Right-sided back pain is typically just pain that happens to be exclusively one-sided. In most cases, there is no significant reason for the asymmetry in pain, with most ordinary back pain simply affecting either the left or right side of the back.
In some cases, however, there is a clear reason for right-sided back pain. This has to do with the specific anatomy of both sides of the body. These cases are much less common as most of the tissue and structures in the lower back and abdomen are symmetrical, including the gut, bones and muscle, and the two kidneys.
The pancreas, a single organ, is located pretty much in the middle of the body. This means that while it can cause right-sided, pain is usually centralized. Most of the time, pancreatic problems that cause pain are experienced as abdominal pain rather than back pain.
Some other organs are asymmetrical and can result in more localized pain that offers clues to a diagnosis.
Right-sided back pain
Right-sided back pain can be a result of appendicitis as the appendix is located on the right of the body. However, appendicitis does not usually cause back pain, unless it is also accompanied by abdominal pain. Appendicitis pain also usually arises quickly and is severe, meaning that it isn’t normally mistaken for simple back pain.
The gall bladder is also situated on the right of the body, in the abdomen. Pain originating from the gallbladder sometimes manifests as pain high up in the back, even as high as the shoulder! However, gallbladder problems are much more likely to cause abdominal pain rather than back pain.
Because most people have a pair of matching kidneys, a problem in one kidney can result in one-sided back pain. However, pain resulting from kidney problems is most often connected to kidney stones. These stones (or calculus) can cause intense pain as they pass through the urinary tract. Such pain is typically so acute and severe that it doesn’t feel like back pain at all.
Anyone who has had surgery to remove a kidney or their gallbladder or appendix may experience one-sided back pain. Such pain could be related to the surgery itself or to the condition or trauma connected to the need for such surgery.
Further causes of asymmetrical back pain
Although the anatomy of the body is largely symmetrical there are small local differences in bones and muscle that can result in right-sided back pain or pain in the left side of the back. Injury to the muscle or bone on one side of the body can also create one-sided pain.
Certain hobbies or professions can cause differences in muscle tone or one-sided injuries, or exacerbate local anatomical variations. For instance, racket sports, golfing, archery, and other sports involving twisting of the spine in one direction over and over again could affect the normally symmetrical muscles and bones of the back.
Spinal discs may also rupture asymmetrically. In fact, this is much more common than a central herniation of a disc. Such disc herniation or a bulging disc may put pressure on the nerves on one side of the spine, causing right-sided back pain or left-sided back pain and other symptoms.
Situs inversus and the spleen – a rare cause of right-sided back pain
In rare cases (around 1 in 10,000) a person has a congenital condition called situs inversus (or transversus or oppositus). This condition causes the major visceral organs to be reversed. This means that the appendix and gallbladder are on the left of the body and may cause left-sided back pain instead of right-sided back pain.
Conversely, the spleen would be on the right in a person with situs inversus. This means that a problem with the spleen could cause right-sided back pain in someone with situs inversus.
In almost all cases, right-sided back pain is simply a result of ordinary pain affecting one side of the body exclusively. Talk to your physician if you are concerned about right-sided back pain that is persistent or worsening. And, as always, seek medical attention if your back pain is accompanied by red flag symptoms such as unexplained weight loss, fever, numbness or altered sensation in your limbs, cognitive deficits, or difficulties breathing.