There are several possible reasons for waking up with severe back pain: first, cold, if the lumbar area gets cold while sleeping can lead to severe back pain after waking up. Second, lumbar muscle strain and lumbar dorsal myofasciitis, two diseases often caused by long-term strain or bending work, sedentary, when the relevant examination and physical examination to exclude other diseases for diagnosis. Third, rheumatoid diseases, when rheumatoid involvement of the spine can appear in the morning or wake up in bed with back pain, after a short period of activity, back pain can be improved, then blood tests and lumbar spine X-ray, CT, nuclear magnetic examination for diagnosis. Lastly, ankylosing spondylitis, which can also occur in the morning or when waking up from sleep, can cause severe back pain, often with morning stiffness, which is diagnosed and treated with blood tests and related X-rays and CT examinations.