Hi, Severe pain below right ribs and referred to back with normal reports - details not given - can be due to the following reasons which are missed easily due to lack of proper clinical examination: Costochondritis is easily missed, there is local tenderness, the pain increases on having viral fever, stress and anxiety. Problem with thoracic spine can cause pain in back and referred pain to the rib area due to nerve being entrapped. Hence I would advise you the following: Get a proper clinical examination done by your Doctor. MRI of the thoracic spine. Ultrasonography of abdomen to rule out gallbladder and liver problems. Colonoscopy for transverse colon and upper GI Endoscopy for stomach or duodenal ulcers. All these will lead to a proper diagnosis and the management will be as per the cause found. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. T. Chandrakant, General Surgeon