Why Is Back Pain at Night a Red Flag? (Plus What To Do)

Why Is Back Pain at Night a Red Flag? (Plus What To Do)

By Dr. Shoaib Muhammad , published on July 13, 2023
Dr Shoaib Muhammad,MD

Back pain can really take the fun out of life.

But when it starts affecting your sleep, that's a whole other matter. Because if your sleep is also bad, your days with back pain get even worse.

It's not a good situation.

Identifying the reasons behind back pain at night is crucial. Because it's very possible that there's an underlying issue that will need professional medical advice and treatment.

That's why back pain at night is considered a red flag.

That includes potential causes and the importance of seeking professional evaluation to ensure timely intervention and relief.

Common Causes of Back Pain at Night

Back pain at night refers to the discomfort or pain experienced specifically during the night or when trying to sleep.

It can be a sharp or dull ache, and it may make it hard to find a comfortable sleeping position.

The pain can be localised in one area or radiate to other parts of the back. 

Here's a quick bullet list of common causes that are good examples of why back pain at night is a red flag. We'll go into each of these in more detail in the section below that. 

  • Injuries
  • Poor desk posture
  • Muscular imbalances
  • Degenerative conditions
  • Sleep-related factors
  • Inflammatory conditions
  • Psychological factors

Here's a closer look at each item on the list to help you identify what might be the causing your back pain at night.


Sometimes, night back pain can be caused by previous injuries. If you hurt your back in the past, like straining a muscle or fracturing a bone, it can lead to pain at night. These injuries can make it harder for you to find a comfortable position to sleep in, causing discomfort.

Poor Desk Posture

If you spend a lot of time sitting at a desk with bad posture, it can strain your back muscles. Slouching or hunching over can put stress on your back, and this can lead to pain in your back at night. So, it is really crucial to maintain excellent posture while working or sitting for extended periods of time.

A summary infographic of causes of back pain at night that help show why it's a red flag. 

Muscular Imbalances

When some muscles in your back are weak while others are too tight, it can create imbalances. These imbalances can put extra strain on certain areas of your back, especially at night when your body is relaxed. This can result in back pain during the night.

Degenerative Conditions

Nighttime back pain can also be caused by degenerative conditions. These conditions involve wear and tear on the spine or its components. For example, osteoarthritis is a typical problem when the cushioning cartilage in the spine's joints slowly gets damaged.

This can make the pain and swelling more intense, particularly at night when the body is at rest.  Another degenerative condition is degenerative disc disease. With this condition, the discs between the vertebrae in the spine can become worn down or damaged over time.

This can cause pain, stiffness, and discomfort, including at night. The discs act as shock absorbers, and when they are affected, it can make movement and sleeping more challenging.

Sleep-Related Factors

Certain sleep-related factors can contribute to back pain while in bed as well. One such factor is an unsupportive mattress or pillow.

If your mattress is too hard or too soft, it may not give the essential support for your back, resulting in discomfort while you try to sleep.

Similarly, using a pillow that doesn't properly support your neck and spine can also contribute to back pain. Sleeping in awkward positions can also strain the back and lead to night pain in your back.

For example, sleeping on your stomach can put stress on the spine's natural alignment and strain the muscles. It is generally recommended to sleep on your back or side with proper pillow support to maintain a more neutral spinal position.

Inflammatory Conditions

Nighttime back pain can be associated with inflammatory conditions that affect the back and joints. Rheumatoid arthritis, ankylosing spondylitis, and other types of arthritis can produce inflammation and back pain, which may be greater at night.

Inflammatory illnesses can induce stiffness, oedema, and discomfort, causing sleep disruption and nocturnal back pain. Rheumatoid arthritis is a sickness where the body's defence system fights against the joints by mistake, making them swollen and sore.

It can cause discomfort and limited movement in your back, especially in the mornings and at night. Ankylosing spondylitis mainly targets the spine and can make it swollen and hurt. The discomfort may increase when you're not moving, like when you're sleeping.  

Psychology & Back Pain While Sleeping

Stress, worry, and sadness are all psychological issues that can contribute to nightly back pain. When we are in emotional discomfort, our muscles, including those in our back, stiffen up.

This muscle tension can cause discomfort and agony, particularly during periods of relaxation, such as when attempting to sleep. Additionally, psychological factors can influence our perception of pain.

When we are feeling stressed or anxious, our pain thresholds may lower, making us more sensitive to discomfort. This heightened sensitivity can exacerbate back pain during the nights.

More Serious Conditions of Nighttime Back Pain

While back pain at night can often be attributed to common causes like muscle strain, it's important to be aware that it could also indicate more serious underlying conditions.

It is essential to recognise the potential signs and symptoms that may suggest a need for medical attention.

Spinal Fractures

Night time back discomfort may be an indication of a spinal fracture, which occurs when the bones in the spine break or crack. This sort of fracture can produce excruciating agony, particularly when lying down, and may necessitate prompt medical attention to stabilise the spine and aid recovery.


Certain infections, such as spinal infections or urinary tract infections that spread to the kidneys, can lead to nighttime back pain. Infections in the spine can cause irritation and harm to the surrounding tissues, resulting in chronic discomfort that may worsen at night.

Timely diagnosis and appropriate treatment are crucial to prevent complications.

Back pain at night is a red flag because it can be caused by serious conditions, as summarised in this infographic.

