How Are Lower Back Pain & Extreme Tiredness Linked?

Have you ever wondered what’s behind the pain in your lower back, even when it seems like you haven’t done much to cause strain? You also wonder why you've been feeling tired ever since you incurred this pain. Well, a variety of everyday behaviors can provoke this kind of discomfort.

This article explores common causes of this tiredness and equips you with the knowledge on how to treat it, so you can go back to feeling energized every day.

How can lower back pain cause extreme tiredness?

Studies have found that about 70% of people with ongoing lower back pain also experience ongoing tiredness and fatigue1. There are a number of reasons why you might feel tired if you have lower back pain. It could be the constant energy drain from dealing with the pain all the time, not being able to sleep well because of the pain, or other accommodations and stressors that come with having persistent pain.

Muscle imbalances and a less active lifestyle, which might happen when you're trying to avoid pain, can make this tiredness worse, as can some medicines that you might take for pain relief.

Energy drain from chronic pain

Think of your energy as water in a bucket, and chronic pain as a series of small holes leaking this vital resource gradually.

Chronic pain, much like a silent thief, stealthily depletes your energy reserves. It's not simply the pain itself that causes fatigue, but also the constant thinking about the pain, how it can affect you, and what changes you need to make to your day to deal with it. Understanding your pain severity can help you manage and adapt to the challenges it presents.

Sleep disruption

Chronic back pain often makes a restful night's sleep seem like an elusive dream. This persistent pain disrupts the restorative sleep your body requires. Finding a position that doesn't aggravate the pain can lead to a night of tossing and turning, and you may wake up feeling as if you haven't slept at all. This problem is quite common among those suffering from persistent back pain.

Side effects from medication

While medications are designed to reduce pain, they often have side effects, including fatigue and drowsiness. This is especially true for powerful drugs such as opioids. The tiredness you experience can be a direct effect of the medication that's supposed to help manage your pain2. Generally, the stronger the medication, the greater the risk of side effects. So, if your pain is intense, the fatigue may be just as significant.

Muscle tension

When we're in pain, we often change how we move or hold our bodies, guarding the painful area. However, it's easy to overcompensate and make other parts of our body work twice as hard, which can be very tiring. Even seemingly simple things like sitting down can feel draining.

Over time, this leads to some muscles working overtime and others getting weaker, which can make you feel more worn out. It's a vicious cycle – your muscles are trying to pick up the slack for the ones that aren't doing their job, causing more pain and tiredness.

Decreased blood flow

When back pain prevents you from being active, it's not just your muscles that miss out on exercise. Your heart doesn't get the workout it needs either. This can lead to a drop in energy levels, trapping you in a cycle of ongoing tiredness. This cycle is tough because it affects both your body and your mind. It can decrease your drive to get moving again and make that feeling of fatigue even worse.

When you're not active, your entire metabolism can slow down3. That means your body isn't as good at making and keeping up the energy you need. So, staying in a cycle of inactivity makes it hard to escape from feeling tired and to get back to a lively, energetic life.

Underlying health conditions

The level of exhaustion caused by lower back pain is not simply about feeling worn out after an active day but rather may indicate serious underlying health conditions that could progress into debilitating diseases such as:

  • Chronic fatigue syndrome – A debilitating condition characterized by extreme fatigue that rest cannot improve and is often exacerbated by physical or mental activity4.
  • Fibromyalgia syndrome – A long-term disorder marked by chronic widespread pain, fatigue, and tenderness throughout the body5.
  • Autoimmune disorders – These disorders cause the immune system to mistakenly attack the body's own tissues, potentially leading to fatigue and joint pain6.
  • Sleep problems – Conditions that disrupt normal sleep patterns, leading to insufficient rest and contributing to chronic tiredness and back pain.
  • Rheumatic disease – A range of disorders affecting joints and connective tissue, causing pain, and swelling, and often associated with profound fatigue.

If you are dealing with unexplained extreme tiredness and lower back pain, seek medical advice in order to identify the root cause and receive proper treatment.

Depression & anxiety

Anxiety and depression are not just about feeling sad or worried. They can show up in your body, making you feel even more tired when you're already dealing with back pain. It's like being stuck in a tough cycle: your back hurts, which makes you feel down, and then those feelings make your back pain feel worse. It can feel like you're trapped in a loop of pain and sadness that's hard to break out of8.

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How to treat lower back pain & extreme tiredness

Managing lower back pain involves a range of methods that reflect the complex nature of the condition. Contrary to common belief, treating it doesn't have to be costly or complicated. A multidisciplinary approach can give you a safe and well-rounded treatment plan. Such a plan typically merges medication with physical therapy and lifestyle changes, such as retraining your pain response and sleeping habits.

