What should I do for pain on the right side of my body?

Evaluation and Management of Right-Sided Body Pain

For pain on the right side of your body, you must first determine the specific location—right upper quadrant (RUQ), right lower quadrant (RLQ), or chest—as this fundamentally changes the diagnostic approach and urgency of evaluation.

Initial Assessment Based on Location

Right Upper Quadrant Pain

Ultrasound of the abdomen is the first-line imaging study for RUQ pain, particularly when biliary disease is suspected 1, 2. This modality has the highest appropriateness rating (9/9) according to the American College of Radiology, offers no radiation exposure, and effectively identifies gallbladder pathology, liver abnormalities, and alternative diagnoses 2.

Key diagnostic considerations for RUQ pain include:

• Acute cholecystitis is the most common surgical condition presenting with RUQ pain 1
• Ultrasound demonstrates gallbladder wall thickening, pericholecystic fluid, gallstones, and sonographic Murphy's sign 1
• If ultrasound is equivocal, cholescintigraphy (HIDA scan) serves as an excellent second-line test with high sensitivity and specificity for acute cholecystitis 1
• CT with IV contrast is reserved for cases where complications (perforation, gangrene, hemorrhage) are suspected or when ultrasound findings are inconclusive 1

Essential laboratory workup includes:

• Complete blood count to assess for leukocytosis indicating infection or inflammation 3
• Liver function tests (ALT, AST, alkaline phosphatase, bilirubin) 3
• Pancreatic enzymes (amylase and lipase) to exclude pancreatitis 3
• Pregnancy test for all women of reproductive age before any imaging 2

Right Lower Quadrant Pain

CT of the abdomen and pelvis with IV contrast is the preferred initial imaging for nonspecific RLQ pain 1. This approach has a summary sensitivity of 95% and specificity of 94% for appendicitis while also identifying alternative diagnoses that frequently require hospitalization or surgical intervention 1.

The diagnostic algorithm for RLQ pain:

• If appendicitis is the primary clinical concern based on presentation (periumbilical pain migrating to RLQ, anorexia, fever), proceed directly to CT imaging 1
• CT frequently identifies the cause of RLQ pain in 94.3% of cases, including appendicitis, diverticulitis, inflammatory bowel disease, ovarian pathology, and colonic conditions 1
• In pregnant patients or young women where radiation is a concern, ultrasound or MRI without contrast are appropriate alternatives 1
• Beyond appendicitis, consider inflammatory conditions of the ileocecal region, diverticulitis, epiploic appendagitis, and gynecologic pathology 4, 5

Right-Sided Chest Pain

If you experience right-sided chest pain, activate 9-1-1 immediately for emergency medical services transport to the nearest emergency department 1. Chest pain requires urgent evaluation to exclude life-threatening conditions.

Critical features requiring immediate evaluation:

• Sudden onset of severe, ripping chest pain suggests acute aortic syndrome (dissection), particularly in hypertensive patients 1
• Chest pain with dyspnea, diaphoresis, lightheadedness, or nausea may indicate acute coronary syndrome even when right-sided 1
• Sharp chest pain worsening with inspiration and lying supine suggests pericarditis or pleuritic causes 1
• In patients >75 years, chest pain accompanied by shortness of breath, syncope, acute delirium, or unexplained falls should raise concern for acute coronary syndrome 1

Pain Management Approach

For mild to moderate pain, ibuprofen 400 mg every 4-6 hours is appropriate while pursuing diagnostic evaluation 6. Use the lowest effective dose for the shortest duration, and do not exceed 3200 mg total daily dose 6.

Important safety considerations:

• Take with meals or milk to minimize gastrointestinal complaints 6
• Avoid NSAIDs if you have a history of stomach ulcers, bleeding disorders, or recent heart attack 6
• Do not use NSAIDs after about 30 weeks of pregnancy 6
• NSAIDs increase risk of heart attack, stroke, and gastrointestinal bleeding, particularly with longer use and higher doses 6

For severe or refractory pain in cancer patients:

• Consider interventional consultation for nerve blocks if pain is well-localized (intercostal nerve blocks for thoracic wall pain, peripheral nerve blocks for specific distributions) 1
• Unilateral pain syndromes may benefit from cordotomy when other approaches fail 1

Common Pitfalls to Avoid

Critical errors that delay diagnosis:

• Failing to obtain pregnancy testing in women of reproductive age before imaging can result in unnecessary radiation exposure and missed ectopic pregnancy 3, 2
• Relying solely on laboratory tests without appropriate imaging leads to missed diagnoses, as normal laboratory values do not exclude serious pathology 3
• Using CT as first-line imaging for RUQ pain in young patients exposes them to unnecessary radiation when ultrasound is more appropriate 2
• Assuming pain location always correlates with underlying pathology—referred pain patterns can mislead (e.g., gallbladder disease causing right shoulder pain, abdominal pathology causing arm pain) 7
• Attempting to identify the painful side by palpation alone has limited accuracy (only 64.8% correct for lower back pain) and should not replace proper diagnostic evaluation 8

The key principle: location-specific imaging protocols combined with appropriate laboratory testing provide the highest diagnostic yield while minimizing unnecessary radiation exposure and cost.