Your Stomach Ulcer Might Be Causing Your Back Pain—Here's Why

Yes, a stomach ulcer can absolutely cause back pain. Research shows that 31.4% of patients with duodenal ulcers (in the small intestine) and 41% of those with gastric ulcers (in the stomach) experience back pain as a symptom. This happens because of referred pain—when nerves from your stomach and back share pathways to your spinal cord, your brain can misinterpret where the pain is actually coming from.

Can a Stomach Ulcer Really Cause Back Pain?

Most people assume back pain comes from muscle strain, a herniated disc, or spinal issues. But if you have a peptic ulcer—an open sore in your stomach or the upper part of your small intestine—it could be the hidden source of your discomfort. The connection isn't obvious because the pain travels through your nervous system in unexpected ways.

Peptic ulcers develop when the protective lining of your stomach or small intestine breaks down, exposing the tissue underneath to stomach acid. This creates inflammation and pain. But here's the surprising part: if that ulcer is located on the back wall of your stomach or duodenum, it can irritate nerves that also supply your back, causing pain to radiate there instead.

How Does Referred Pain Work?

Referred pain happens because of how your nervous system is wired. When you have an ulcer, pain signals travel from your stomach through sensory nerves to your spinal cord. At the spinal cord, these visceral sensory fibers (which carry signals from internal organs) mix with somatic sensory fibers (which carry signals from your skin and muscles). Your brain can't always tell the difference, so it interprets the pain as coming from your back instead of your stomach.

"The pain associated with peptic ulcers can radiate to the back, a phenomenon attributed to the shared innervation of the ulcer site and the back," explains the research from Liv Hospital. The deeper or more severe the ulcer, the more likely it is to cause back pain, especially if it penetrates through the stomach or intestinal wall.

What Are the 5 Alarming Signs Your Back Pain Might Be From an Ulcer?

Ulcer-related back pain has distinct characteristics that set it apart from typical muscle or spine-related back pain. If you recognize these patterns, it's worth discussing with your doctor:

• Pain Location and Pattern: The pain typically appears in your upper or middle back and may spread to your lower back. It often strikes at night or shortly after eating, lasting anywhere from a few minutes to several hours.
• Timing Related to Meals: Ulcer-related back pain frequently worsens after eating or improves with antacids and acid-reducing medications. This connection to food intake is a key distinguishing feature from mechanical back pain.
• Associated Stomach Symptoms: You may experience abdominal pain, nausea, vomiting, loss of appetite, bloating, or belching alongside the back pain—signs that point to a digestive issue rather than a spine problem.
• Intermittent vs. Constant Pain: The pain may come and go rather than being constant, and it might feel different from typical muscle soreness or sharp nerve pain you'd expect from a herniated disc.
• Response to Digestive Treatments: If your back pain improves when you take antacids or acid-reducing medications, this strongly suggests an ulcer is the culprit rather than a structural spine issue.

What Causes Peptic Ulcers in the First Place?

Understanding what creates ulcers can help you prevent them and recognize when you're at risk. The main culprits include:

• Helicobacter pylori Infection: This bacterium infects the stomach lining and causes chronic inflammation that can lead to ulcers. Studies show that eliminating H. pylori significantly reduces the chance of ulcers returning. The infection is typically acquired during childhood and can persist for life without treatment.
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Common pain relievers like aspirin, ibuprofen, and naproxen can damage the stomach lining, making it more vulnerable to acid damage. The risk increases with longer use or higher doses of these medications.
• Lifestyle Factors: Smoking, excessive alcohol consumption, and chronic stress don't directly cause ulcers but can significantly worsen them and increase your risk of developing one.

The risk varies depending on which NSAID you use. Aspirin carries a moderate risk, ibuprofen is moderate, and naproxen ranges from moderate to high.

How Do Gastric and Duodenal Ulcers Differ in Their Pain Patterns?

Not all ulcers cause back pain in the same way. Gastric ulcers (in the stomach) and duodenal ulcers (in the small intestine) have different pain signatures. Gastric ulcers tend to cause more widespread pain that can radiate broadly to the back, while duodenal ulcers often produce more localized pain. Additionally, the timing of pain differs: gastric ulcer pain can be triggered by eating, whereas duodenal ulcer pain often occurs between meals and may be relieved by food. Understanding these differences helps doctors pinpoint the exact cause of your back pain and recommend the right treatment.

When Should You Seek Emergency Care?

While most ulcer-related back pain is manageable, certain symptoms demand immediate medical attention. If you experience severe stomach pain, vomit blood, or notice black tarry stools, seek emergency care right away. These signs indicate a serious complication that requires urgent intervention.

The key takeaway: if you have persistent back pain that doesn't fit the typical muscle strain or spine injury pattern, and especially if it's accompanied by stomach symptoms, don't assume it's a structural spine problem. A thorough medical evaluation can determine whether a peptic ulcer is the real culprit behind your discomfort. With proper diagnosis and treatment targeting the underlying ulcer, your back pain may finally resolve.