Lifestyle changes, such as exercise, improving your sleep, and managing stress and any emotional or mental health challenges are likely to provide the most effective and long-lasting effects. "Passive" therapies, such as massage and acupuncture can provide short-term relief to some people, but are unlikely to give long-lasting results.

Medication for short-term relief

While medications can be an important part of pain management, they should be seen as one element of a holistic treatment strategy, as they are not a sustainable solution for long-term pain relief. The body's central nervous system can become accustomed to these medications over time, necessitating increasingly stronger doses to achieve the same effect. And as mentioned previously, these may be causing your fatigue so it's essential to speak to your doctor first to understand the risks.

Physical therapy

Physical therapy is a key component in your recovery from lower back pain. It's personalized, combining various techniques to meet your specific needs.

Research shows that physical therapy can improve your ability to move and decrease your pain8. A good physical therapist will work with you to create a program that includes exercises to strengthen your back and other areas of the body. They'll use hands-on methods to help ease your pain and improve your movement.

Exercise & stretching

Integrating low-impact activities into your daily routine can significantly ease your symptoms. Gradually increasing your movement with gentle exercises such as walking, swimming, and basic strength training can be very beneficial. These exercises not only help manage your symptoms but also contribute to the recovery process by strengthening the muscles that support your spine9.

Stretching is a helpful tool for symptom management in the short term. It's an effective way to promote relaxation, particularly before bedtime, and can help alleviate stress10.


Yoga, an ancient practice that marries breath control, meditation, and physical postures. It's quite the holistic approach for those suffering from chronic lower back pain. By promoting careful, intentional movement, yoga enhances flexibility, bolsters strength, and can lead to more comfortable movement. It also helps to reduce stress.

There's evidence supporting this; a study in 2011 showed that participants engaging in a 12-week yoga program saw improvements in their back function compared to those who stuck with standard care14.

Mindfulness & stress reduction

Stress often intensifies muscle tension and discomfort. Techniques such as cognitive behavioral therapy (CBT), part of mindfulness-based stress reduction, can offer mental reprieve, aiding in more effective pain management.

Sleep hygiene

Creating an environment that is optimal for restful sleep is the essence of sleep hygiene. This includes maintaining regular sleeping patterns and transforming your bedroom into a distraction-free haven designed specifically for slumber.

To improve your sleep and overall health, try these tips:

  • Aim for eight hours of sleep each night and keep a consistent sleep schedule.
  • If you need a nap, keep it short so it won't interfere with your night's sleep.
  • Stay active during the day to help you fall asleep more easily at night.
  • Cut down on screen time before bed to help your mind unwind.
  • Make your bedroom dark and quiet to create a peaceful space for sleep.
  • Watch your caffeine intake, especially later in the day, as it can keep you awake.
  • Avoid big meals or alcohol before bedtime, as they can mess with your sleep.
  • Practice relaxation techniques daily to help improve your sleep and manage symptoms better.

Heat therapy & cold therapy

A 2021 study suggests that both heat and cold therapies can effectively alleviate pain. Cold therapy is especially good at reducing inflammation, swelling, and bruising, and it provides a numbing effect for immediate pain relief11.

Conversely, heat therapy is advantageous once the initial inflammation has eased. Applying mild heat can help improve blood circulation to the affected area, promoting the delivery of oxygen and nutrients, which in turn assists in the relaxation of stiff muscles and aids the recovery process.


Acupuncture, a practice with its roots in ancient Chinese medicine, involves inserting needles at strategic points on the body. This technique is designed to rebalance your body's energy flow. For some, it can offer relief from pain and improve how well they function. A significant study in 2012, involving nearly 20,000 participants with chronic pain, compared the effects of genuine acupuncture, sham acupuncture, and no acupuncture. The findings showed that those who received real acupuncture treatments experienced a reduction in pain symptoms by half12.


Chiropractic care is a form of treatment that looks closely at how your body's structure, especially the spine, affects your overall health. By adjusting the spine, chiropractors can often provide relief and improve your ability to move around. It's a treatment that many patients find satisfying, particularly when compared to some other medical treatments. In fact, a study showed that after four weeks, patients who received more chiropractic adjustments reported a notable improvement in both pain and their ability to carry out daily activities13.

Manipulations and adjustments are considered "passive therapies", so if you only ever receive short-term relief, consider looking for an alternative provider who may be more familiar with the modern science of pain.

When to seek professional help

If pain in the lower back continues to be present or intensifies, it is crucial to consult a doctor. Be alert for additional symptoms such as fever or functional impairment that may signify serious underlying health issues.

At MoreGoodDays®, we've crafted a program grounded in scientific research to support you in dealing with chronic back pain. Our approach helps dispel common myths about back pain, focusing on understanding its root causes, identifying triggers, and learning to alter your body's reaction to pain using neuroplasticity principles.

We provide tailored coaching and a range of tools to guide you in managing pain, supporting mental health, and enhancing your overall quality of life.

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