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What Is Nocturnal Pain (Nighttime Pain) ?

Posted in Back Pain

The majority of people with back pain are able to adjust how they sleep to get relief from the pain they experience during the day. But with nighttime back pain — also called nocturnal back pain — the hurting doesn’t stop when a person lies down, no matter what adjustments he or she makes.

Nighttime back pain is a special type of lower back pain that could indicate a serious problem with your spine. In the U.S., up to 80% of the population experiences some form of low back pain at some time in their lives. It’s the second most common reason people see their doctor. But as debilitating as back pain can be, most instances of it are manageable, and people who get adequate rest and proper exercise often see improvement within a matter of weeks.With nighttime back pain, however, people can’t get the rest they need because they can’t get relief from their pain.

An individual can experience a day with minimal pain, only to encounter significant challenges in achieving a restful night’s sleep. According to a study published in the 2005 issue of the journal “Spine,” 44% of individuals seeking treatment at a back pain clinic in the United Kingdom reported experiencing nighttime pain. Among these individuals, 42% stated that they endured nightly pain. Some participants in the study described being awakened as frequently as six times during the night, and on average, those with nocturnal pain experienced less than five hours of uninterrupted sleep.

What Is Nighttime Back Pain?

The majority of people with back pain are able to adjust how they sleep to get relief from the pain they experience during the day. But with nighttime back pain — also called nocturnal back pain — the hurting doesn’t stop when a person lies down, no matter what adjustments they make. For some, the pain actually gets worse. And for others, the pain doesn’t even start until they lie down.

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A person can actually go through a day virtually pain-free. But then at night, they might find it nearly impossible to get a full night’s sleep.

back pain
back pain

Nocturnal pain refers to pain or discomfort that occurs specifically at night or during the nighttime hours. This type of pain can affect various parts of the body and may have a wide range of underlying causes. Some common examples of conditions that can lead to nocturnal pain include:

  1. Arthritis: Certain types of arthritis, such as rheumatoid arthritis and osteoarthritis, can cause increased pain and stiffness in the joints during the night.
  2. Neuropathic pain: Conditions like diabetic neuropathy or sciatica can cause burning, tingling, or shooting pain that may worsen at night.
  3. Musculoskeletal injuries: Injuries to muscles, tendons, or ligaments may become more painful during rest or when lying down, which can be particularly noticeable at night.
  4. Toothache: Dental problems, such as cavities or gum infections, may lead to increased pain when lying down, as blood flow to the head increases.
  5. Gastrointestinal issues: Conditions like acid reflux, gastritis, or peptic ulcers can cause stomach pain or discomfort that tends to worsen when lying down, especially after eating.
  6. Restless leg syndrome: This neurological disorder is characterized by an uncontrollable urge to move the legs, often leading to discomfort and pain that can be more pronounced at night.
  7. Menstrual cramps: Some individuals may experience severe menstrual cramps, known as dysmenorrhea, that become worse during the nighttime.
  8. Psychogenic pain: In some cases, emotional factors such as stress or anxiety can contribute to the perception of pain, and these factors may be more pronounced or noticed at night when the person is at rest.

Nocturnal pain, or pain that occurs primarily at night, can have various underlying causes. The specific cause of nocturnal pain can vary depending on the individual and their medical history. Some common causes of nocturnal pain include:

  1. Musculoskeletal Issues: Problems with bones, muscles, tendons, or ligaments can lead to nocturnal pain. Conditions like arthritis, tendinitis, or muscle strains may worsen at night, particularly when the affected area is not in motion.
  2. Inflammatory Conditions: Inflammatory diseases like rheumatoid arthritis or ankylosing spondylitis can cause increased pain and stiffness during the night.
  3. Neurological Conditions: Conditions such as sciatica or neuropathy can result in nighttime pain due to nerve irritation or compression.
  4. Gastrointestinal Issues: Certain gastrointestinal conditions, including acid reflux, gastritis, or peptic ulcers, may lead to nighttime pain or discomfort, especially if lying down exacerbates the symptoms.
  5. Menstrual Pain: Some individuals, particularly women, may experience severe menstrual cramps (dysmenorrhea) that become more pronounced during the nighttime.
  6. Psychological Factors: Emotional stress, anxiety, or depression can contribute to perceived pain and discomfort that may be more noticeable at night when a person is trying to relax and sleep.
  7. Sleep Disorders: Sleep disorders like restless leg syndrome (RLS) or periodic limb movement disorder (PLMD) can cause discomfort and pain at night, leading to disrupted sleep.
  8. Medication Side Effects: Certain medications can cause side effects such as muscle pain or discomfort, which may be more noticeable at night.
  9. Trauma or Injuries: Injuries sustained during the day may lead to increased pain at night as the body attempts to heal.
  10. Unknown Causes: In some cases, the exact cause of nocturnal pain may not be readily apparent, and a thorough medical evaluation may be necessary to determine the underlying issue.
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It’s crucial to consult a healthcare provider if you are experiencing persistent or severe nocturnal pain to determine the cause and develop an appropriate treatment plan. Identifying and addressing the underlying cause is essential for managing and alleviating nighttime pain effectively.

Can Nocturnal Back Pain Be a Sign of Something Serious?

Yes, nocturnal back pain can sometimes be a sign of something serious, although it can also result from more benign causes. It’s essential to pay attention to the nature and characteristics of the pain, as well as any accompanying symptoms, and to consult a healthcare provider for a proper evaluation. Some potential serious causes of nocturnal back pain include:

  1. Spinal conditions: Serious spinal conditions such as herniated discs, spinal stenosis, or fractures can lead to back pain that is worse at night, especially when lying down.
  2. Infections: Infections of the spine or surrounding tissues (e.g., vertebral osteomyelitis or discitis) can cause severe back pain that may worsen at night.
  3. Tumors: Although rare, tumors or cancers that affect the spine or nearby structures can cause nighttime back pain, often accompanied by other concerning symptoms like unexplained weight loss or neurological deficits.
  4. Inflammatory conditions: Inflammatory diseases like ankylosing spondylitis or rheumatoid arthritis can lead to persistent back pain that may flare up at night.
  5. Kidney problems: Kidney stones or kidney infections can cause referred pain to the back, which may be more noticeable during rest.
  6. Aortic aneurysm: In rare cases, an abdominal aortic aneurysm can cause back pain, and this pain may be more pronounced at night.
  7. Sleep disorders: Sometimes, conditions like sleep apnea or restless leg syndrome can lead to disrupted sleep and perceived nighttime back pain.
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It’s important to note that it’s rare that nighttime back pain is caused by a tumor, infection, or AS.

For some, the pain actually gets worse. And for others, the pain doesn’t even start until they lie down.


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