Pain localized to the right side of the back, especially when taking a deep breath, coughing, or sneezing, is often described as pleuritic pain. This sharp or stabbing discomfort is triggered by the expansion of the chest cavity, which irritates surrounding tissues or organs. While many causes are temporary and minor, this symptom is also associated with conditions that require immediate medical evaluation. Understanding the potential origins of this pain helps determine the appropriate next steps for care.
Pain Stemming from the Rib Cage and Muscles
The most frequent source of localized back pain that worsens with breathing is a musculoskeletal issue involving the chest wall. The intercostal muscles, thin layers of tissue between the ribs, are constantly engaged in moving the rib cage during respiration. A sudden, forceful movement, intense coughing, or repetitive strain can partially tear these muscles, resulting in intercostal muscle strain. This injury causes sharp pain that is often tender to the touch directly over the affected area, and the pain intensifies with deep breaths or twisting.
Another common cause is costochondritis, the inflammation of the cartilage connecting the ribs to the breastbone (costosternal joints). While typically felt in the front of the chest, the pain can radiate to the back and feel aggravated by rib movement during breathing. Unlike internal organ pain, the discomfort from costochondritis or a muscle strain is frequently reproducible by pressing on the affected area. Mild rib injuries, such as bruising or a stress fracture, also cause significant pain when the rib cage expands. Palpable tenderness helps differentiate these structural causes from more internal problems.
Conditions Affecting the Lungs and Lining
When pain is triggered by breathing, the respiratory system is often involved, specifically the pleura. The pleura is the two-layered membrane surrounding the lungs and lining the chest wall. Pleurisy (pleuritis) is the inflammation of this membrane, causing the layers to rub against each other instead of gliding smoothly. This friction generates a sharp, stabbing pain that is exacerbated by deep inhalation, coughing, or sneezing, and the pain can spread from the chest to the back or shoulder.
Pleurisy is commonly caused by infections, with pneumonia being a frequent culprit, where the lung infection extends inflammation to the pleural lining. In these cases, the pain is typically accompanied by systemic symptoms such as a fever, chills, and a productive cough. A more serious cause is a pneumothorax, or collapsed lung, which occurs when air leaks into the space between the lung and the chest wall. This condition presents with sudden, severe pain on one side, often radiating to the back, accompanied by acute shortness of breath.
Pain Originating from Abdominal Organs
Pain felt in the back right side that is aggravated by breathing can sometimes be referred pain from organs located in the upper abdomen or flank area. The right kidney is situated just below the ribs in the back, and conditions affecting it can cause flank pain. A kidney stone lodged in the ureter, or an infection like pyelonephritis, can cause intense, sharp pain felt deeply in the back or side.
This type of pain, often called renal colic, is typically severe, comes in waves, and may radiate toward the front of the abdomen or groin. Although primarily non-respiratory, the pain can feel aggravated by deep breathing because the diaphragm pushes on the inflamed organ capsule. Unlike musculoskeletal pain, kidney pain is generally not relieved by changing position. It is often accompanied by non-respiratory symptoms, such as nausea, vomiting, blood in the urine, or painful and frequent urination.
Warning Signs Requiring Immediate Care
While many causes of pain in the back right side when breathing are benign, certain associated symptoms act as “red flags” that indicate a potential medical emergency. A sudden onset of severe, crushing chest or back pain that lasts for more than a few minutes requires immediate emergency attention. This is especially true if the pain is accompanied by sudden, unexplained shortness of breath, which could signal a life-threatening condition like a pulmonary embolism (a blood clot in the lung).
Other urgent warning signs include:
- Coughing up blood, which may appear as flecks, streaks, or more significant amounts.
- Development of a high fever with chills.
- Signs of circulatory compromise, such as bluish discoloration of the lips or face.
- A very rapid heartbeat, or signs of shock like confusion or lightheadedness.
If the pain is severe enough to prevent a person from taking a full breath, or if the pain does not improve within 48 hours and is accompanied by a mild fever or persistent cough, a prompt visit to a healthcare provider is appropriate to rule out a developing infection.