Odd: Pain Much Worse At Night

[ans]

Hi. I've been having a flare-up and notice that during the day, it's manageable w/Celebrex and Vicodin. However, at night, it's unbearable and obviously I need stronger meds as I can't sleep.

I know that there's a thing called "Sundowner Syndrome" for the elderly (getting there!).

I wonder if I'm alone in this or if this is normal re: the natural history of discogenic back pain (very positive discogram at L5-S1).

Wishing all well. Thanks. - Allan

[racheleddie]

You are definitely not alone in this. Some of my worse pain is at night. I am not sure if it is because we are going longer between pain med doses, or if the lying down for an extended period of time causes more pain due to the position. Either way, it is no way to live. I have been averaging about 5-6 hours of sleep a night now, and I used to be an 8-10 hour sleeper. I really miss my painfree sleep!

[Harrison]

Allan,

I think you already know this, but certain pain meds may be more (or less effective) at certain times of the day. Our bodies have many rhythms (the circadian is the most described) that will def. effect the absorption of meds. Have you experimented with the times that you take the meds? Whatever the case, a good pain mgt doc should be able to coach you on these fundamentals. See these references:

http://www.arthritis-treatment-and-relief.com/arthritis-and-pain-medication.html
“…Pain and inflammation sometimes occur in a circadian rhythm (daily rhythmic cycle based on a 24 hour interval). Therefore NSAIDs may be more effective at certain times…”

http://www.news-medical.net/?id=13145
Natural daily body rhythms may influence the effectiveness of spinal-epidural pain medication

http://www.douglasrecherche.qc.ca/groups/circadian-rhythms/about-circadian-rhythms.asp
"...Pain tolerance is highest in the afternoon - for example, tooth pain appears lowest in the late afternoon..."

And a "duhhh" point: when you are vertical during the day, especially sitting, you are compressing and loading the spine. So as the day goes on, it's logical to assume the pain may increase...

Hope this helps.

[ans]

Thank you H. for posting these links. They are both interesting and very helpful.

You be well - Allan

[annapurna]

Pain is also perceptually based. I regularly fight sleep problems due to very low level pain that is unnoticable when I'm awake and surrounded by a stimulating environment but becomes difficult to ignore when I'm trying to sleep. This sounds like I'm telling you that your pain is in your head, but I'm really trying to point out that this is just an extension of pain gating (you only perceive the worst pain in an area and don't feel all the other pain generators until the worst is removed, why DDD often masks facet problems). If I were me, though, I'd work first on real reasons why your pain is worst at night and only chalk it up to my explanation if you can't find another reason.

[daveinaustin]

Have you looked into replacing your mattress?
Depending on your sleeping position, are you placing a pillow between / under your legs?

They are maive questions that you've probably already considered. However, I've listed them in case they were overlooked.


Before I had my L5-S1 fusion, my DDD also lead to strong pain in the middle of the night, which I attributed to lying in a static position for too long. During the daytime, I would take a Norco at Level 6-7 pain. At night, if I was lucky enough to achieve deep sleep, pain has to cross a threshold that was high enough to wake me (level 7-8).

One Norco typically knocks down pain by two levels. Therefore, when awoken from pain, it typically took more medication to get down to a level where I could fall asleep again.

[ans]

Thank you Laura; I will ask why.

Dave, you too: thank you for your suggestions and you heal well.

Allan