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What Causes Pain On Right Side Of Lower Rib?

Posted on Tue, 31 May 2016

Question: my ribs hurt right side lower rib; pain is constant and sometimes intense. I have had many ct scan, x ray, bone cans, blood tests and nothing has been identified. I has been going on for 5 months.

Answered by Dr. T Chandrakant (47 minutes later)

Brief Answer:
Please give additional information

Detailed Answer:
Hi.
Thanks for your query.
To recapitulate: Female/71 - constant and sometimes intense pain in the right lower ribs - Many CT scans, X-rays, bone scans, blood tests - all normal - consulted Doctor/s - going for 5 months...
The most probable causes of such pains which are missed by so many investigations can be:
Costochondritis,
Nerve pinching pain,

Please give a few details for me to assist you better:
- Does the pain comes on or increases if you press on the area?
- Is there a local diffuse swelling or a localized mass?
- Does it increase with stress and or anxiety?
- Any other factors that increase or reduce the pain?
- Type of pain: throbbing/ burning/ ants crawling?
- Any other information that you would like to share?

This feedback will help me the most, awaited...

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (22 minutes later)

Does the pain comes on or increases if you press on the area? no, it helps to press on the area
- Is there a local diffuse swelling or a localized mass? no
- Does it increase with stress and or anxiety? no
- Any other factors that increase or reduce the pain? when sitting the pain increases; it usually is less severe in the morning and gets worse as the day goes on
- Type of pain: throbbing/ burning/ ants crawling? feels like poking that grows more intense in pain.
- Any other information that you would like to share? 3 years ago I feel off my bike and broke 4 ribs on that side but this completely healed and I was without pain for probably 2 years before this started.

I do think that Costochondritis,
Nerve pinching pain,or likely candidates but what can I do to relieve the pain or get over this problem.

Answered by Dr. T Chandrakant (5 hours later)

Brief Answer:
Take help of pain management Doctor.

Detailed Answer:
Thanks for your feedback.
Looks most likely to be caused by the nerve that must have got trapped in the scar tissues.
You may please take the help of a pain management Doctor to have diagnostic xylocaine test. If indicative, local nerve ablation may help.
This is one good possibility.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (10 hours later)

For either the diagnostic xylocaine test or local nerve ablation, it seems to me that you need to localize the offending nerve. I asked the doctor if it could be a nerve problem and he said "we do not see nerve problem in this area". Do you think that 2.5 years after the accident that the a nerve could have gotten trapped in the scar tissue?

Answered by Dr. T Chandrakant (38 minutes later)

Brief Answer:
All the possibilities for the cause have to be explored

Detailed Answer:
Ideally speaking, no. Not expected but can occur.
The reason being the fractured ribs are not the same as where before fractures and amenable to further trauma may be due to even trivial things that can not be remembered like sneezing, coughing, sudden movements like while slipping or so.

If there is a pain, there has to be a cause.
And you have already undergone all sorts of investigations without finding the cause. Hence we have to explore other possibilities, may be odd indeed.

Also get Vitamin D estimation, you may need supplement if below normal levels and may help.
I hope medicines like Gabapentin/Amitriptyline might have been tried by your Doctors, these are prescription medicines and you need a valid prescription.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar