Causes of Lower Back Pain When Lying Down and Treatment

From verywellhealth.com

There are many potential reasons for experiencing 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 can described as dull, sharp, throbbing, and more.

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 the lumbar muscles, ligaments, vertebrae, and nerves work together to provide control and strength for daily movements and activities.

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Possible Causes

Night-time 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.
• Degenerative disc disease (DDD): Gradual deterioration of the spinal discs and vertebrae due to aging can lead to painful, restless nights.
• 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 tumour: Although rare, pain from a tumour 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 scoliosis, a curvature of the spine, and spinal stenosis, a narrowing of the spinal column.

Night time 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 night time back pain is caused by a tumour, infection, or AS.

When to See a Doctor

Night-time back pain that wakes you up from sleep or prevents you from sleeping is likely a sign that it's time to discuss the issue with your doctor. Remember that along with lower back pain, muscle stiffness and a limited range of motion are also often reported, 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 instance. 

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 decide when your night-time lower back pain merits a trip to the doctor. It's a good idea to visit your doctor 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 doctor or other first-line health care professional is a good start. They will be able to either treat or refer you to another specialist, if needed.

For example, if your doctor suspects your back pain at night could be related to an overall 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 doctor will start with a physical exam and review of your medical history to identify or rule out any serious conditions.

Your doctor will be interested in the specifics of your discomfort and will ask you to describe your pain. You should be prepared to give details on 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 the doctor could order to help with the diagnosis, including:

• Neurologic tests, or movement screenings, can measure muscle strength to determine if the pain is 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 for concerning symptoms such as a fever, which may suggest 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, doctors 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 doctor 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:

• Massage therapy
• Acupuncture
• Chiropractic care

When the pain is severe and cannot be relieved with non-invasive methods, it's possible that your doctor 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 tumour, or another serious condition, your doctor will discuss treatment options that may include surgery, radiation therapy, or another immediate intervention.

Coping

While not all conditions that cause night-time lower back pain can be prevented, there are several strategies you can implement to help keep your back healthy and hopefully 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 or the lower back.

Getting Quality Sleep

Experiencing night-time lower back pain can make it especially difficult to get quality sleep, which is an important part of recovery for many conditions causing the pain. 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 doctor as soon as possible, so you can get back to the restful sleep your body deserves.

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