Left Side Pain (Upper, Lower, Back): Causes, Symptoms & When to Worry

What is Left Side Pain?

Left side pain, also referred to as left flank pain, is a symptom associated with a wide range of medical conditions of varying severity. It can affect people of all ages and may arise suddenly or develop gradually over time.

Anatomically, the left flank is the region of the body bounded:

• Superiorly by the lower margin of the rib cage (costal arch),
• Inferiorly by the upper margin of the pelvis (iliac crest of the iliac bone).

This anatomical area contains numerous organs and structures, including:

• Spleen
• Pancreas (tail portion)
• Stomach
• Descending colon
• Left kidney and urinary tract
• Left adrenal gland
• Aorta
• In women: left ovary and fallopian tube
• Musculoskeletal structures of the abdominal wall and left flank

Given the density of organs in this area, left side pain can originate from many different sources. In the majority of cases, it is caused by:

• Intense or unaccustomed physical activity,
• Musculoskeletal disorders (muscle strains, rib injuries),
• Urogenital or gastrointestinal conditions,
• Psychological stress and psychosomatic causes,
• Abdominal or lumbar trauma.

Understanding the possible causes of left side pain is essential for appropriate medical evaluation and timely treatment. This guide provides a comprehensive overview of the most common conditions responsible for left flank pain, along with their clinical characteristics and treatment principles.

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Characteristics of Left Side Pain

The sensation of pain in the left flank is not always the same. Depending on its origin, it can present with a wide variety of features. Accurately describing the type of pain to your doctor is one of the most valuable tools for reaching the correct diagnosis.

Left side pain can be described along several dimensions:

Location

• Localized: clearly perceived in a specific area of the flank (e.g., upper left side, lower left back);
• Diffuse: spread across a broad area, difficult to pinpoint.

Intensity

• Severe: sharp, stabbing, like an electric shock;
• Mild to moderate: dull, vague, more of a nagging discomfort.

Pattern Over Time

• Constant: persists at the same intensity without remission;
• Intermittent: comes and goes, with periods of relief between episodes.

Triggering Factors

• Activity-related: appears only during or after physical exertion;
• Position-related: worsens with certain body movements (e.g., trunk rotation);
• Spontaneous: present even at rest, without an apparent trigger.

Onset

• Acute: appears suddenly within seconds or minutes;
• Chronic: persists for weeks, months, or even years.

Radiation

• Radiating: spreads from a point of maximum intensity to adjacent areas (e.g., from the flank toward the groin or shoulder);
• Non-radiating: confined to a single, specific area.

Associated Symptoms

The presence or absence of associated symptoms is extremely informative. The most relevant include:

• Fever
• Nausea and/or vomiting
• Unexplained weight loss
• Blood in urine (hematuria)
• Headache
• Palpitations and tachycardia
• Rapid breathing (tachypnea)

Clinical Examples

Because left side pain is a non-specific symptom, the combination of all these features guides diagnostic reasoning:

Example 1: Kidney Stone A sudden, very intense, intermittent (“colicky”) pain in the mid-left flank that radiates downward toward the groin strongly suggests renal colic due to a kidney stone.

Example 2: Kidney Infection A persistent, dull, moderate ache in the mid-to-lower left back that develops alongside fever with chills, blood in the urine, fatigue, and weight loss is more suggestive of pyelonephritis (kidney infection).

As these examples illustrate, the same anatomical location can produce very different pain patterns depending on the underlying condition. The following sections describe the most common causes of left side pain in detail.

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Musculoskeletal Causes

Musculoskeletal pain is pain arising from damage or dysfunction of one or more of the following structures:

• Bones
• Joints
• Muscles
• Ligaments
• Tendons

Musculoskeletal disorders are among the most common causes of left flank pain. They typically result from:

• Excessive physical exertion, especially in untrained individuals (e.g., starting a new sport or significantly increasing workout intensity);
• Prolonged poor posture (e.g., sitting with a twisted spine for extended periods);
• Direct trauma (e.g., a fall or a blow to the side).

At the level of the left flank, the most frequently injured structures are the internal and external oblique abdominal muscles and the rectus abdominis muscle, which can sustain muscle strains, pulls, or spasms.

Although the ribs are not technically part of the abdominal wall, cracked or fractured ribs and injuries to the intercostal muscles can generate intercostal pain that radiates to the left flank.