Tumors or Cancer

While rare, tumours or cancer in the spine can cause back pain at night. These abnormal growths can put pressure on the spinal nerves, leading to persistent pain that can be more noticeable during rest.

If back pain at night persists or is accompanied by other concerning symptoms, further medical evaluation is necessary to rule out the possibility of tumors or cancer.

Spinal Stenosis

Nighttime back pain could indicate spinal stenosis, a condition where the spaces within the spine narrow, putting pressure on the nerves. This can cause pain that worsens when lying down. Seeking medical evaluation is important to manage spinal stenosis effectively and prevent further complications.

Kidney Stones or Infections

Back pain at night may be a sign of kidney stones or infections. Kidney stones can cause severe pain that radiates to the back, while kidney infections can cause back discomfort that increases at night.  Prompt medical attention is necessary to address kidney-related issues and prevent complications.


Osteomyelitis is a bone infection that can affect the spine and cause back pain during the wee hours. This condition is usually caused by bacteria and can lead to persistent discomfort, especially during rest. Timely diagnosis and appropriate treatment, often involving antibiotics, are crucial to manage osteomyelitis effectively.

Disc Herniation

Nighttime back pain might be associated with a herniated disc, where the cushioning discs between the vertebrae become damaged and press on nerves. This can lead to pain that worsens when lying down. Seeking medical evaluation is important to determine the extent of disc herniation and explore suitable treatment options.

Cauda Equina Syndrome

Cauda equina syndrome is a rare but serious condition where the nerves at the lower end of the spinal cord become compressed.

This can cause severe back pain, along with other symptoms like bladder or bowel dysfunction. If nighttime back pain is accompanied by these symptoms, immediate medical attention is necessary to prevent permanent nerve damage.

Treatment Options For Sleeping With Back Pain

Dealing with nightly back pain can be difficult, but there are things you can do to reduce the agony and enhance your sleep. Consider the following practical suggestions.

Modify Your Sleep Position

Experiment with different sleeping positions to find the one that gives you the greatest back relief. According to numerous individuals, using a pillow between your knees when sleeping on your side or under your knees when sleeping on your back can bring relief from back pain.  

Supportive Mattress and Pillow

Invest in a mattress and pillow that provide adequate support for your spine. Look for options that align with your comfort preferences and consider ones specifically designed for back pain relief. A medium-firm mattress and a pillow that supports the natural curve of your neck can help reduce nighttime back pain.

A bullet list infographic of how to treat the red flag of nighttime back pain that sumarises the content in this section

Maintain Good Posture Throughout the Day

Pay attention to your posture during the day, especially if you have a sedentary lifestyle or work at a desk. Sit with proper back support, keep your feet flat on the ground, and avoid slouching. Taking regular breaks to stretch and move around can also prevent stiffness and alleviate back pain.

Gentle Exercise and Stretching

Engage in regular low-impact exercises such as swimming and stretching routines that strengthen your back and core muscles. Consult with a healthcare professional or a physical therapist to determine suitable exercises for your condition. We also have a full article on gentle exercises for back pain here.

Heat or Cold Therapy

Applying a heating pad or a warm towel to your back before bed can help relax muscles and relieve pain. Heat rubs also work well for back pain. Alternatively, some individuals find cold therapy, such as using an ice pack wrapped in a cloth, soothing for reducing inflammation and numbing the area.

Over-the-Counter Pain Relief

Nonprescription pain relievers such as paracetamol and non-steroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen can provide short relief for mild to severe evening back discomfort. However, before beginning any medicine, consult with a healthcare practitioner. I discussed more options in our article on painkillers and back pain.

Relaxation Techniques

Practicing relaxation techniques, such as deep breathing exercises, meditation, or guided imagery, can help reduce stress and promote muscle relaxation. Stress and tension can contribute to nighttime back pain, so finding ways to relax and unwind before bed can be beneficial.

Improve Sleep Environment

Create a sleep-friendly environment by ensuring your bedroom is dark, quiet, and at a comfortable temperature. Use blackout curtains, earplugs, or white noise machines if necessary. Establish a consistent sleep routine and prioritise quality sleep to aid in overall pain management.

Seek Professional Help

If your back pain persists making the nights feel long, or it worsens despite self-care measures, as a doctor I always recommend that people speak with their healthcare providers.

The doctors can check how you're doing, find out what's wrong, and suggest the right treatment, like exercises, medicine, or more tests if needed. Always remember that every person's situation is special, so what might be effective for one person may not be effective for another person depending on their own unique circumstances.

It may take some trial and error to find the strategies that provide the most relief for your pain. By implementing these tips and seeking professional guidance when needed, you can take proactive steps towards managing your back pain and improving your overall well-being.


Pro health clinic: Back Pain Red Flags https://prohealthclinic.co.uk/blog/back-pain-red-flags/

Very Well Health: Common Back Pain Red Flags https://www.verywellhealth.com/common-back-pain-red-flags-296730

Acep Sports Medicine: Re-evaluating Red Flags for Back Pain https://www.acep.org/sportsmedicine/newsroom/newsroom-articles/august2022/re-evaluating-red-flags-for-back-pain

UMMS: 8 Signs It’s Time to Call a Doctor for Your Back Pain https://www.umms.org/health-services/spine/signs-symptoms

Atlantic Spine Center: Causes and Treatments for Nighttime Back Pain https://www.atlanticspinecenter.com/blog/v/causes-and-treatments-for-nighttime-back-pain