Struggling with Back Pain: Finding Relief for Sleepless Nights

Q: Struggling with Back Pain: Finding Relief for Sleepless Nights

Hello, Mei-Yi： Are you taking your lupus medication regularly? If so, we can temporarily rule out the possibility of recurrent pleural effusion (or pulmonary edema). <br>A small number of lupus patients may experience this kind of shortness of breath, especially when unable to li

The back pain prevents me from lying flat to sleep?

Hello Doctor: About two years ago, I was diagnosed with lupus erythematosus after experiencing pleural effusion.
At that time, I had difficulty breathing; whenever I lay flat, I would experience chest pain and shortness of breath with a feeling of not being able to breathe.
I consulted with pulmonologists and cardiologists, who performed imaging and tests, and they said everything was normal.
However, I still experienced pain while breathing, which forced me to sleep sitting up at night.
Additionally, I frequently have pain in my back, particularly on the right side near the scapula, where the muscles and bones meet.
It hurts every time I breathe, and lying flat at night exacerbates the pain, making it impossible to sleep that way.
I also tried seeing an orthopedic doctor, but they couldn't identify any issues and only prescribed pain relievers and muscle relaxants.
While these medications provided some relief, I still couldn't lie flat to sleep.
This situation has significantly affected my sleep quality, and my follow-up appointments show no improvement in my symptoms.
I would like to ask the doctor what I should do.
Did I perhaps consult the wrong specialties before? Please give me some advice.

Meiyi, 20~29 year old female. Ask Date: 2006/06/16

Dr. Chen Baoli reply Internal Medicine

Hello, Mei-Yi: Are you taking your lupus medication regularly? If so, we can temporarily rule out the possibility of recurrent pleural effusion (or pulmonary edema).
A small number of lupus patients may experience this kind of shortness of breath, especially when unable to lie flat.
X-rays or pulmonary function tests may appear normal.
I recommend seeking assistance from a rheumatologist and a cardiologist at a major hospital (especially a medical center) to check for any signs of diaphragm tension or pulmonary hypertension.
Please feel free to write back and let me know.
As for your back pain, it may be due to muscle fascia inflammation caused by the inability to lie flat for an extended period.
Appropriate heat therapy and massage (such as acupressure) may help alleviate the symptoms, but this is just one possibility.
I suggest you first identify the cause of your shortness of breath when lying flat.
Wishing you all the best!

Reply Date: 2006/06/16

More Info

Dear patient,
Thank you for sharing your concerns regarding your back pain and sleep difficulties. It sounds like you have been through a challenging journey with your health, particularly with your diagnosis of lupus and the associated symptoms. Your experience of pain while breathing and the inability to lie flat at night can significantly impact your quality of sleep and overall well-being.

Firstly, it is important to understand that chronic pain conditions, such as those associated with lupus, can lead to sleep disturbances. Pain can activate the body's stress response, making it difficult to relax and fall asleep. Additionally, the position in which you sleep can exacerbate pain, particularly if you have underlying musculoskeletal issues.
Given your description of pain near the scapula and the difficulty in breathing when lying flat, it may be beneficial to explore a few strategies to improve your situation:
1. Sleep Positioning: Since lying flat causes you pain, consider using a reclined position for sleeping. You might try sleeping in a recliner or propping yourself up with pillows to find a comfortable angle that alleviates pressure on your back and chest. This can help reduce pain while allowing you to rest.

2. Pain Management: While you have been prescribed pain medications and muscle relaxants, it may be worth discussing with your physician the possibility of a multidisciplinary approach to pain management. This could include physical therapy, which can help strengthen the muscles around your back and improve flexibility, potentially reducing pain. Additionally, a pain management specialist may offer alternative treatments such as nerve blocks or acupuncture.

3. Cognitive Behavioral Therapy for Insomnia (CBT-I): If your sleep issues persist, consider seeking out a therapist who specializes in CBT-I. This type of therapy can help address the thoughts and behaviors that contribute to insomnia, teaching you techniques to improve your sleep hygiene and manage anxiety related to sleep.

4. Mindfulness and Relaxation Techniques: Incorporating mindfulness practices, such as meditation or deep breathing exercises, can help reduce anxiety and promote relaxation, making it easier to fall asleep despite discomfort. Gentle yoga or stretching before bed may also help relieve tension in your back and shoulders.

5. Follow-Up with Specialists: If your current treatment plan is not providing relief, it may be beneficial to seek a second opinion from a rheumatologist who specializes in lupus management. They can evaluate your symptoms in the context of your autoimmune condition and may suggest adjustments to your treatment plan.

6. Sleep Studies: If you continue to experience significant sleep disturbances, a sleep study may be warranted to assess for any underlying sleep disorders, such as sleep apnea, which can be common in individuals with chronic pain and can further complicate sleep quality.

7. Lifestyle Modifications: Ensure you are maintaining a healthy lifestyle, including a balanced diet, regular physical activity (as tolerated), and avoiding stimulants like caffeine close to bedtime. These factors can all contribute to better sleep quality.

In conclusion, your situation is complex, and it may take time to find the right combination of treatments and strategies to improve your sleep and manage your pain effectively. I encourage you to communicate openly with your healthcare providers about your symptoms and any changes you experience. Together, you can develop a comprehensive plan that addresses both your pain and sleep issues.

Wishing you the best in your journey toward better health and restful nights.

Similar Q&A

Chronic Back Pain: Seeking Solutions After Years of Suffering

Dear Doctor, I have been suffering from chronic back pain for a long time. I have been taking sleeping pills for two years because three years ago, I discovered that whenever I lie down in bed to sleep, I start to feel sharp pain in my back after a few minutes, which escalates to...

Dr. Wu Zongying reply Family Medicine
Hello: I recommend that you consult with a rehabilitation specialist or a neurologist for further evaluation, as they may provide different insights and treatment options.

Persistent Lower Back Pain at Night: Seeking Solutions for Sleeplessness

Hello doctor, I have been experiencing lower back pain that wakes me up at night for the past month. I have already consulted with the orthopedic department at Hsinchu Mackay, the neurosurgery department at Taoyuan Chang Gung, the rheumatology and immunology department at Taipei ...

Dr. Zhang Junwei reply Neurosurgery
It is really difficult to answer such questions online; I recommend going to a medical center for further examination.

Understanding Chronic Back Pain: Why Sleep Over 4 Hours Hurts

Hello, Vice Dean Zheng: My husband has been experiencing severe back pain since early November last year. Whenever he sleeps for more than four hours, he wakes up with intense pain, as if a nerve is being compressed. When he sleeps on his right side, he feels pain in his right lo...

Dr. Zheng Shunping reply Rehabilitation
In response to your question: Since your symptom description is quite rare, generally speaking, if the pain occurs only when lying flat or at night, it is important to pay special attention to the possibility of an autoimmune disease or other less common conditions. I recommend t...

Managing Pain and Discomfort After Spinal Injuries: Tips for Better Sleep

Hello Doctor, at the end of 2015, my mother fell while cleaning the windows at home. She was careful but stepped into empty space and landed on her back. Fortunately, there were no fractures, but she did sustain compression injuries to the first and second vertebrae. During her v...

Dr. Shi Guozheng reply Orthopedics
Are you referring to the compression fractures of the first and second lumbar vertebrae? Typically, if the height of the vertebral body has not decreased significantly (greater than 50%), conservative treatment can be applied, which includes medication and a back brace for about ...