How It Feels

Musculoskeletal left side pain can range from a sharp, stabbing sensation (similar to an electric shock) to a dull, diffuse ache that is difficult to localize. A key distinguishing feature is that it is typically worsened by trunk rotation, deep breathing, or movement of the ipsilateral shoulder and arm, which helps differentiate it from visceral (organ-related) causes of pain.

Remedies

• Rest is the cornerstone of treatment. However, complete bed rest is generally not recommended beyond the first 24–48 hours, as gentle movement aids recovery.
• Over-the-counter analgesics such as paracetamol (acetaminophen) or NSAIDs (non-steroidal anti-inflammatory drugs) can provide effective pain relief.
• Cold therapy (ice packs) in the first 48 hours, followed by heat therapy, may help reduce inflammation and muscle spasm.
• More severe musculoskeletal injuries may require bracing, physiotherapy, or in rare cases, surgical intervention.

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Spleen Injury

The spleen is the largest secondary lymphoid organ in the human body. It performs two critical functions:

1. Immunological: lymphocytes (a type of white blood cell) within the spleen, as in lymph nodes, recognize threats and activate the immune response.
2. Hemocatheretic: the spleen filters and removes aging or damaged red blood cells from the circulation.

Anatomically, the spleen is located just beneath the diaphragm on the left side, nestled between the posterior wall of the stomach and the anterior surface of the left kidney.

Causes of Splenic Injury

Spleen injuries are most commonly caused by:

• Major abdominal trauma, such as a direct blow to the abdomen (e.g., during a car accident, sports collision, or a punch to the stomach);
• Penetrating wounds (knife stab or gunshot wound);
• Complication of infectious mononucleosis (Epstein-Barr virus infection): in this case, the spleen becomes enlarged and fragile and can rupture even from minor trauma.

Types of Splenic Lesions

Splenic injuries range in severity:

• Subcapsular hematomas (mild, blood pooled under the capsule);
• Small capsular lacerations;
• Deep parenchymal lacerations (severe, often life-threatening).

Symptoms

A splenic injury typically presents with sudden, intense, sharp pain in the upper left abdomen, immediately below the left costal margin. It is often described as a “stabbing” pain that may radiate to the left shoulder (known as Kehr’s sign, due to irritation of the left phrenic nerve by blood pooling under the diaphragm).

Because the spleen is a highly vascular organ, injuries often result in significant internal bleeding, which can cause:

• Altered consciousness, confusion, or loss of consciousness
• Pallor (pale skin)
• Rapid heart rate (tachycardia)
• Rapid breathing (tachypnea)
• Profuse sweating
• Blurred vision

A suspected spleen injury is a medical emergency. Call emergency services immediately.

Remedies

Treatment depends on the severity of the injury:

• Mild injuries: conservative management with careful monitoring and observation, allowing spontaneous resolution;
• Moderate injuries: angio-embolization (a minimally invasive radiological procedure to stop bleeding);
• Severe injuries: splenectomy (surgical removal of the spleen).

Although the spleen is not essential for survival, its removal significantly increases the risk of life-threatening infections caused by encapsulated bacteria, including Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. For this reason, splenectomy is reserved for the most severe cases, and patients who undergo it should receive vaccinations against these pathogens and, in some cases, lifelong prophylactic antibiotics.

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Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder characterized by a group of symptoms that occur together, including:

• Recurrent abdominal cramps
• Bloating and abdominal distension
• Diarrhea and/or constipation (or alternating between the two)

These symptoms tend to fluctuate over time, with periods of worsening (“flares”) interspersed with periods of remission lasting days, weeks, or months.

What Causes IBS?

The exact cause of IBS is not fully understood, but current evidence suggests it is a multifactorial condition involving:

• Altered gut motility (food moves too quickly or too slowly through the digestive tract);
• Visceral hypersensitivity (the intestinal nerves are abnormally sensitive to normal stimuli);
• Gut-brain axis dysfunction (disrupted communication between the brain and the gut);
• Psychological factors such as stress, anxiety, and depression;
• Genetic predisposition (family history of IBS increases risk);
• Post-infectious IBS (IBS developing after a gastrointestinal infection).

How IBS Causes Left Side Pain

The pain associated with IBS is often felt in the lower left abdomen or left flank, particularly when stool or gas is present in the descending colon and sigmoid colon, which are the sections of the large intestine running down the left side of the abdomen.

