Pneumonia and Back Pain

What is pneumonia?

In our lungs, we have airbags called alveoli to thank for being alive at this very moment. It's our lungs that give us that feeling of taking a breath of fresh air. However, when the little air sacs of one or both lungs get infected and swollen by a contagious agent called pneumonia,1 it does not always feel comfortable to take regular breaths. 

Pneumonia is the leading cause of death for contagious diseases in children worldwide. 740,180 children under the age of five died from pneumonia in 2019, accounting for 14% of all childhood deaths in that age group, but 22% of all childhood deaths in children from 1 to 5. Children and families worldwide are affected by pneumonia, but South Asia and sub-Saharan Africa have the highest death rates. Pneumonia can be minimized in children, treated with easy access, low-tech drugs, and staved off with simple and effective treatments.2 

Stages of pneumonia

As mentioned, pneumonia starts abruptly and undergoes different stages. The first stage is called congestion,4 which starts within the first 24 hours. During this stage, fluid accumulates in the tiny air sacs of the affected area of the lung, and as a result, you may experience coughing, exhaustion, loss of appetite, fast breathing, and pressure or heaviness in the chest as the early symptoms of pneumonia. As a response to fluid accumulation, red blood cells and defense cells gather in the affected area, initiating the second phase, which is red hepatization4 (ranging from 2-4 days). By this stage, you might experience coughing, exhaustion, a temperature, and chills. On the fourth day, gray hepatization,4 which is the third stage of pneumonia, occurs until the eighth day, when the red blood cells that had been sent to the lungs to aid in the infection's defense start to break down. The lungs seem scarlet when the red blood cells are active in stage two, but they turn gray once they have disintegrated. The last stage is resolution,4 and as the name implies, it is the phase of recovering from all the symptoms and feeling better.3 


The most common cause of pneumonia is a bacterial infection. Other kinds of pneumonia, aside from bacterial pneumonia, include:

  • Pneumonia that is caused by a virus, such as a coronavirus.
  • Aspiration pneumonia is brought on by inhaling throwup, a foreign object like a peanut, or a dangerous agent like smoke or a chemical
  • Rehabilitated cases with compromised immune systems are more susceptible to acquiring fungal pneumonia, which is uncommon in the UK.
  • Acquired pneumonia is pneumonia that occurs in a hospital when a patient is taking treatment for another illness or enduring surgery; cases in critical care who are using breathing machines are especially vulnerable to getting ventilator-associated pneumonia.5


Symptoms of pneumonia may appear briskly over the course of 24 to 48 hours, or gradually over several days. These are as follows:

  1.  Cough could be dry or productive Cough, i.e. produce yellow or green secretions   and occasionally blood stained mucus.
  2.  Difficulty breathing - you may feel shortness of breath while resting.
  3.  Rise in body temperature.
  4.  Rapid heartbeat.
  5.  Feeling ill and tired.
  6.  Rib Cage pain.5 

How does pneumonia cause back pain?

Pneumonia affects the lung tissue, and the inflammation may extend to the layer that lines the lung from the outside, which is the pleura.3 Inflammation of the pleura is the leading cause of pleuritic chest pain. It mainly affects the upper back where the lung is situated.6

Other possible causes of back pain

Back pain is a significant cause of disability and can persist from childhood into adulthood. Back pain is a major cause of morbidity and mortality. A variety of diseases that causes back pain include:14

  1. Trauma
  2. Cancer
  3. Pregnancy 
  4. Inflammatory disorders10
  5. Osteoporosis11
  6. Nerve root compression12
  7. Radiculopathy13

What does back pain from pneumonia feel like?

Upper back pain during pneumonia is experienced as sharp, stabbing pain that might lead to extreme discomfort while breathing, especially while taking a deep breath, coughing, and moving.7

Diagnosis and treatment

The steps to diagnose pneumonia are:

  • History taking: Your doctor will ask you about the symptoms you have experienced and other questions about your general health, especially whether you have any other medical conditions (such as hypertension).
  • Examination: A thorough examination of your chest by inspecting and hearing your breath sound.
  • Imaging: you might not need an X-ray16 of your chest if you experienced a mild infection. But in moderate and severe cases, your doctor needs to determine the extent of the infection using imaging studies.
  • Blood tests: to confirm the inflammatory state, other organs damaged as a result of the inflammation, and the type of causative agent.15

Treatment of pneumonia depends upon the severity of your illness status. Usually, mild cases are treated at home by resting, enough water intake, and antibiotics in case of bacterial infection. All symptoms will usually disappear, but you might continue to cough. However, severe pneumonia cases might need ICU admission and stay in the hospital for several days.

Depending on the patient’s age and current health condition, pneumonia could lead to serious complications and even death.5

How to treat back pain from pneumonia

Back pain management depends on two factors: controlling the underlying cause and relieving the pain.

