What could the dull ache in back be?
Patient: Hello, I am concerned about an dull aching right side, that moves more towards my back, but not low back. Will sometimes move from right hip inward. This does leave for a few days but returns. I have had an ultra sound and cat scan done, with results showing nothing of concern. Have wondered if it could be the start of an appendix or ovarian issue, but the symptoms I have leave and come back. Would appreciate some educated info as what I should do. Thank you Doctor: Hi, thanks for posting your concern in the HCM.Dull aching pain in the back may be due to several reasons, which need to be excluded by further evaluation.This may be due to1. Mechanical back pain. This may be due to faulty posture or injury to paraspinal muscles due to any reason. The former cause seems to be more likely because the pain is on and off.2. Any liver or pancreatic pathology. This seems to be less likely, taking into consideration that your imaging reports came out to be normal. Furthermore, they more commonly cause pain over both abdomen and back.3. Functional bowel disease. If you have irregular bowel habit and / or bloating, the pain may arise from the same. This is more common with constipation predominantly irritable bowel syndrome.4. Renal or ureteric pathology , stone or urinary tract infection may be associated with this. Usually, the pain is associated with dysuria, fever with chills etc. in these cases. However, renal pain may present with this alone. I think your imaging should have ruled out this also.5. Ovarian pathology e.g SOL, infected cyst or torsion may produce back pain. Even genital infection or PID may present with this.Appendicitis usually don't present with back pain as a sole complaint.I think except for mechanical back pain and IBS or FBD all others can be ruled out by imaging (usg or CAT scan).Therefore, you should consult your local physician  for further evaluation.For the time being1. Maintain good oral hydration2. Avoid refined carbohydrate, spices and carbonated beverages. Have high fiber diet at frequent interval in small amount.3. Perform abdominal muscle strengthening exercise.For any further questions, please write back to me.Regards,Dr. Kaushik