Chronic pain frequently fluctuates during the day and worsens at night for some people — but why?
According to a recent survey, as many as one in every five adults in the United States — 50.2 million — suffer from chronic pain. These people typically experience pain fluctuations throughout the day: it may be better in the morning and worse in the afternoon, or vice versa.
But what happens after the sun goes down? According to some research, which is supported by many chronic pain patients, chronic pain worsens at night.
“At the end of the day, people don’t necessarily get a break from flare-ups,” says Ellen Slawsby, director of pain services at Harvard’s Benson-Henry Institute for Mind Body Medicine. “In some cases, nighttime pain is the worst and can severely disrupt sleep.”
What exactly is chronic pain?
Chronic pain is defined as pain that lasts for at least two to three months, often long after the original injury or illness has healed. The discomfort may even become permanent. It can affect specific areas of the body, such as the back and neck, or it can affect individual joints or muscles. Persistent pain from conditions such as arthritis or fibromyalgia may be more diffuse.
Chronic pain symptoms and severity vary and can include a dull ache, shooting, burning, stabbing, or electric shock-like pain, as well as tingling and numbness sensations.
Why does chronic pain worsen at night?
Pain can worsen at night for a variety of reasons. According to Slawsby, hormones could play a significant role. “At night, the anti-inflammatory hormone cortisol production is at its lowest.”
According to new research, pain may follow a circadian rhythm, similar to the body’s internal 24-hour clock that regulates our sleep-wake cycle. “This helps explain why some people have higher pain levels at certain times of day, such as at night,” Slawsby says.
While there is no good time for chronic pain, it is especially troublesome at night because it disrupts sleep. Inadequate sleep impairs our ability to manage pain. Sleep issues are also common in people suffering from chronic pain. Chronic pain affects at least 50% of people with insomnia (the most commonly diagnosed sleep disorder).
“Insomnia can cause sleep deprivation, which increases the release of proteins called cytokines, which are involved in the body’s inflammatory response and make people more sensitive to pain,” Slawsby explains.
Ways to get the rest you need if you have nighttime pain
If nighttime pain has been keeping you awake, these strategies may help you sleep better.
- Perform a relaxing routine before going to bed. A relaxing end to a busy day can help prepare your body and mind for sleep. “Spend at least 20 minutes before bedtime focused on relaxation, which helps slow the heart and breathing rate, decrease cortisol levels, and reduce the likelihood of flare-ups occurring,” Slawsby recommends. Take a warm or cool shower, for example.
- Perform several minutes of deep breathing exercises after a series of gentle stretches or yoga poses.
- Make your sleeping environment healthy. Make your bedroom as dark as possible and as cool as possible (the ideal temperature is 65 degrees Fahrenheit). Consider purchasing a sound machine that emits soothing white noise or nature sounds. “Also, use comfortable pillows and supports for painful areas, such as under your knees if you have back pain,” Slawsby advises. Consistent routines and tools such as cognitive behavioral therapy for insomnia can also help you sleep better.
- Reframe your thinking. People suffering from chronic pain frequently worry about when their pain will strike, which can add to their stress and anxiety. “If you’re afraid of not sleeping because of your pain, remind yourself that you’ve slept well before and can do so again,” says Slawsby. “If you experience chronic pain at night, remind yourself that it will pass soon. It is difficult to change this mindset, but more positive thinking is important in pain management “Allow your body time to recover if pain wakes you up so you can go back to sleep. Listen to soft music or read, but avoid using blue light-emitting electronic devices (computers, tablets, and smartphones), which disrupt sleep cycles. Another option is to keep track of your breaths. Close your eyes and perform a simple breathing exercise in which you inhale while mentally counting to one, exhale while mentally counting to two, and repeat until you reach ten. Repeat as needed. This can help you shift your focus away from the pain and relax your body. “Most of the time, you’ll fall back asleep after a few minutes,” Slawsby says.
Erin Balsa is a highly skilled and knowledgeable health journalist with a passion for educating the public on important health and wellness topics. With extensive experience in both traditional and digital media, Erin has established herself as a trusted voice in the field.