
- Lying flat in bed instead of at an incline
By making lifestyle changes and avoiding the triggers mentioned above, you can minimize experiencing the symptoms of heartburn.
For example, you can try eating “GERD-safe” foods such as oatmeal, bananas, green vegetables, root vegetables, melons, yogurt, and foods with high water content.
Other treatment modalities can include gentle stretching to ease tension in the rhomboids and surrounding muscles between the shoulder blades.
One effective yet simple exercise you can do anywhere is to bring your straightened right arm directly in front of you, place your left hand on your right elbow, and gently pull it toward your left side.
Hold the stretch for at least 30 seconds, breathing slowly and deeply. You should feel a really nice stretch in your shoulder blade area. Repeat the same stretch with your left arm.
Targeted back-strengthening exercises help create stability in the back area and help with faster recovery. Resistance band pull-aparts are great for this purpose.
Choose a resistance band you can comfortably pull apart with your hands, stand or sit upright, hold the band out directly in front of you at shoulder width, and gently pull it apart.
Bring it back to the starting position, and repeat it 10 – 15 times. Rest for one minute, and repeat the exercise one more time. You can do this 2 to 3 times a week.
You should feel good resistance in your scapular area, but don’t overdo it!
Medication management of GERD and Acid reflux
However, these symptom-reduction strategies may not be enough for most people. This is likely true for people suffering from GERD or severe acid reflux.
In these situations, medication therapy may be the best option.
There are many prescription and over-the-counter (OTC) medications available for treating acid reflux disease and GERD:
These inexpensive options work for occasional heartburn. Common examples are Tums and Rolaids. The thing to remember about these products is that they work for a very short time, usually only 30-60 minutes before the heartburn symptoms return.
The reason is that they do not work to reduce stomach acid directly, but rather form a temporary bubbly layer on top of your gastric contents. When these bubbles dissipate inside your stomach, the heartburn returns.
A longer-acting treatment option is the use of H2 receptor antagonists. These medications can be purchased over-the-counter and work by binding to the receptors in your stomach involved in acid production.
They work quickly, usually within 30 minutes to alleviate your heartburn symptoms.
Common examples are Pepcid and Tagamet.
Proton pump inhibitors (PPIs)
The best class of drugs used to treat frequent, persistent, or severe heartburn and GERD are the proton pump inhibitors or PPIs.
These drugs are among the most commonly prescribed medications in the U.S.
They work well because their site of action in the body is directly where stomach acid is produced, the hydrogen-potassium ATPase pump.
If you decide to try a PPI, please consult your doctor first, as they may interfere with your prescription medications. However, most of these interactions are not clinically significant, and PPIs can be taken relatively safely.
Another important point to note is to ask your doctor if your symptoms are consistent with GERD vs. Gastritis. If you wish to learn more about this topic, you can read my article here.
Also, it is important to note that these medications take 1-4 days to take full effect, unlike the H2 antagonists – so you need to give them time to work.
If you are considering PPI therapy (some people refer to them as the purple pills for acid reflux), ask your doctor if they are comfortable with you starting dual treatment with the PPI and an H2 antagonist for the first week.
This way, the H2 antagonist provides immediate, consistent benefits until the PPI achieves therapeutic levels in your body.
As of the second week, you can stop taking the H2 antagonist and continue with the PPI.
This regimen must be approved and overseen by your doctor. If your doctor suspects that you have GERD, a proper diagnosis must be completed first. If GERD is confirmed, proper treatment options must be initiated. This is because untreated GERD can cause esophageal cancer.
Examples of OTC PPIs are Prilosec and Nexium (the purple pill).
Other causes of pain between the shoulder blades
As with any other part of the body, any damage or injury to a muscle or tendon in the general area of the shoulder blades can bring about pain.
Muscle strain: This is perhaps the most common cause of scapular pain. Any heavy lifting or intense workout, poor posture, sitting at the computer for extended periods of time, or even sleeping in an atypical position can trigger this type of pain.
Injuries: Any injury to muscle or tendon in and around the general area of the shoulder blades can be felt as pain here as well. As I mentioned above in my discussion above about the relationship between interscapular pain and GERD/acid reflux disease, referred pain can result.
Examples of such injuries are rotator cuff tears, injuries to the shoulders, or even spinal fractures.
Other types of musculoskeletal injuries are:
- Arthritis in the neck, spine, or ribs
- Herniated disc
- Spinal stenosis or compression of the spinal cord, usually due to age-related disc degeneration
- Cancers (liver, esophageal, bone, lung, blood, etc)
The following life-threatening events can also result in pain to be felt between the shoulder blades:
- Pulmonary embolism (PE) is where a blood clot or clots from the legs break off and travel to the lungs in your bloodstream. Pain is felt as a sharp, sudden, and severe pain in the upper back. Usually, this is accompanied by shortness of breath.
- Heart attack (myocardial infarction) – shoulder blade pain may be an active heart attack symptom. This type of pain is reported by women especially. Just like in a PE, the person may experience shortness of breath.
- Aortic tear (aortic dissection) – The aorta is a large blood vessel branching off directly from your heart, supplying life-sustaining blood to the rest of the body. When there is a rupture or tear of this artery, the person may experience sharp and severe pain in their upper back.
Any of the three causes mentioned above are emergencies, and immediate medical care must be sought to prevent loss of life.
You should seek immediate medical attention, ESPECIALLY if you or a loved one are experiencing the following symptoms in addition to pain between the shoulder blades:
- Pounding or rapid heartbeat
- Profuse sweating (a sign of a heart attack)
- Dizziness/lightheadedness (a sign of heart attack)
- Painful swelling or reddish discoloration in your legs, skin feels warmer than usual (signs of a blood clot and impending PE)
- Sudden slurring or difficulty speaking (a sign of stroke)
- Sudden loss of eyesight (a sign of stroke)
- Paralysis of one side of the body (a sign of stroke)
- Losing consciousness
- Hemoptysis (coughing up blood)
- GERD and Acid reflux can cause referred pain in the area between the shoulder blades.
- Musculoskeletal and cardiovascular problems can also cause interscapular pain.
- Interscapular pain caused by GERD and acid reflux can be managed by treating the underlying medical problems.