Harding IJ et al. (2005) The symptom of night pain in a back pain triage clinic. Spine 30: 1985–1988

Severe back pain at night can be associated with serious spinal pathology and is therefore a common reason for urgent referral to a back pain triage clinic, but guidance in this area varies considerably. Harding et al. evaluated 482 patients attending a back pain triage clinic between April and September 2002, to determine whether nocturnal back pain is a useful diagnostic indicator of serious spinal pathology.

Back pain at night was reported in 213 patients (44%); 90 of these had pain every night. Local guidelines identified the need for MRI in 135 patients. No serious pathologies were seen; however, degenerative disk disease was commonly identified by MRI, with 'simple' degeneration (degeneration not associated with other pathologic findings) affecting significantly more patients suffering from nightly back pain than those experiencing occasional night pain (P <0.001). Oswestry Disability Index, Hospital Anxiety Depression Scale and VISUAL ANALOG SCALE scores were significantly higher (i.e. worse) in patients with nightly back pain than in those with no or occasional nocturnal back pain. A limitation discussed by the authors, however, is that, as the Oswestry Disability Index takes sleeping disturbance into account, it is unsurprising that patients with nightly back pain score more highly than those with occasional pain.

Harding et al. conclude that, although nocturnal back pain is an important symptom, it is not a specific marker for serious spinal pathology. Further studies are required to clarify the importance of nocturnal back pain and other factors in guiding clinical decisions.