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Tony asked...

I have back pain in the morning.

I have back pain which only ever comes on in the morning, just as I wake up. Its just below the centre of my back and feels a little either side of that, in the ribs. When I wake with the pain its impossible to find a comfortable position to sleep in, so have to get up. After being up for a while, it gets gradually better during the day. I worry that its indicative of something worse than just sleeping position, as sleeping on my side or back has no effect.

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The answer

Low back and neck pain are extremely common – most people suffer from bouts of one or both at least once in a lifetime. ‘Thoracic’ back pain – pain in the spine over the back of your ribcage – is much rarer and usually needs checking out.

However, pain in the muscles between the ribs or the muscles of the back on either side of your spine is common and rarely a cause for concern. The fact that your pain is to the side of your spine and comes on after lying in one position, but gets better when you’re moving around, is very reassuring. Strains of the muscles between the ribs – intercostal strain – tend to take much longer to settle than other muscle strains and can last many weeks. This is because most people are able to rest an affected muscle in, say, an arm or leg if they strain it. Since you breathe about 12-18 times a minute, 24 hours a day, these muscles don’t get much time to rest!

Try taking a course of anti-inflammatory tablets such as ibuprofen 400mg three times a day (check with your pharmacist if they’re suitable for you) for a week to see if your symptoms settle. If they do, you can be fairly confident the cause was a simple muscle strain.
Warning symptoms to look out for with pain in your chest, whether at the front or the back, include:     

  • Coughing up blood
  • Chest pain that’s worse when you breathe (rather than when you twist or move)
  • Sudden onset shortness of breath
  • A history of cancer

Answered by Dr Sarah Jarvis.


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