For many patients, IBS is a chronic, recurring condition that can significantly impact quality of life. It is important to note, however, that IBS does not cause structural damage to the intestine and is not associated with an increased risk of colorectal cancer.

Remedies

There is no universal cure for IBS, but the condition can be effectively managed through:

• Dietary modifications: Identifying and avoiding trigger foods (e.g., high-FODMAP foods, fatty foods, caffeine, alcohol); increasing dietary fiber intake for constipation-predominant IBS;
• Regular physical activity: Exercise has been shown to reduce IBS symptom severity;
• Stress management: Cognitive behavioral therapy (CBT), mindfulness, and relaxation techniques can significantly improve symptoms;
• Medications: Antispasmodics (for pain and cramps), laxatives (for constipation), antidiarrheal agents, low-dose antidepressants (for pain modulation), or specific IBS medications (e.g., linaclotide, rifaximin);
• Probiotics: Some strains may help restore gut microbiome balance and reduce symptoms.

A gastroenterologist can help develop an individualized management plan based on the specific subtype of IBS (IBS-C, IBS-D, or IBS-M).

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Kidney Stones and Renal Colic

Renal colic refers to the severe, cramping pain caused by the passage of a kidney stone (renal calculus) through the ureter, the narrow tube connecting the kidney to the bladder.

When the stones are very small (like grains of sand), the condition is sometimes colloquially referred to as “gravel” or “sand in the kidney”.

What Are Kidney Stones?

Kidney stones are small, hard deposits of mineral salts that form in the kidney. They develop when the urine becomes oversaturated with certain chemical compounds (most commonly calcium oxalate, calcium phosphate, uric acid, or struvite), which crystallize and clump together into solid masses.

Risk factors for kidney stone formation include:

• Inadequate fluid intake (the single most important risk factor: drinking too little water concentrates the urine)
• Unhealthy diet (excess salt, animal protein, or oxalate-rich foods);
• Obesity;
• Chronic urinary tract infections;
• Family history of kidney stones;
• Medical conditions such as hyperparathyroidism (excessive parathyroid hormone production) and gout (elevated uric acid levels).

How Renal Colic Develops

Renal colic occurs when a stone becomes wedged in the ureter, blocking the normal flow of urine. This causes:

• Upstream dilation (hydronephrosis) of the ureter and kidney pelvis;
• Smooth muscle spasms of the ureteric wall as it attempts to push the stone toward the bladder.

These ureteric spasms are responsible for the characteristic colicky pain, which is sudden, severe, and intermittent, alternating between peaks of intense pain and partial or complete relief.

Symptoms

• Intense, acute, intermittent left flank pain that typically radiates downward toward the groin and inner thigh (following the path of the ureter);
• Hematuria (blood in the urine, which may be visible or detected only on urinalysis)
• Profuse sweating;
• Nausea and vomiting;
• Tachycardia (rapid heartbeat);
• Tachypnea (rapid breathing).

Remedies

Conservative management (for small stones): Most kidney stones are small enough to pass spontaneously through the ureter. Treatment during this period focuses on pain control:

• NSAIDs (e.g., ibuprofen, ketorolac) are the first-line analgesics for renal colic;
• Paracetamol (acetaminophen) as an alternative or adjunct;
• Alpha-blockers (e.g., tamsulosin) or calcium channel blockers (e.g., nifedipine) can relax ureteral smooth muscle, facilitating stone passage;
• High fluid intake to encourage the stone to pass.

Interventional procedures (for larger or impacted stones):

When a stone is too large to pass spontaneously or causes serious complications, it must be removed using one of the following techniques:

• Extracorporeal Shock Wave Lithotripsy (ESWL): External shock waves break the stone into smaller fragments;
• Percutaneous nephrolithotomy (PCNL): A minimally invasive procedure for large kidney stones;
• Ureteroscopy (URS): A thin telescope is passed through the urethra and bladder into the ureter to remove or fragment the stone;
• Retrograde Intrarenal Surgery (RIRS): A flexible ureteroscope is advanced into the kidney to treat stones directly;
• Open or laparoscopic surgery: Reserved for very rare, complex cases.

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Intestinal Gas (Bloating and Meteorism)

The presence of gas in the gastrointestinal tract is an entirely normal physiological phenomenon. Gas is produced through:

• Swallowing air during eating, drinking, or talking;
• Bacterial fermentation of undigested food residues in the colon by the normal gut microbiota.

