Why Do I Wake Up With Back Pain?

Before I answer the question above, there are two caveats we need to raise first.

Firstly, if you your back pain is waking you up at night for no reason and you are unable to get back to sleep because of it, or your back pain is worse at night than during the day, this needs to be checked by your GP urgently.

The second caveat. If you are waking up in the morning with a stiff back that is also painful, and this stiffness lasts more than 45 minutes, this is again something you want your GP to check fairly promptly.

If none of the above apply to you, and you just want to know 'Why do I wake up with back pain?' then let me answer that for you now.

Our body runs on a cycle - one that is governed by light during the day and darkness at night. This cycle is called our circadian rhythm.

Circadian rhythms are daily oscillations in behaviour and physiology that prepare us to better cope with earths natural rotation that changes the environment (light, temperature etc) (Geiger et al., 2015).

Our immune system (and consequently, our inflammation levels in the body) are also under circadian control. During sleep we get an increase in pro-inflammatory molecules in the body, a natural part of the healing and clean up process of the body, and then anti-inflammatory molecules increase sharply on awakening (Geiger et al., 2015).

These levels peak between the hours of 3am to 7am before sharply declining.

Current thinking around why we get a peak in pro-inflammatory pathways during the rest (sleeping) phase is because it allows immunological memory formation (Geiger et al., 2015) - critical to long term host survival.

So Why Do I Wake Up With Back Pain?

Higher levels of inflammation and immune activity over night accumulate in the tissues of the body. Although you get a sharp anti-inflammatory response on waking, this is not instantaneous and so they linger around for a number of minutes (usually less than 30 minutes...).

Inflammatory molecules, like IL-6, IL-1, TNF-a are all pro-nociceptive (Schaible et al., 2014; de Oliveira et al., 2011). That means they have the ability to reduce the threshold at which our pain fibres start getting excited and throwing a party (sending signals back to the central nervous system...), and if you have enough of them, then is usually leads to pain.

That is why when you wake up with back pain; your back hurts because the tissues are less tolerant to the forces from walking, sitting and bending because they have spent the night being bathed in higher levels of inflammatory molecules (necessary for healing and maintenance), and then are used before inflammation has a chance to full ameliorate.

If I wake up with back pain does that mean I have higher levels of inflammation?

Quite possibly.

In patients with either rheumatoid arthritis or polymyalgia rheumatica, pain is consistently higher on waking in the hours between 4 and 9am before then dropping over the day (Galbo & Kall, 2016) and this correlated well with the peaks in pro-inflammatory cytokines like IL-6, TNF-a during that same time period.

Most patients that I tend to see in the clinic, that have back pain but no auto-immune or rheumatoid conditions, report the same thing. Obviously there is always exceptions to the rule but I see more that report this pattern than those that do not.

So if you are getting consistently worse back pain on waking in the morning and you have not got an auto-immune condition, the likelihood is that is a sign your immune system is a little off kilter and your circadian regulation needs resetting.

If you suffer with back pain and you want to see how I can help you with physiotherapy and lifestyle and health coaching, head over to our physiotherapy services page to find out more.

References

Schaible, H. G. (2014). Nociceptive neurons detect cytokines in arthritis. Arthritis research & therapy, 16(5), 470.

de Oliveira, C. M. B., Sakata, R. K., Issy, A. M., Gerola, L. R., & Salomão, R. (2011). Cytokines and pain. Brazilian Journal of Anesthesiology, 61(2), 255-265.

Geiger, S. S., Fagundes, C. T., & Siegel, R. M. (2015). Chrono‐immunology: progress and challenges in understanding links between the circadian and immune systems. Immunology, 146(3), 349-358.

Galbo, H., & Kall, L. (2016). Circadian variations in clinical symptoms and concentrations of inflammatory cytokines, melatonin, and cortisol in polymyalgia rheumatica before and during prednisolone treatment: a controlled, observational, clinical experimental study. Arthritis research & therapy, 18(1), 174.