  • Tip 1: simply lying on the side of pain would ease the pain.
  • Tip 2: the consumption of painkillers such as Non-steroidal anti-inflammatory drugs (NSAIDs)9 would be beneficial in controlling the pain.
  • Tip 3: treat the causative agent; if the cause is viral, symptom-relieving medications are the right choice. In contrast, a bacterial infection is managed by antibiotics depending on the type of bacteria.8

Complications of back pain from pneumonia

The hallmark complication of back pain is the worsening of the course of pneumonia due to the mucous being stuck in the air sacs and not being able to cough it up because of the pain. So it is important to manage the back pain to facilitate a full recovery.

Recovering from pneumonia

When pneumonia is confirmed, it is crucial to follow your treatment plan, support your body's recovery, keep an eye on your condition, and work to stop the infection from spreading to other people.

Recovering from pneumonia could take some time. Some people recover and resume their regular habits in one to two weeks. For others, it can take a month or more. For about a month after recovering, most people experience fatigue. Find out from your healthcare professional when you can resume your regular activities.17

Managing back pain

Back pain is relieved by getting rid of the trapped mucus. The mucus in your lungs can be moved by performing five to ten deep breaths, followed by a few vigorous coughs or huffs to move the mucus. Keep in mind that sleeping on the side that hurts will help manage back pain.

You need to ask your doctor before performing the breathing exercise to find out if this will be effective in your condition.18

When to see a doctor

You should visit your doctor whenever you experienced the following:

  • You have severe symptoms or feel quite ill
  • You have chest pain or difficulty breathing, you feel confused, disoriented, or sleepy, and you cough up blood or blood-stained sputum.
  • Your lips or skin start to turn bluish (cyanosis)
  • You suspect a child under the age of five has a chest infection, you're pregnant, you're 65 or older, you're extremely overweight and having trouble breathing, your immune system is compromised, or you have a chronic medical condition.
  • You've had a cough for more than three weeks.19


Pneumonia involves an inflammation of the lung by a bacterial, viral, or fungal infection. Symptoms of pneumonia vary from mild to severe. Recent studies show that pneumonia as a result of COVID-19 sometimes causes back pain. Pneumonia back pain causes a pleuritic nature of pain which can be relieved by either taking medications or performing breathing exercises.5


  1. Pneumonia - Symptoms and causes [Internet]. Mayo Clinic. [cited 2022 Jul 22] Available from:
  2. Pneumonia [Internet]. [cited 2022 Jul 22]. Available from:
  3. Pahal P, Rajasurya V, Sharma S. Typical Bacterial Pneumonia. StatPearls [Internet], Treasure Island (FL): StatPearls Publishing; 2022.
  4. What Are the 4 Stages of Pneumonia? [Internet] AICA Orthopedics 2021. [cited 2022 Jul 22] Available from:
  5. Pneumonia [Internet]. NHS 2017. [cited 2022 Jul 22]. Available from:
  6. Why does COVID-19 cause back pain? [Internet]. [cited 2022 Jul 22] Available from:
  7. Pleurisy - Better Health Channel [Internet]. [cited 2022 Jul 22]
  8. Pleurisy symptoms and treatments [Internet]. [cited 2022 Jul 22] Available from:
  9. NSAIDs [Internet]. [cited 2022 Jul 22] Available from:
  10. Inflammatory diseases - OxPARC [Internet]. [cited 2022 Jul 22]. Available from:
  11. Osteoporosis [Internet]. NHS 2018. [cited 2022 Jul 22] Available from:
  12. Lumbar decompression surgery - When it’s used [Internet]. NHS 2017. [cited 2022, Jul 22]. Available from:
  13. Radiculopathy [Internet]. 2021 [cited 2022 Jul 22]. Available from:
  14. Casiano VE, Sarwan G, Dydyk AM, Varacallo M. Back Pain. StatPearls [Internet],TreasureIsland (FL): StatPearls Publishing; 2022.
  15. Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. The Lancet [Internet] 2015 Sep; 386(9998):1097–108. Available from:
  16. X-ray [Internet]. NHS 2017. [cited 2022 Jul 22]. Available from:
  17. Pneumonia - Recovery | NHLBI, NIH [Internet]. [cited 2022 Jul 22].
  18. Recovering from pneumonia - British Lung Foundation [Internet]. Asthma + Lung UK 2015. [cited 2022 Jul 22]. Available from:
  19. Chest infection [Internet]. [cited 2022 Jul 22] Available from: 
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Usra Fakhreldin Abuelgassim

Bachelor of Medicine, Bachelor of Surgery - MBBS, Medicine, Ibn Sina University

A fresh medical graduate working on herself in terms of skills and research. Looking forward to being part of the Global Health community leaders as well as being part of the change toward health unity, equity, and adequacy.
Member of Community Medical Response Team - Khartoum, Sudan.

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