However, an excessive accumulation of intestinal gas (known as meteorism or bloating) can cause noticeable tension in the intestinal walls. This may result in abdominal discomfort, particularly in the left flank, for example in the area of the descending colon.

Common Causes

Behavioral and dietary factors:

• Eating too fast or talking while eating (increases air swallowing);
• Drinking carbonated beverages in excess;
• Chewing gum (promotes air ingestion, a process called aerophagia)
• Overeating gas-producing foods, including:
  • Dairy products (especially in individuals with reduced lactase activity);
  • Legumes (beans, lentils, chickpeas, peas);
  • Certain fruits (bananas, grapes, figs, prunes, persimmons);
  • Whole grains with indigestible fibers;
  • Cruciferous vegetables (broccoli, cabbage, cauliflower, Brussels sprouts).

Note: In most cases, gas-producing reactions to healthy foods like legumes and cruciferous vegetables are related to an unaccustomed gut microbiome. Gradually introducing these foods into the diet usually leads to significant improvement over time.

Medical causes:

• Dysbiosis (imbalance of the gut microbiota);
• Lactose intolerance;
• Fructose or sorbitol malabsorption;
• Small intestinal bacterial overgrowth (SIBO);
• Post-infectious gut disturbances.

Remedies

In most cases, intestinal gas resolves spontaneously within a few hours after a meal and requires no medical treatment.

• Dietary adjustments (reducing intake of gas-producing foods, eating slowly, avoiding carbonated drinks);
• Probiotics (especially useful after gastrointestinal infections or antibiotic use to restore healthy gut flora);
• Simethicone-based medications can help reduce gas bubble formation;
• Peppermint oil capsules have some evidence for reducing bloating and abdominal discomfort.

If bloating and gas occur persistently and without an obvious cause, it is important to consult a physician to rule out underlying conditions such as IBS, lactose intolerance, celiac disease, or SIBO.

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Herpes Zoster (Shingles)

Herpes zoster, commonly known as shingles, is a viral infection caused by the Varicella-zoster virus (VZV), which is the same virus responsible for chickenpox.

After the initial chickenpox infection (typically in childhood), VZV does not leave the body. Instead, it becomes dormant (latent) in the dorsal root ganglia, clusters of nerve tissue near the spinal cord. Years or even decades later, the virus can reactivate, traveling along the sensory nerve fibers to the skin, causing herpes zoster.

Who Is at Risk?

Reactivation is most likely to occur in:

• Older adults (risk increases significantly after age 50);
• Individuals with weakened immune systems due to illness (e.g., HIV, cancer) or immunosuppressive medications;
• People under significant physical or psychological stress.

Symptoms

Herpes zoster typically presents as a unilateral (one-sided) dermatomal rash: a band or stripe of fluid-filled blisters (vesicles) that wraps around one side of the trunk, following the distribution of a single sensory nerve. When it affects the left-sided thoracic or lumbar dermatomes, it causes characteristic left flank pain.

Key symptoms include:

• Prodromal pain: burning, tingling, or hypersensitivity in the affected skin area, which may begin 2–4 days before the rash appears. This can make early diagnosis challenging.
• Characteristic vesicular rash: clusters of fluid-filled blisters on a red base, following a dermatomal distribution.
• Intense burning pain: often described as “a burning fire under the skin”.
• Altered skin sensitivity (allodynia, or pain from normally non-painful stimuli; hyperalgesia).
• Itching.
• Fever.
• Fatigue.

In some cases, herpes zoster can present without the characteristic rash (a condition called zoster sine herpete), making it particularly difficult to diagnose based on symptoms alone.

Complications

The most important complication is postherpetic neuralgia (PHN), which is persistent neuropathic pain in the affected area. This pain can continue for weeks, months, or even years after the skin lesions have healed. PHN can be severely debilitating and is more common in older adults.

Other complications include:

• Herpes zoster ophthalmicus (involvement of the ophthalmic branch of the trigeminal nerve, threatening vision);
• Secondary bacterial infection of skin lesions;
• Rare neurological complications (encephalitis, myelitis).

Remedies

Antiviral therapy is the cornerstone of herpes zoster treatment. It should be initiated as early as possible, ideally within 72 hours of rash onset, to:

• Reduce the severity and duration of the acute infection;
• Accelerate healing of skin lesions;
• Reduce the risk of postherpetic neuralgia.

