Causes of Lower Back Pain When Lying Down and Treatment

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There are many causes of lower back pain when lying down. Also called nocturnal or nighttime back pain, some of the most common causes include injuries, like a strain, and conditions like arthritis or sciatica. The pain can range from mild to debilitating and is often described as dull, sharp, or throbbing.

Pain in the lower back (or lumbar region) while lying down can make it difficult to get a good night's sleep, and may affect the way you move your lumbar muscles, ligaments, and vertebrae during your daily movements and activities.

Low back pain at night

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Possible Causes

Nighttime back pain isn’t always a sign of a serious health condition, especially if it only happens occasionally or for a short period of time. But when nocturnal back pain is frequent and bothersome, it might be time to get it checked out.

Some of the most common reasons for having back pain while lying down include:

  • Strain or sprain: As the most common causes of low back pain, lumbar strains and sprains happen when muscles or ligaments are stretched too far.
  • Ankylosing spondylitis (AS): This rare form of arthritis, characterized by chronic inflammation in the back and neck, tends to improve with exercise and worsen at night.
  • Spine osteoarthritis: Pain from wear and tear on the joints of the spine may intensify at night due to inactivity.
  • Sciatica: The vertebrae in the lower back can further irritate the sciatic nerve in certain sleeping positions, leading to radiating pain in the lower body.
  • Spinal tumor: Although rare, pain from a tumor or growth on the spine can worsen when lying down due to direct pressure on the area.

Other causes of lower back pain while lying down include conditions like spinal stenosis, a narrowing of the spinal column.

Nighttime back pain can also be a symptom of kidney stones, endometriosis, certain cancers, pregnancy, and other forms of arthritis. Keep in mind that it’s rare that nighttime back pain is caused by a tumor, infection, or AS.

When to See a Healthcare Provider

Nighttime back pain that wakes you up from sleep or prevents you from sleeping is a sign that it's time to discuss the issue with your healthcare provider. Along with lower back pain, you can also experience muscle stiffness and a limited range of motion, especially if the cause is a strain or sprain.

It's also helpful to know how pain is commonly categorized:

  • Acute pain is short-term pain lasting a few days or a few weeks. It’s typically connected to an injury or specific event. 
  • Chronic pain is longer-term pain lasting for several months or more. In many cases, it isn't initiated by an injury.

While each individual's situation and pain threshold will be different, there are some common guidelines that'll help you decide when your nighttime lower back pain merits a trip to the healthcare provider.

Contact your healthcare provider as soon as possible if your pain:

  • Began with a specific injury
  • Continues or gets worse for more than a few days
  • Feels severe or radiates to other parts of the body, like your legs
  • Is accompanied by signs of infection, such as redness, warmth, swelling, or fever
  • Is accompanied by weakness, numbness, or tingling in your lower body

Checking with your primary care healthcare provider or other first-line healthcare professional is a good start. They will be able to treat or refer you to another specialist if needed.

For example, if your healthcare provider suspects your back pain at night could be related to an inflammatory condition, you may be referred to a rheumatologist (who specializes in arthritis and diseases that involve the bones, muscles, and joints) for further evaluation.

Consider seeking immediate medical attention if you have a personal history of cancer, unexplained weight loss, or sudden bladder control issues in addition to lower back pain while lying down.

Diagnosis

To get to the bottom of your nocturnal back pain, your healthcare provider will start with a physical exam and review of your medical history to identify or rule out any serious conditions.

Your healthcare provider will ask about the specifics of your discomfort and will ask you to describe your pain. You should be prepared to give details about when the pain started, what makes it worse or better, its quality and intensity, and whether you've noticed any additional symptoms—like numbness or tingling.

Aside from the basic examination, there are some other tests that your healthcare provider might order to help with the diagnosis, including:

  • Neurologic tests, or movement screenings, can measure muscle strength to determine if the pain is spine or nerve-related.
  • Imaging tests, such as an MRI or CT scan, can help rule out specific causes of pain, such as cancer, infection, or fracture. 
  • Lab tests like a complete blood count may be helpful if you have a possible infection or unexplained weight loss, which may suggest cancer or inflammatory arthritis like AS.

Treatment

Treatment for lower back pain at night can vary, depending on the exact diagnosis. In general, for the most common conditions, healthcare providers will usually recommend remedies to alleviate discomfort at bedtime, such as:

  • Applying heat or ice
  • Taking an over-the-counter pain reliever
  • Gentle stretching or light (not vigorous) exercise
  • Physical therapy to strengthen core muscle groups that support the low back
  • Spinal injections such as corticosteroid or epidural

Because the lower back pain is occurring at night, your healthcare provider will also likely recommend approaches to improve your sleeping environment, which involves your sleeping position, pillows, and mattress.

Complementary at-home remedies may also be incorporated into your treatment plan.

These include:

When the pain is severe and cannot be relieved with noninvasive methods, it's possible that your healthcare provider may recommend surgery to treat certain conditions like degenerative disk disease, sciatica, spinal osteoarthritis, and sometimes ankylosing spondylitis.

If you've been diagnosed with cancer, spinal tumor, or another serious condition, your healthcare provider will discuss treatment options that may include surgery, radiation therapy, or another immediate intervention.

Coping

While not all conditions that cause nighttime lower back pain can be prevented, there are several strategies you can implement to help keep your back healthy and pain-free.

Many experts suggest the following to help prevent the progression of pain:

  • Maintain a healthy weight.
  • Practice good posture.
  • Avoid movements or heavy lifting that can strain the back.
  • Avoid smoking, which some research suggests can increase the risk of chronic back pain.
  • Use ergonomically friendly chairs (furniture that's designed to minimize physical discomfort) at home and work, if possible.
  • Switch sitting positions and take frequents breaks to walk or stretch during the day.
  • Wear comfortable, low-heeled, supportive shoes.

Keep in mind that there are also some risk factors that can increase the chances of getting low back pain. These include excess body weight, a sedentary lifestyle, lifting heavy objects, and repetitive bending or twisting of the lower back.

Getting Quality Sleep

Experiencing nighttime lower back pain can make it especially difficult to get quality sleep, which is an important part of recovery for many conditions. To improve your sleep while dealing with lower back pain at night, experts recommend these tips:

  • Find a sleeping position that supports your specific back condition.
  • Choose a mattress that will keep your spine aligned.
  • Use pillow support to prop up certain body parts, alleviating pressure and strain on the low back.

A Word From Verywell

Lower back pain while lying down can be especially frustrating, even after you have a diagnosis. When the pain interferes with your ability to get the sleep your body needs to recover, it opens the door to other health issues that are linked to poor sleep.

Any lower back pain that only occurs when you're lying down or regularly wakes you up in the middle of the night should be checked out by a healthcare provider as soon as possible, so you can get back to the restful sleep your body deserves.

Frequently Asked Questions

  • What conditions include lower back pain that radiates down the leg?

    Sciatica is nerve pain that often radiates from the back through the hip and down the leg. This type of pain usually flares up and resolves on its own within six weeks for about 80% of people.

  • What can I do to soothe back pain?

    There are various forms of complementary therapy that you can do at home to help with back pain, including exercises like yoga or tai chi, stress reduction programs, massage therapy, and hydrotherapy. You may also want to consider seeing a chiropractor for additional relief,

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10 Sources
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