Understanding Back Pain Behind the Rib Cage: Causes & Relief

Question
Hi, I am a 22 year old female and I have been having pain in my back behind my right rib cage. This started about 2 years ago when I was about 6-7 months pregnant with my son. After I delivered him the pain ceased for a short period of time, but has come back. It doesn't really feel like a muscle problem and tends to hurt more after eating a large meal (or any meal anymore). I have been to the doctor many times, had many untrasounds of the abdomin w/ attention to the gallbladder, and blood drawn NUMEROUS times. Everything comes back normal everytime (but coincidentally everytime I have the tests done it is not hurting that bad). I am at the point now where my doctor is saying that nothing is wrong with me, but I know that it hurts and it doesn't feel like much of nothing. It is a dull pain all day but in the evening, or after eating or sitting in the same position too long it is very severe. Any ideas would be wonderful right now as I am very confused about what to do. Thanks!

Answer
Hi Brittany,

You certainly are experiencing multiple symptoms that should be addressed appropriately. You pain which radiates to your back after meals and/or sitting in a particular position may indicate a problem with alterations of bile flow due to a stricture of a valve call the Sphincter of Oddi or an obstruction of the cystic duct. Ultrasounds and blood tests usually do not show anything particularly abnormal unless you are experiencing symptoms at the time of the procedure.

Not all gallbladder problems are due to gallstones. It may be caused by an abnormal opening/closing of the valves. As such, you will experience pain and discomfort in your right shoulder blade area 1/2 hour to hours after meals. It usually increases if you ingest carbonated drinks, fatty meals, or alcohol due to spasms of the valves. You are usually relieved by moving around.

Thus, it is best to request a HIDA scan and have your physician determine if you are positive for Murphy's sign. Just remember not to eat at least 12 hours prior to having a HIDA scan and not to fast more than 24 hours. Your physician may also choose to schedule you for an ERCP for a closer direct observation. If there is a dysfunction of the valves and/or gallbladder, a laparoscopic removal of the gallbladder is highly recommended.

Regards,

John Thai, MD