Common antivirals used include acyclovir, valacyclovir, and famciclovir.

Pain management may involve:

• Standard analgesics (paracetamol, NSAIDs) for mild to moderate pain;
• Neuropathic pain medications (e.g., gabapentin, pregabalin, tricyclic antidepressants) for more severe or persistent pain;
• Topical treatments (e.g., lidocaine patches, capsaicin cream) for localized pain relief.

Prevention: Vaccination A highly effective vaccine against herpes zoster (Shingrix, a recombinant zoster vaccine) is available and recommended:

• For adults aged 50 and over (regardless of prior chickenpox or shingles history);
• For adults aged 18 and over with increased risk (e.g., immunocompromised individuals, transplant recipients, patients with onco-hematological conditions).

The vaccine significantly reduces the risk of developing shingles and, if it does occur, substantially decreases the likelihood and severity of postherpetic neuralgia.

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Pyelonephritis (Kidney Infection)

Pyelonephritis is a bacterial infection of the kidney. It most commonly results from the upward spread of a lower urinary tract infection, such as cystitis (bladder infection) or urethritis.

Less frequently, pyelonephritis can arise from hematogenous spread, which occurs when bacteria travel through the bloodstream and seed the kidney. This process may result from bacteremia or sepsis.

Causative Organisms

The most common causative bacteria belong to the Gram-negative group:

• Escherichia coli is responsible for approximately 80% of cases.
• Proteus mirabilis, Pseudomonas aeruginosa, and Klebsiella pneumoniae are less common but often linked to more severe and complicated infections.

Types of Pyelonephritis

• Acute pyelonephritis: develops rapidly, over hours or days;
• Chronic pyelonephritis: persists for weeks or months, or recurs repeatedly over time. Chronic cases can cause progressive kidney scarring and, in severe cases, kidney damage.

Risk Factors

Pyelonephritis is significantly more common in women, due to the anatomically shorter female urethra (which allows bacteria easier access to the bladder and then the kidney). Additional risk factors include:

• Urinary tract abnormalities (structural or functional);
• Kidney stones or urinary obstruction;
• Urinary catheters;
• Pregnancy;
• Diabetes mellitus;
• Immunosuppression.

Symptoms

Pyelonephritis characteristically presents with a triad of:

1. Flank pain, located in the left or right flank depending on which kidney is affected (or bilateral if both kidneys are involved). The pain is typically persistent, dull, and poorly localized, felt posteriorly in the lower flank. It is often worsened by costovertebral angle percussion (Giordano’s sign, which involves tapping at the junction of the 12th rib and the spine to elicit pain).
2. High fever with chills, characteristically spiking and often worse in the evening or at night.
3. Urinary symptoms (often already present due to the underlying lower UTI):
   • Dark or cloudy urine with a strong, unpleasant odor;
   • Blood in urine (hematuria);
   • Painful or burning urination (dysuria);
   • Increased urinary frequency or urgency.

Systemic symptoms may also be present:

• Fatigue and malaise
• Loss of appetite
• Nausea and vomiting
• Headache
• Muscle aches (myalgia)

Remedies

Pyelonephritis is treated with antibiotics, selected based on:

• The suspected or confirmed causative organism (guided by urine culture results);
• Antibiotic resistance patterns in the local community.

Commonly used antibiotics include fluoroquinolones (e.g., ciprofloxacin), trimethoprim-sulfamethoxazole, and third-generation cephalosporins.

Mild to moderate cases can be managed with oral antibiotics on an outpatient basis for 7–14 days. Severe or complicated cases require:

• Hospital admission;
• Intravenous (IV) antibiotics;
• Supportive care (IV fluids, antipyretics).

Untreated or inadequately treated pyelonephritis can lead to serious complications including kidney abscess, sepsis, and chronic kidney disease.

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Intestinal Diverticula and Diverticulitis

Diverticula are small, pouch-like protrusions, often described as “finger-like outpouchings”, that develop in the wall of the colon (large intestine). They are hollow on the inside and remain in communication with the intestinal lumen.

Types of Diverticula

• True diverticula: Rarer; present from birth; involve all layers of the intestinal wall;
• False (pseudo)diverticula: Far more common; acquired over time; involve only the mucosal and submucosal layers of the intestinal wall, representing weak points that herniate outward due to increased intraluminal pressure.

