Morning Back Pain: Causes and Seeking Relief

Every morning, I experience internal soreness in my lower back and back, which causes me difficulty sleeping due to the pain?

Dear Doctor, I really don't know what to do.
Please help me with these questions.
I am unsure about my condition, and it feels like the range of issues is very broad.
Going to a large hospital for an examination would take a long time, and I don't know which department to visit or how to start explaining my situation.

Let me describe my symptoms: the most distressing issue is the persistent pain in my lower back every morning.
For the past two to three weeks, I have been waking up with internal soreness in my back and lower back.
The pain is so intense that I can't sleep well, and changing positions doesn't help.
My mattress is quite soft, but I've been using it for a year and a half, so it shouldn't suddenly cause this issue.

About a month ago, I had a cough and diarrhea, which felt like a cold.
After seeing a doctor multiple times (including pediatric, ENT, and eventually gastroenterology due to ongoing diarrhea), I underwent an endoscopy and was diagnosed with a mild duodenal ulcer, but my stomach was fine.
I initially thought the morning soreness was due to stomach discomfort, but after seeing several doctors without improvement, I realized that the pain is not from my stomach but rather from the lower back area.

The sensation feels like muscle soreness from not exercising for a long time, but it's much more intense, almost like internal spinal pain.
Strangely, this pain only occurs after lying down to sleep and improves significantly once I sit up in the morning.
During normal activities, I don't feel discomfort, although I do experience some soreness when twisting my lower back.
I have tried lying down for a couple of hours at night, which causes some soreness, but moving around when not lying down also leads to soreness, so I'm unsure of the root cause.
A few days ago, I suddenly recalled the term "ankylosing spondylitis" and found that several points match my condition.
The main symptoms that align with my situation are: 1.
Chronic lower back pain, morning spinal stiffness, and limited range of motion.
2.
Some patients may have ulcerative colitis (I had a small duodenal ulcer found during the endoscopy).
3.
Skin issues: some patients may have psoriasis (I have had itchy skin for five years due to chronic urticaria, which often leads to skin being scratched and broken.
I don't know if this is psoriasis, but certain areas on my fingers, toes, and joints become very itchy and hard, leading to skin breaking, but it always occurs in those specific areas.
I have always thought this was due to my chronic urticaria).
I have mentioned my symptoms that align with ankylosing spondylitis.
I previously had elevated uric acid levels, and I wonder if that could be related.
My uric acid levels have caused pain in my right ankle, but it has only flared up three or four times in the past two to three years.
I am unsure if my lower back pain could be related to this.
My work over the past couple of years has involved long periods of sitting, but I have been playing table tennis every day recently, although it seems ineffective.

I have also experienced neck and shoulder pain for many years, which I attributed to poor circulation or a diet high in meat, as I sit for long periods at work.
I occasionally seek acupuncture for shoulder and neck pain, which is sporadic.
My right shoulder pain sometimes triggers migraines on the right side of my head, but these occurrences are infrequent, happening a few times every few months.
I am truly distressed and would greatly appreciate your help in diagnosing my issues.
Where should I start with my examinations? Thank you very much for your assistance.

Ye, 20~29 year old female. Ask Date: 2007/09/14

Dr. Wang Shouji reply Orthopedics

Dear Mr.
Yeh,
Based on your description, you are experiencing lower back pain upon waking in the morning, and since you are a male patient, it is important to rule out ankylosing spondylitis.
Most patients with ankylosing spondylitis experience morning lower back pain and stiffness.
Therefore, I recommend that you first visit a rheumatologist for blood tests.
If ankylosing spondylitis is confirmed, it will require medication for treatment.
If the tests indicate that it is not ankylosing spondylitis, it may simply be a case of muscle inflammation.
Treatment options in that case can include medication or physical therapy.
Additionally, maintaining good posture and avoiding lifting heavy objects in your daily life are effective ways to care for your lower back muscles.
Best regards,
Chen Shih-Tien
Changhua Hospital

Reply Date: 2007/09/14

More Info

Morning back pain can be a frustrating and debilitating issue that affects many individuals. Understanding the potential causes and seeking appropriate relief is essential for improving your quality of life. Based on your description, it seems that you are experiencing persistent discomfort in your lower back and upper back, particularly upon waking. This discomfort is exacerbated by your sleeping position and the type of mattress you are using.

Possible Causes of Morning Back Pain
1. Poor Sleep Position: The way you sleep can significantly impact your back health. If you sleep on a very soft mattress, it may not provide adequate support for your spine, leading to misalignment and discomfort. It’s essential to maintain a neutral spine position while sleeping. Consider trying a firmer mattress or using additional pillows to support your back and neck.

2. Muscle Strain: If you have been less active or have recently increased your physical activity, such as playing table tennis, your muscles may be experiencing strain. This can lead to soreness, especially if your body is not accustomed to the activity level.

3. Inactivity and Sedentary Lifestyle: A sedentary lifestyle can contribute to muscle weakness and stiffness, particularly in the back. Regular movement and stretching can help alleviate some of this discomfort. Incorporating exercises that strengthen your core and back muscles may also be beneficial.

4. Underlying Medical Conditions: You mentioned the possibility of ankylosing spondylitis (AS), which is a type of inflammatory arthritis that primarily affects the spine. Symptoms of AS include chronic lower back pain, stiffness, and decreased range of motion, particularly in the morning. Given your history of gastrointestinal issues and skin conditions, it may be worthwhile to discuss these symptoms with a rheumatologist, as they can evaluate for conditions that may have systemic effects.

5. Psychosomatic Factors: Stress and anxiety can manifest physically, leading to muscle tension and pain. If you are experiencing significant stress, it may be contributing to your back pain. Consider stress management techniques such as mindfulness, yoga, or counseling.

Steps to Seek Relief
1. Consult a Healthcare Professional: Given the complexity of your symptoms, it would be wise to consult with a healthcare provider who can perform a thorough evaluation. This may include imaging studies (like X-rays or MRIs) to assess your spine and rule out any serious conditions.

2. Physical Therapy: A physical therapist can develop a personalized exercise program to strengthen your back and core muscles, improve flexibility, and teach you proper body mechanics to prevent further injury.

3. Sleep Hygiene: Evaluate your sleep environment. A supportive mattress and pillow can make a significant difference. Additionally, maintaining a consistent sleep schedule and creating a relaxing bedtime routine can improve sleep quality.

4. Regular Exercise: Incorporate regular physical activity into your routine. Activities such as swimming, walking, or yoga can help improve flexibility and strength, reducing the likelihood of back pain.

5. Pain Management: Over-the-counter pain relievers, such as NSAIDs (e.g., ibuprofen), may provide temporary relief. However, it’s essential to use them as directed and consult with a healthcare provider for long-term management strategies.

6. Monitor Your Symptoms: Keep a journal of your symptoms, noting when the pain occurs, its intensity, and any activities that may exacerbate it. This information can be helpful for your healthcare provider in diagnosing and treating your condition.

Conclusion
Morning back pain can stem from various factors, including poor sleep posture, muscle strain, inactivity, and potential underlying medical conditions. It’s crucial to consult with a healthcare professional to determine the exact cause of your pain and develop an appropriate treatment plan. By addressing your symptoms holistically—through lifestyle changes, physical therapy, and medical evaluation—you can work towards alleviating your discomfort and improving your overall well-being. Remember, early intervention is key to preventing chronic pain and maintaining a healthy, active lifestyle.

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