Why is pain worse at night, and what can family caregivers do about it?
Have you ever wondered why pain seems more intense at three in the morning than three in the afternoon?
Here are some reasons that suffering from pain is worse at night, and more importantly, what you can do if you’re caring for the person in pain.
Why is pain worse at night?
Think about the ways night is different than day. You’re lying down rather than sitting up or standing. It’s dark and quiet, and everyone’s tucked in bed. The body’s physiology is geared for rest and recharging.
Many of these factors lead to consequences that explain why pain is worse at night.
Skipped doses of pain meds. When I was a practicing surgeon, I told my patients that the most important post-operative instruction was to stay ahead of their pain. I recommended they take medication every three or four hours. Imagine the person who does well with dosing every three hours. If they go to bed at 9:00 PM, and wake up at 3:30 AM, they’re now two doses behind.
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Absence of distractions As my dentist was about to begin some work, I shut my eyes. He said, “Closing your eyes intensifies the experience; try opening them..” The quiet and dark of night can intensify pain.
The body’s circadian rhythm Cortisol and other stress hormones act like gatekeepers in the brain that regulate which pain signals will get through to the pain processing centers. When the levels are low, more pain signal get through; when the levels are high, you feel much less pain. Stress hormones ebb and flow throughout the day, and levels are low at night.
Breathing problems when lying down. When you’re short of breath or coughing the anxiety magnifies the pain.
Pain attracts pain. Other sources of pain, whether it’s chronic back pain or the sadness about the loss of a partner or even financial pain—worrying how the bills will get paid—intensify the acute pain .
“I can’t get comfortable.” Scratchy sheets, cold feet or a full bladder can intensify pain. We’re designed to automatically shift positions when we’re awake or asleep. However, if some sort of mobility problem gets in the way, it can intensify pain.
“I’m all alone.” Isolation is the most important and least discussed source of nighttime pain. One woman said “At three in the morning it feels like I’m the only person on the earth awake. I’m in pain, and there’s no one to help!” If you like math, here’s the pain equation
Pain + Isolation = Suffering
Most people can tolerate high levels of pain; what is intolerable to be alone with the pain.
Fear of imposing. Many people would rather try to just get trhough the pain than getting someone out of bed to help, whether it’s the doctor or a family member.
What can you as a caregiver do about it?
Check in with the doctor. If pain’s in the picture, invite the doctor into the picture. Make sure you’re doing everything you can to keep the body in tip-top shape, and that all the underlying medical conditions are being treated.
Stay on top of the pain. Plan to take regular doses of pain medicine. You can titrate the amount of pain medicine to the level of pain. Although your clock’s alarm that reminds you to take the nighttime medication is a disruption of sleep, it’s much less of a disruption than dealing with pain that wakes you.
Consider pre-treating for uncomfortable procedures. My patients all had anesthesia on board before I picked up the scalpel and began the operation. Check with your doctor about taking a larger dose of pain medication before physical therapy, uncomfortable dressing changes or other medical procedures.
Talk to the doctor or pharmacist if the medicine isn’t working. If the pill is too big to swallow, there are other formulations. If the side effects are unacceptable, there are manyothers to try.
Challenge the “tough it out” attitude. Your aging parents may have been taught that toughing it out through pain is a good thing. We now understand that pain gets in the way of healing.
Prepare for a trip to slumber land. Go through the routine checklist: take care of bladders and hunger and thirst. Make sure that sleeping clothes and bed clothes are clean and comfortable. Get the best firmness mattress and plenty of pillows. Make a plan for rolling over and turning. If someone has to get up at night to help, share this duty with other family members.
Talk with the doctor and make sure that you’re headed in the right direction. If the recovery is not following the expected course, there could be another medical condition that needs to be addressed. Be sure to tell your doctor about shortness of breath or coughing at night.
Create distractions so if your loved one wakes up in pain, there’s something to help them distract themselves as they get back to sleep. Here are a few ideas that engage all the senses:
Night lights and bedside lamps that are easy to access.
Soothing music that’s easy to turn on and off
Prayer beads, knitting or crocheting.
Books on tape
A comforting smell, whether it’s flowers or the unwashed shirt with the scent of a loved one
Framed pictures and get well cards at the bedside
Special afghans or comforters
Crossword puzzles and funny movies are best saved for daylight hours.
Address the worries that keep you up at night during the day, and have a plan for dealing with the worries that take over when the sun is down.
Get and stay connected. We all have a thirst for human connection, and it’s best managed with the same strategy as the thirst for water. Keep the love cup filled during the day, then offer a little sip at night as needed. Make sure you are speaking your loved ones’ love languages.
It takes a whole team to manage pain. Families that work best let the doctor be the quarterback in charge of the medical interventions to decrease pain, while the family caregivers offer strong connections to decrease isolation. Together the whole team can be a powerful force to minimize suffering—day and night.
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