Differential Diagnosis for Right Back Pain

The following is a differential diagnosis for right back pain, categorized for clarity and emphasis on potential severity.

• Single Most Likely Diagnosis
  • Musculoskeletal strain: This is often the most common cause of back pain, including right back pain, due to overuse, poor posture, or direct injury to the muscles or ligaments in the back.
• Other Likely Diagnoses
  • Kidney stones: Pain from kidney stones can manifest as severe back pain, typically on one side, and may radiate to the groin area. The pain is often colicky in nature.
  • Urinary tract infection (UTI) or pyelonephritis: Infections of the urinary tract, especially when they involve the kidneys (pyelonephritis), can cause back pain, usually accompanied by other symptoms like fever, dysuria, and flank pain.
  • Herniated disk: Although more commonly associated with sciatica or lower back pain, a herniated disk can cause pain that radiates to one side of the back.
  • Osteoarthritis: Degenerative changes in the spine can lead to back pain, which may be more pronounced on one side depending on the distribution of the arthritic changes.
• Do Not Miss Diagnoses
  • Pulmonary embolism: While less common, a pulmonary embolism can cause sudden, severe back pain, especially if the embolism is located peripherally and affects the lung pleura, causing pleuritic chest pain that may be perceived as back pain.
  • Aortic dissection: This is a medical emergency where the inner layer of the aorta tears, causing severe, tearing chest or back pain that can radiate to the back.
  • Pneumonia: Certain types of pneumonia, especially those involving the lower lobes of the lungs, can cause pleuritic pain that may be felt in the back.
• Rare Diagnoses
  • Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain that radiates to the back, though this is typically more central than lateralized to one side.
  • Spinal tumors: Both primary and metastatic tumors can cause back pain, which may be localized to one side depending on the tumor's location.
  • Osteomyelitis or discitis: Infections of the bone or intervertebral disc can cause back pain, often accompanied by fever and other signs of infection.

Each of these diagnoses has distinct characteristics and accompanying symptoms that can help guide a more specific diagnosis and appropriate treatment plan.