Causes and Treatment of Lower Back Pain When Lying Down

It’s a good idea to seek immediate medical care if you have low back pain and a personal history of cancer. Your pain may need urgent treatment if you also have unexplained weight loss or sudden bladder control issues.

Lower Back Pain When Lying Down

Lower back pain when lying down can be caused by a number of things. Sometimes, getting relief is as simple as switching sleeping positions or getting a mattress that’s better suited to your needs.

However, if you can’t get relief from changes to your sleep environment, or if the pain occurs only at night, it may be a sign of something more serious, like arthritis or degenerative disk disease.

Talk to your doctor if your back pain is accompanied by:

• fever
• weakness
• pain that spreads to the legs
• weight loss
• bladder control issues

Your spine and the muscles surrounding your spinal cord can be sensitive. They form the central structure of your body and work hard to keep you standing straight and balanced. If you have pain when you lie down, here are some possible causes.

Pulled muscle or strain

A pulled muscle or strain can happen while lifting or twisting incorrectly. Muscles, ligaments, and tendons can be overstretched to a point of being painful when in certain positions or during specific movements.

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Ankylosing spondylitis

Ankylosing spondylitis (AS) is a type of arthritis. The pain from AS typically is located in the lower back and pelvis area. Often, the pain gets worse at night when you’re less active.

Spinal tumor

If you’re experiencing back pain that has gotten worse over time, you may have a tumor or growth in your spine. Your pain will likely be worse when you’re lying down due to the direct pressure on your spine.

Disc degeneration

Often called degenerative disc disease (DDD), the exact causes of this disease are unknown. Despite the name, DDD isn’t technically a disease. It’s a progressive condition that happens over time from wear and tear, or injury.

Treatment for your lower back pain varies depending on the diagnosis. Short-term treatment can be done at home to try to alleviate minor aches and pains. At-home treatment includes:

• changing sleeping positions
• elevating legs or knees when sleeping
• applying heat pads
• taking over-the-counter medication
• getting a massage

Try not to remain idle or inactive for long periods of time. Consider refraining from physical activities for a few days, and slowly ease yourself back into your normal activities to prevent stiffness.

Minor lower back pain will usually go away on its own after a while. If it doesn’t, review your situation with your doctor.

Treatment for AS

Treatment for ankylosing spondylitis depends on the severity of your case. Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs).

If the NSAIDS aren’t effective, your doctor might talk to you about biologic medications, such as a tumor necrosis factor (TNF) blocker or an interleukin 17 (IL-17) inhibitor. You may require surgery if your joint pain is severe.

Treatment for spinal tumor

Treatment for a spinal tumor depends on the severity of your tumor. Your doctor may recommend surgery or radiation therapy to help prevent nerve damage in your spinal cord. If you catch symptoms early, you have a better chance of recovery.

Treatment for degenerative discs

Degenerative discs are usually treated with nonsurgical approaches, such as:

• pain medication
• physical therapy
• massage
• exercise
• weight loss

Surgery is typically complicated and thus postponed until other efforts prove ineffective.

Causes and Treatment of Lower Back Pain When Lying Down

Cristina Mutchler is an award-winning journalist with more than a decade of experience in national media, specializing in health and wellness content. A multilingual Latina, Cristina’s work has appeared on CNN and its platforms, local news affiliates across the country, and in the promotion of medical journal articles and public health messaging.

Updated on August 11, 2021

Stuart Hershman, MD, is a board-certified spine surgeon. He specializes in spinal deformity and complex spinal reconstruction.

Table of Contents
Table of Contents

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 exercise. 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.

Other causes of nighttime back pain include kidney stones, endometriosis, certain cancers, pregnancy, and other forms of arthritis. It’s rare for it to be caused by a tumor, infection, or AS.

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.

It’s a good idea to seek immediate medical care if you have low back pain and a personal history of cancer. Your pain may need urgent treatment if you also have unexplained weight loss or sudden bladder control issues.

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.

If you have cancer, a spinal tumor, or another serious condition, your healthcare provider will discuss your options with you. You may need surgery, radiation therapy, or another speedy intervention.

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.

Recap

Nighttime back pain can be treated with OTC or steroid medications. Heat, ice, and stretches may help you heal, too. You may also need to change your sleep habits or work with a physical therapist to fully recover. The best treatment will depend on the cause of your pain.

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.

A Word From Verywell

Lower back pain while you’re lying down can be frustrating. This is especially true if the pain keeps you from getting the sleep your body needs to recover. It opens the door to other health issues linked to poor sleep.

If the pain only happens when you lie down, or if it wakes you up in the middle of the night, get it checked out by a healthcare provider as soon as possible. The right diagnosis and treatment are the key to feeling better day and night.

Frequently Asked Questions

What causes 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?

Complementary therapies like yoga, tai chi, stress reduction programs, massage therapy, and hydrotherapy may help. You may also want to consider seeing a chiropractor,

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. American Association of Neurological Surgeons. Low back strain and sprain.
2. Arthritis Foundation. Axial spondyloarthritis.
3. Ho KKN, Ferreira PH, Pinheiro MB, et al. Sleep interventions for osteoarthritis and spinal pain: a systematic review and meta-analysis of randomized controlled trials. Osteoarthritis and Cartilage. 2018;27(2)196-218. doi:10.1016/j.joca.2018.09.014
4. American Association of Neurological Surgeons. Spinal pain.
5. National Institute of Neurological Disorders and Stroke. Low back pain fact sheet.
6. Arthritis Foundation. When it’s time to see a doctor for joint pain.
7. American Academy of Family Physicians. Low back pain.
8. Goldsmith R, Williams NH, Wood F. Understanding sciatica: illness and treatment beliefs in a lumbar radicular pain population. A qualitative interview study.BJGP Open. 2019;3(3):bjgpopen19X101654. doi:10.3399/bjgpopen19X101654

By Cristina Mutchler
Cristina Mutchler is an award-winning journalist with more than a decade of experience in national media, specializing in health and wellness content.

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