If you experience chronic pain at night you’ll recognize the feeling of discomfort in the wee small hours. Of not quite knowing which position will deliver relief. Of battling to fall – and stay – asleep.
But why do ailments seem like a vampirish affliction? What is it about the rise of the moon that moves the dial of tenderness up a notch? And, more importantly, what can you do about it?
The human body adheres to a circadian rhythm; a 24-hour body clock that cycles through the night and day. This in-built timepiece regulates processes like the hormonal release, body temperature, glucose homeostasis, immune and brain function… and pain sensitivity.
The authors of the study, Implications of Disrupted Circadian Rhythms on Pain, investigated why pain sensitivity appears to drop during the day and ramp-up at night. They believe that it serves a function. Makes sense. After all, this is so for the rest of the body.
When we are active during the day, lower pain levels mean we can focus on “doing”. In ancient times, this allowed our ancestors to hunt and forage. In modern times, this state allows us to work, playhouse, and tick off our to-do list. But during the night — our inactive phase — pain transmission is fostered. This may encourage wound-healing behaviors like prioritizing rest and taking due care. So, there is a physiological reason why pain occurs more at night.
Then there are other physical and psychological factors.
Laying in one position for an extended period of time or resting on an unsupportive mattress and pillow can trigger discomfort. Mental illness — which is common in those with ongoing pain — can interfere with sleep. Sleep deprivation lowers the pain threshold, meaning soreness can be sparked more easily. Poor slumber can also impede the effectiveness of painkillers, meaning pain remains less controlled. As you can see, it’s a complex situation!
Chronic Pain at Night
Do you settle into bed with hopes of a good night’s slumber, only to be struck with pain of increasing intensity? Maybe you manage to fall asleep but are awakened by — or with — pain? Yes, that’s the life for someone with chronic pain at night.
While nighttime pain can strike anywhere, there are four prevalent problem sites; the legs, hips, shoulders, and back.
Chronic Leg Pain at Night
Chronic leg pain at night has a number of causes including two common conditions; nocturnal leg cramps and restless legs syndrome.
An estimated one in three people over the age of 50 suffer from episodic nocturnal leg cramps; lower limb muscle spasms that strike after sundown. A review article published in the journal, BMC Family Practice, listed seven diagnostic criteria that should be used to diagnose this condition:
Intense pain, period of duration from seconds to maximum 10 minutes, location in calf or foot, location seldom in thigh or hamstrings, persistent subsequent pain, sleep disruption, and distress.
Restless legs syndrome affects up to 10% of the population. Occurring at rest in the evenings or overnight, this condition causes uncomfortable and troublesome sensations in the legs or feet and a strong desire to move. Movement of the affected limb provides temporary respite only.
Chronic Hip Pain at Night
Do your hips ail when you lay down? Does tossing onto one side trigger more discomfort than the other?
Your hips, like other joints, can become arthritic. Arthritis is a significant cause of chronic hip pain at night.
Many people with hip arthritis find that if they overdo it throughout the day, there’s a good chance they’ll suffer that night. Then during a flare, it can be hard to find a comfortable position. If a period of sound sleep is managed, waking up can be plagued by stiffness.
There are other issues that can cause chronic hip pain at night, too. For example, the bursa on the outside of the “hip” can become angry. When inflamed, this small, fluid-filled sac can feel exquisitely tender. Known as trochanteric bursitis, this problem can cause strong pain that is exacerbated by lying on it. This makes nighttimes troublesome.
Chronic Shoulder Pain at Night
From the lower limb, we move upward to the most agile joint in the body; the shoulder. Chronic shoulder pain at night also has a number of causes. A long-standing tear, tendonitis, or tendinosis can affect the muscles of the rotator cuff.
Osteoarthritis or adhesive capsulitis — commonly referred to as a frozen shoulder — can restrict and irritate shoulder joint motion. Lying on the sore side can cause pain.
Chronic Back Pain at Night
Chronic back pain at night is oh so common. Given that 8% of American adults suffer from ongoing backache, this is hardly surprising. This ailment may be experienced or exacerbated at night for a variety of reasons; including discomfort, associated psychological distress that leads to wakefulness, and pain medications that disturb slumber.
Conditions that can lead to overnight back pain include degenerative disc disease, a herniated disc, an inflammatory condition called ankylosing spondylitis, fibromyalgia, and biomechanical joint dysfunctions (“stuck joints”).
Chronic Pain and Sleep
Chronic pain and sleep problems are bedfellows, each able to exacerbate the other. The combination can create a nasty cycle where pain equals insomnia and insomnia equals pain.
For example, the review article, The association between chronic low back pain and sleep: a systematic review, found that chronic low back pain was associated with “greater sleep disturbance; reduced sleep duration and sleep quality; increased time taken to fall asleep; poor day-time function; and greater sleep dissatisfaction and distress.”
So, to break the cycle of night pain you need to break the cycle of poor sleep… and vice versa. While this can be challenging, it is possible. You’ll learn three key approaches next.
Important note: Ongoing nighttime pain may also be a red flag; a warning that something more sinister is at play. If you have a history of trauma, cancer, unexplained weight loss, fever, night sweats, or pain that either isn’t relieved by rest or seems unrelated to your position, it’s best to seek professional advice.
Treatment Options for Chronic Night Pain
As important as it is to understand why chronic pain at night happens, you’re likely here because you want relief. So, let’s dive into two simple, effective approaches and one treatment method that can calm nighttime soreness and encourage sound sleep.
Set & Stick to a Regular Bedtime
As difficult as it may seem, it is important to set and stick to a regular bedtime. A study published in the journal, Pain Reports, found that people who hit the hay at irregular times suffered for this choice.
They woke up more often and achieved fewer hours of sleep. This translated into higher pain scores, a more negative mood, increased trouble engaging in daytime activity, and a jump in prescription opioid use. Worst of all, their condition worsened over time. Aim for a bedtime between 9pm and midnight and hold fast.
Calm your Body & Mind
It’s hard not to get caught up in the endless monkey mind chatter… “You’re in pain!”, “It hurts so much,” “You need to do something!”, “I wish it would go away,” “What if it never gets better?”…
Sadly, this understandable narrative can worsen pain and make it more difficult to sleep and sleep well. So, how can you mute this chitter-chatter?
— Take a warm bath before you retire
— Sip Chamomile tea
— Choose a supportive, comfortable mattress and pillow
— Avoid blue light-emitting devices for at least two hours before bedtime. That means your computer, laptop, tablet, eReader, TV, and smartphone
— Practice mindfulness meditation. Meditation has multiple benefits; lowering depression and general anxiety, enhancing psychological well-being, increasing the feeling of being in control of pain, and experiencing greater pain acceptance. Evidence also suggests a reduction in pain severity.
XRHeath’s Groundbreaking Treatment for Chronic Pain Relief
XRHealth provides a science-backed, drug-free, and personalized approach. Because chronic pain can make traveling a pain, we deliver treatments via cyberspace. That translates to online therapy from the comfort of your home!
We blend the power of engaging chronic pain therapy with cutting-edge tech, and clinically proven results with support from licensed physical and occupational therapists. That’s how we achieve groundbreaking results for those with living with chronic pain at night or any other time.
Begin your chronic pain treatment journey with us now. Find out how here.