Causes and Treatment of Lower Back Pain When Lying Down

If your lower back hurts when you lie down, it could be caused by a number of different problems. You may have an injury such as a strain. Or you may be dealing with a health condition like arthritis or sciatica.

Lower back pain can be mild. It can also be so severe that it keeps you from functioning in your daily life.

Nighttime pain can make it hard to get enough rest. It can also affect you during the day. Lower back pain can lead to muscle stiffness and a limited range of motion.

This article takes a look at some of the things that can cause back pain when you lie down. It also explains how the cause can be diagnosed and treated.

Causes

Nighttime back pain usually isn't a sign of a serious health condition. But when it happens often or it interferes with your life, it's probably time to get it checked out.

Some of the most common causes include:

• Strain or sprain: Lumbar (lower back) strains and sprains happen when muscles or ligaments are stretched too far. Injuries like these are very common.
• Ankylosing spondylitis (AS): This rare form of arthritis causes persistent inflammation in the back and neck. AS symptoms tend to get better with physical therapy. They can be worse at night.
• Spine osteoarthritis: Wear and tear on the spine may spur more intense pain at night. That could be because you're less active.
• Sciatica: Certain sleeping positions can aggravate the sciatic nerve. This kind of pain often shoots down your legs.
• Spinal tumor: Tumors or growths on the spine are rare. They can cause worse pain when you lie down if the growth puts pressure on the back.
• Spinal stenosis. This condition narrows the spinal column and can compress nerves.

When to See a Healthcare Provider

Everybody handles pain differently. Still, it's a good idea to talk to your healthcare provider right away if your pain:

• Began with a specific injury
• Wakes you up at night
• Keeps you from sleeping
• Lasts longer than a few days
• Feels severe
• Travels to other parts of the body, like your legs
• Comes with signs of infection, such as redness, warmth, swelling, or fever
• Comes with weakness, numbness, or tingling in your lower body

You may want to start by checking with your primary healthcare provider. They will be able to treat or refer you to a specialist if needed.

For example, if your healthcare provider thinks your pain may be caused by an inflammatory condition, you may need to see a rheumatologist. A rheumatologist specializes in arthritis and diseases that involve the bones, muscles, and joints.

You may find it helpful to know how pain is categorized:

• Acute pain is short-term—a few days or weeks. It often happens after an injury or specific event. 
• Chronic pain is longer-term. It may last for several months or more. In many cases, it isn't from an injury.

Diagnosis

To find the cause, your healthcare provider will start with a physical exam. Be prepared to talk about your medical history to help identify or rule out health conditions.

Your healthcare provider will ask you to describe your pain. You may want to note:

• When it started
• What makes it worse or better
• Its quality (aching, burning, throbbing)
• Its intensity (how strong it is)
• Whether you have other symptoms like numbness or tingling

You may also need other tests to help with the diagnosis, including:

• Neurologic tests: These measure muscle strength and skin sensation to see if the pain is spine or nerve-related.
• Imaging tests, such as an MRI or CT scan: These can help rule out cancer, infection, or fracture. 
• Lab tests like a complete blood count: These may be helpful if you have an infection or unexplained weight loss, which may suggest cancer or inflammatory arthritis.

Treatment

Your treatment will depend on what's causing your pain. Healthcare providers often start with pain remedies such as:

• Heat or ice
• Over-the-counter (OTC) pain relievers
• Gentle stretches or light exercise
• Physical therapy to strengthen core muscles that support the lower back
• Corticosteroids to reduce inflammation
• An epidural, where pain medication is injected into the spine

Because the pain happens at night, your healthcare provider will probably want to improve your sleep environment. You may need to change your sleeping position, pillows, or mattress.

Your treatment plan could also include complementary remedies.

These might include:

• Massage therapy
• Acupuncture
• Chiropractic care

If your pain is severe or isn't getting better with these methods, your healthcare provider may recommend surgery. Surgery may be a good option for degenerative disc disease, sciatica, and spinal osteoarthritis. It sometimes helps with AS.

Coping

Not all conditions that cause nighttime lower back pain can be prevented. Even so, there are strategies you can use to keep your back healthy and pain-free.

Many experts suggest the following to keep pain from getting worse:

• Maintain a healthy weight.
• Use good posture.
• Avoid movements or heavy lifting that can strain the back.
• Avoid smoking. Some research suggests it can increase the risk of chronic back pain.
• Use ergonomic chairs (designed to maximize comfort) at home and work, if possible.
• Switch sitting positions and take frequent breaks to walk or stretch during the day.
• Wear comfortable, low-heeled, supportive shoes.

Some risk factors increase the chance of having low back pain. These include:

• Excess body weight
• A sedentary (not very active) lifestyle
• Lifting heavy objects
• Frequent bending or twisting of the lower back

Getting Quality Sleep

Nighttime lower back pain can make it hard to get good sleep. Without rest, you may have a harder time recovering from illness or injury.

To improve your sleep while dealing with lower back pain, experts recommend that you:

• Find a sleeping position that supports your specific back condition.
• Choose a mattress that keeps your spine aligned.
• Use pillows to support body parts and ease strain on the low back.

Summary

Back pain when you lie down can have a wide range of causes. Some are serious and others are less so. It's important to find out what's causing your pain, especially if it's disrupting your sleep.

Muscle strains are the most common cause. Different types of arthritis, sciatica, and spinal changes can also lead to nighttime back pain.

A healthcare provider will need to find out when your pain started and what makes it better or worse. You may also need to have bone scans, blood tests, or other tests to pinpoint the cause.

See if your back pain responds to OTC pain medications, heat, ice, or gentle stretching. And check to see if your pillow or mattress are making it worse. If these changes don't help, it's time to see your healthcare provider.