Understanding Nocturnal Back Pain

Written by Katie Cameron, Joseph Saling
Medically Reviewed by Shruthi N, MD on September 02, 2026

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 people experience some form of low back pain at some time in their lives. It's the second most common reason people see their doctor. In most cases, back pain can be managed no matter how severe it is. And people who get adequate rest and proper exercise often see improvement within weeks.

But with nighttime back pain, people can't get the rest they need because they can't get relief from their pain.

Most people with back pain can adjust their sleep to ease their pain during the day. But with nighttime back pain, also called nocturnal back pain, the pain 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.

A person may have an almost pain-free day, but at night, the pain might keep them from getting a full night's sleep.

Just as with normal back pain, the cause of nighttime back pain isn't always clear. Among other things, back pain can be caused by any of the following:

Problems with how the spine moves or other mechanical problems. The most common of these problems is disc degeneration. Disks are tissue between the vertebrae that function as shock absorbers; these can break down with age.

Injuries. Sprains, fractures, or more severe injuries like a fall or an auto accident can also cause back pain.

Diseases and conditions. Examples include scoliosis, a curvature of the spine, or spinal stenosis, a narrowing of the spinal column. Kidney stones, pregnancy, endometriosis, certain cancers, and various forms of arthritis can all lead to back pain.

A large number of the participants in a British study had disk degeneration.

Sometimes the cause of back pain might not be determined.

Guidelines for discovering serious spinal health problems list many "red flags," including nocturnal back pain.

Nocturnal back pain can be a symptom of spinal tumors. It could be a primary tumor, one that starts in the spine, or it could be a metastatic tumor, one that results from cancer that started elsewhere in the body and then spread to the spine.

Nocturnal back pain is also a symptom of spinal bone infection (osteomyelitis) and ankylosing spondylitis (AS), a condition that can cause the spine to fuse in a fixed, immobile position.

Other "red flags" include:

If one or more of these symptoms come with back pain, especially if you have a history of cancer, see your doctor right away. It's also important to call the doctor if your back pain is the result of a recent injury.

It's rare for nighttime back pain to be caused by a tumor, infection, or AS.

Initial steps to take to prevent nighttime back pain include:

Adjusting how you sleep. If you sleep on your back, try to tuck a pillow under your knees to help your lower back stay relaxed. If you prefer sleeping on your side, keep a pillow between your legs with your knees drawn up slightly to your chest to keep your spine, pelvis, and hips aligned. Avoid sleeping on your stomach, as this position is hard on your back.

Replacing your mattress. A firmer mattress can give your back more support while you sleep.

Upgrading your pillow. Consider buying a new pillow with enough support to keep your neck aligned with your spine.

Sleeping in a recliner or at an angle. Take pressure off your back by sleeping more upright.

If these steps don't help you get a better night's sleep, talk with your doctor to rule out more serious causes of your nighttime back pain.

If you have nighttime back pain that's keeping you from getting a good night's rest, you may find relief by changing how you sleep. Prop a pillow between or under your knees if you sleep on your side or back, and try your best to avoid sleeping on your stomach. If you're experiencing fever, tingling in your legs, or unexplained weight loss in addition to your back pain, talk to your doctor to check if something more serious may be going on.

What medical tests are used to diagnose nocturnal back pain? 

Your doctor will physically examine you and may order imaging tests like an X-ray, MRI, CT scan, or a nerve scan called an electromyography (EMG). If they think you have an infection, they may even draw blood for blood tests.

How can I tell if my nighttime back pain is caused by my kidneys or my spine?

If the pain in your back comes in throbbing waves, is accompanied by a fever, or is coming from higher up in your back, there's a chance it may be kidney pain. In this case, see your doctor right away. Your pain could be spinal if you feel it in sharp waves or have sudden weakness in your legs. If this is the case, seek treatment immediately. 

What should I do if back pain wakes me up in the middle of the night?

Try to go back to sleep on your back with a pillow or rolled-up towel underneath your knees to take pressure off your lower back. If you sleep on your side, sleep with a pillow between your knees to properly align your spine.

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