Persistent Back Pain at Night: Possible Causes and Solutions - Internal Medicine

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Persistent back pain at night can be a frustrating and debilitating issue, especially when it disrupts your sleep. Given your description of the pain being located between your shoulders and lower back, and the fact that it primarily occurs at night, there are several potential causes to consider.

One of the conditions you mentioned is ankylosing spondylitis (AS), which is a type of inflammatory arthritis that primarily affects the spine and can lead to severe, chronic pain and discomfort. AS typically presents with pain that improves with movement and worsens with rest, which aligns with your experience of pain at night. It is also common for individuals with AS to experience stiffness in the morning that improves with activity throughout the day. To confirm a diagnosis of ankylosing spondylitis, a rheumatologist may perform specific blood tests, such as checking for the HLA-B27 antigen, and imaging studies like MRI, which can reveal inflammation in the sacroiliac joints that may not be visible on X-rays.

Other potential causes of your nighttime back pain could include:
1. Muscle Strain or Ligament Sprain: If you have been engaging in activities that strain your back muscles or ligaments, this could lead to pain that is more pronounced at night when your body is at rest.

2. Poor Sleep Posture: The way you sleep can significantly impact back pain. If you sleep on a mattress that does not provide adequate support or if your sleeping position is not conducive to spinal alignment, this could exacerbate your pain. It may be beneficial to evaluate your mattress and pillows, and consider sleeping on your side with a pillow between your knees or on your back with a pillow under your knees to relieve pressure on your spine.

3. Degenerative Disc Disease: As we age, the discs in our spine can degenerate, leading to pain that may be more noticeable at night. This condition can cause discomfort due to changes in the structure of the spine and may require physical therapy or other interventions.

4. Other Inflammatory Conditions: Conditions such as rheumatoid arthritis or fibromyalgia can also cause persistent pain and may require further evaluation by a specialist.

5. Psychological Factors: Stress and anxiety can manifest as physical pain, including back pain. If you are experiencing significant stress, it may be worth exploring relaxation techniques or speaking with a mental health professional.

Given that you have already undergone X-rays with no significant findings, it may be prudent to follow up with a rheumatologist or an orthopedic specialist who can conduct a thorough evaluation, including a detailed history and physical examination. They may recommend further imaging studies, blood tests, or even a referral to a physical therapist who can help you with exercises designed to strengthen your back and improve flexibility.

In the meantime, consider implementing some self-care strategies to help manage your pain. Regular gentle stretching, heat therapy (such as a warm bath or heating pad), and over-the-counter pain relief medications may provide temporary relief. Additionally, maintaining a regular sleep schedule and creating a calming bedtime routine can help improve your overall sleep quality.

In conclusion, persistent back pain at night can stem from various causes, and it is essential to seek a comprehensive evaluation to determine the underlying issue. By working closely with healthcare professionals, you can develop a tailored treatment plan that addresses your specific needs and helps alleviate your discomfort, ultimately improving your quality of life.