If, like many people, you find that you wake up relatively pain free but have back pain worse at night, read on!

There are numerous reasons why back pain can arise, which can make diagnosis and treatment difficult. Back pain that tends to be worse in the evening can offer an indication of the cause of the symptom. Similarly, waking with back pain can also offer a diagnosing physician clues as to what’s going on.

Nighttime back pain can be especially troublesome as it can prevent you from sleeping properly. A lack of sleep actually makes you more sensitive to pain and more likely to fall or have an accident or injury.

Back pain at night can suggest a mechanical issue with the spine (i.e. how it moves). This is often related to disc degeneration in the spine, which itself is more common in older people. Additionally, anyone with back pain worse at night might want to consider talking to their physician to rule out the following issues:

  • Consequences of a fall or traffic collision
  • Recent injuries while playing sports or being physically active
  • Kidney stones
  • Pregnancy
  • Endometriosis
  • Arthritis
  • Cancer – a metastatic tumor or a primary tumour
  • Sprain, strain, and fractures
  • Scoliosis
  • Spinal bone infection – osteomyelitis
  • Ankylosing spondylitis.


If you have back pain worse at night, consider this a red flag. This means seeking medical attention as soon as possible to get thoroughly assessed and rule out any serious conditions. Where nocturnal back pain spreads down one or both legs, is accompanied by weakness, numbness, or tingling in the legs, or occurs alongside bowel or bladder incontinence, urgent medical assistance is needed.

Other red flags that can accompany back pain that’s worse at night include:

  • Abdominal pain or throbbing
  • Fever
  • Unusual warm spots on the back
  • Weight loss with no clear cause
  • History of cancer
  • History of immune suppression
  • History of trauma

If you experience back pain worse at night, alongside any of these symptoms, be sure to get proper medical care. Early diagnosis and treatment can make all the difference for a positive prognosis. If nothing else, knowing you’re being proactive about back care may help you sleep more easily!

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