The most common sites for diverticulum formation are the sigmoid colon and descending colon, which explains why symptoms are typically felt in the lower left abdomen and flank.

Diverticulosis vs. Diverticulitis

Diverticulosis refers to the simple presence of diverticula. In many cases it is entirely asymptomatic and discovered incidentally during colonoscopy or imaging. When symptoms do occur, they may include:

• Mild, intermittent, crampy abdominal pain, often in the lower left quadrant;
• Abdominal bloating and distension;
• Altered bowel habits (constipation and/or diarrhea).

Diverticulitis occurs when one or more diverticula become inflamed or infected, resulting in a significantly more serious clinical picture. The precise trigger for inflammation is not fully understood, but leading theories involve:

• Obstruction of the diverticulum’s neck by retained fecal matter (a “fecalith”), leading to bacterial overgrowth and infection;
• Micro-perforation due to ischemia (poor blood supply to the diverticulum wall).

Diverticulitis presents with:

• Acute, well-localized pain in the lower left abdomen (often described as more severe and constant than diverticulosis-related discomfort);
• Fever;
• Nausea and vomiting;
• Diarrhea or constipation;
• Occasionally blood in the stool.

Remedies

For diverticulosis (prevention and symptom management):

• High-fiber diet: A diet rich in dietary fiber (from whole grains, legumes, fruits, and vegetables) softens stools and reduces intraluminal pressure, helping prevent diverticulitis;
• Adequate hydration;
• Regular physical activity.

For acute diverticulitis (first, uncomplicated episode):

• Bowel rest (liquid diet or temporary fasting);
• Adequate fluid intake (IV fluids if hospitalized);
• Antibiotics targeting colonic bacteria.

For recurrent or complicated diverticulitis, complications may include the following:

• Diverticular abscess;
• Intestinal perforation;
• Bowel obstruction;
• Intestinal hemorrhage;
• Fistula formation (abnormal connection between the colon and an adjacent organ, such as the bladder).

In these cases, hospitalization, IV antibiotics, percutaneous drainage of abscesses, or surgical resection of the affected bowel segment may be necessary.

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Other Causes of Flank Pain

The conditions described above represent the most common causes of left side pain, but many other medical conditions can also produce pain in the left or right flank. These include:

• Abdominal aortic aneurysm
• Abscesses (intra-abdominal collections of pus)
• Ovarian cysts
• Cystinuria (a rare hereditary cause of kidney stones)
• Cystopyelitis (simultaneous inflammation of all segments of the renal excretory system)
• Colitis
• Intestinal infarction (mesenteric ischemia)
• Endometriosis (including intestinal endometriosis)
• Abdominal hernia
• Gastritis
• Ectopic pregnancy (medical emergency)
• Hydronephrosis (swelling of the kidney due to urine backup)
• Splenic infections
• Food intolerances and allergies
• Leukemia
• Pelvic inflammatory disease (PID) (a complication of untreated sexually transmitted infections)
• Menstrual pain (dysmenorrhea)
• Crohn’s disease and ulcerative colitis (inflammatory bowel diseases)
• Intercostal neuralgia
• Intestinal obstruction (ileus)
• Pubalgia (groin pain syndrome)
• Severe constipation
• Kidney cancer (renal cell carcinoma)
• Colorectal cancer
• Wilms tumor (a kidney cancer primarily affecting children)
• Peptic or duodenal ulcer
• Gastric volvulus (rotation of the stomach on its axis)
• Intestinal volvulus (twisting of a loop of intestine)

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When Should You See a Doctor?

While not all causes of left side pain are serious, certain features should prompt immediate medical evaluation or emergency care:

Seek emergency care immediately if left side pain is accompanied by:

• Signs of internal bleeding (pallor, confusion, loss of consciousness, rapid heart rate);
• Sudden, severe, unbearable pain following trauma;
• High fever with chills and blood in the urine;
• Suspected ectopic pregnancy (positive pregnancy test with acute abdominal pain);
• Chest pain or difficulty breathing.

Schedule a non-urgent medical appointment if:

• Pain is persistent, lasting more than a few days;
• Pain keeps recurring without a clear explanation;
• Pain is accompanied by unexplained weight loss, fatigue, or blood in stool/urine;
• Pain is progressively worsening over time.