Severe Back Pain: Nighttime Discomfort and Possible Causes

Excruciating back pain?

I would like to inquire about back pain (approximately located at the back, between the ribs) that is very painful (to the point of being unbearable) and occurs mainly at night.
The individual has a history of ovarian tumor removal, and I wonder if this is related.
Additionally, during these episodes, she experiences nausea but is unable to vomit, although she has mentioned expelling some air or sour substances.
Previously, these episodes occurred infrequently or a few days before her menstrual period, but now they happen almost every night! She often wakes up in pain while trying to sleep.

P.S.
I am asking on behalf of my friend, and it is heartbreaking to see her in such pain that she almost rolls on the floor.

Ming, 20~29 year old female. Ask Date: 2000/12/26

Dr. Yang Guojun reply Internal Medicine

There are many causes of back pain, ranging from the simplest and most common, which is muscular and nerve pain, to more serious conditions such as stones or tumors (for example, chronic back pain could be a sign of colon cancer with bone metastasis) or severe back pain due to aortic dissection.
It is advisable to first arrange for an ultrasound examination and a consultation (preferably with a qualified specialist who has undergone rehabilitation training, such as a physiatrist or orthopedic surgeon) to determine the cause.

Regarding the second scenario you mentioned, where back pain is accompanied by gastrointestinal discomfort and is related to menstruation, it is likely irritable bowel syndrome (IBS).
However, IBS typically occurs in the week leading up to menstruation, with gastrointestinal discomfort appearing before back pain.
It is recommended to consult a gastroenterologist.
Treatment approach: If a patient adopts a "shopping at the department store" mentality towards medical care, switching hospitals after a day or two without improvement, they may ultimately suffer more.
To avoid back pain, it is essential to maintain a daily routine of stretching exercises.
If this habit is not changed, back pain will likely recur.
"Pain" is a signal that a problem is beginning, especially in the musculoskeletal system.
Whether during exercise or daily activities, the first thing to do when pain occurs is to "immediately" rest to prevent further injury.

Muscle and nerve pain can lead to back pain, and in most cases, back pain symptoms do not require medication and will heal on their own after some time, provided that the individual performs fifteen minutes of stretching exercises daily.
In the United States, approximately 80 million people have back problems, and this number is increasing at a rate of two million per year.
However, "ninety percent of those affected will improve automatically as long as they do not sustain further injuries."
People with back pain often visit chiropractors, physiatrists, acupuncturists, etc., but it is not necessary to see these specialists, as the condition can still improve within one to two months.
The modern lifestyle of prolonged sitting, combined with poor posture, is a major cause of back pain.
Maintaining an upright posture and using back support when necessary is the best way to prevent back pain.
Many people work in front of a computer all day without changing their posture, which naturally puts pressure on the back.
If they finally start to feel better but do not change their habits, the back pain will likely return and may even worsen.

Patients are advised that to recover quickly, they should exercise daily.
To avoid improper posture: when lifting heavy objects or picking things up from the ground, bend your knees instead of bending at the waist.
Bending forward puts extra strain on the back muscles to maintain that position, leading to muscle overload and potential strains.
Therefore, if the kitchen sink or countertop is too low, one can support themselves with one hand on the sink or sit on the edge of the bathtub while washing their face or brushing their teeth to reduce the time spent standing and leaning forward.
Alternating feet on a small stool while at the countertop can also effectively prevent leaning forward.
If working long hours, a back brace may be used for support.
Regular exercise habits: Regardless of age, starting an exercise routine should be based on one’s physical condition, choosing appropriate and enjoyable activities, and progressing gradually without rushing.
The goal is to improve or maintain good cardiovascular function, muscle strength, endurance, and flexibility.
Swimming, brisk walking, and stationary cycling are less likely to cause exercise injuries, so these are the activities I often recommend to patients and friends.
However, it is essential to maintain this routine at least 3 to 4 times a week for half an hour each time.

Regarding the second scenario you mentioned, where back pain is accompanied by gastrointestinal discomfort and is related to menstruation, it is likely irritable bowel syndrome (IBS).
However, IBS typically occurs in the week leading up to menstruation, with gastrointestinal discomfort appearing before back pain.
It is recommended to consult a gastroenterologist.

This response is provided by Dr.
Yang Guojun, a gastroenterologist at Miaoli Hospital.

Reply Date: 2000/12/26

More Info

Severe back pain, especially when it occurs predominantly at night, can be a distressing experience, and it’s understandable that you are concerned for your friend. The pain described, located around the rib area at the back, along with accompanying symptoms such as nausea and the sensation of vomiting, could indicate several underlying issues that warrant further investigation.

Firstly, it’s important to consider the nature of the pain. Is it sharp, dull, constant, or intermittent? Does it radiate to other areas, such as the abdomen or legs? The fact that the pain intensifies at night and disrupts sleep is significant. Nighttime pain can sometimes be associated with conditions such as musculoskeletal disorders, kidney issues, or even gastrointestinal problems.

Given your friend's history of ovarian tumor removal, it is crucial to consider whether there could be any connection. While back pain is not a direct symptom of ovarian issues, it is possible that post-surgical changes, such as scar tissue or adhesions, could lead to discomfort in the back area. Additionally, if there are any complications related to the surgery, such as nerve entrapment or referred pain from abdominal organs, these could manifest as back pain.

The nausea and the sensation of vomiting, particularly if it involves expelling air or acidic contents, may suggest gastrointestinal involvement. Conditions such as gastroesophageal reflux disease (GERD) or gastritis could potentially cause referred pain to the back, especially if the pain is accompanied by discomfort in the upper abdomen. The timing of these symptoms, occurring predominantly at night, could also indicate that lying down exacerbates the reflux or discomfort.

Moreover, it’s important to consider lifestyle factors that could contribute to her symptoms. Stress, anxiety, and poor posture during the day can lead to muscle tension and exacerbate back pain. If your friend has been experiencing increased stress or changes in her daily routine, this could also play a role in her discomfort.

In terms of management, it is essential for your friend to seek medical evaluation. A healthcare professional can conduct a thorough assessment, including a physical examination and possibly imaging studies, to determine the underlying cause of her symptoms. Depending on the findings, treatment options may include physical therapy, pain management strategies, or addressing any gastrointestinal issues if they are identified.

In the meantime, there are some general recommendations that may help alleviate her discomfort. Encouraging her to maintain good posture, engage in gentle stretching exercises, and apply heat to the affected area may provide temporary relief. Additionally, if she experiences nausea, small, frequent meals and avoiding lying down immediately after eating could help mitigate those symptoms.

Ultimately, it is crucial for your friend to communicate her symptoms clearly to her healthcare provider, including the frequency, intensity, and any associated symptoms. This information will be invaluable in guiding her diagnosis and treatment plan. It’s commendable that you are looking out for her well-being, and with the right medical support, she can find relief from her pain and improve her quality of life.

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