Have you had a fracture and you notice your pain is worse at night-time? Are you wondering if this is normal, when to worry, could it be a sign of complications?
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Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: June 2024. Written by Juliet Semakula, a diagnostic radiographer.
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Summary: when you have had a fracture it is painful, but this pain tends to get worse at night. This is explained by hormones fluctuations, immobility, more anxiety or depression at night and cease of effectiveness of any kind of pain medication.
▶️Why do you feel more pain at night after a broken bone?
1️⃣Repetitive movement of the injured fracture without knowing while sleeping.
To begin with, a fractured bone under treatment, which is in the healing process will cause pain till complete healing has happened.
But the question is, why does pain intensify more at night-time when you are sleeping.
When we sleep our body goes through different types of sleep, one of which is deep sleep where you involuntarily start moving and changing sleeping positions unknowingly.
So, it is common when sleeping to change your sleeping positions and when you have a fracture, you unconsciously move the injured side which can increase your pain.
Based on scientific publications and patients I see in x-ray; it is not likely to worsen your fracture even when you make a bad move in your sleep.
For a better sleeping position to help you reduce pain, you can use cushions under your limbs or behind your back.
2️⃣A drop in cortisol hormone at night:
When you have had a fracture, the inflammatory reaction results in the release of cytokines, growth factors and prostaglandins, whereby healthy cells are brought together to work on the damaged cells to help with healing. This process is more active during the day.
During the night when we are sleeping our body enters a state of recovery and generation which leads to change in our hormone production, there is normally a drop in the stress hormone cortisol which has an anti-inflammatory response.
When there is less inflammation, less healing, so the damage to bone due to the above conditions accelerates in the night, which increases pain and discomfort associated with the fracture.
3️⃣Immobility while sleeping can increase pain.
Limiting movement of the injured fracture is always recommended by doctors because it helps in tissue healing and can reduce sudden onsets of inflammation in our soft tissues as well.
Movement keeps the fluid around our joints loose and smooth and keeps our muscles active and strong which happens during daytime, when you are actively moving up and down, this keeps the fluid flow and reduces bone pain.
But at night, since there is no activity, movement of this fluid is limited, so symptoms like pain and swelling will increase.
Prolonged immobilisation causes a disruption to how our bodies normally function, this can lead:
To stiff joints causing increased production of fibrofatty connective tissue in our joint spaces and holds in the fluid that normally keep our joints smooth and free to move. This can lead to reduced range of motion and joint stiffness while sleeping which causes increased pain.
Prolonged immobility can lead to inactive blood flow which can lead to fluid build-up and inflammatory substances within the injured area which can cause swelling in the leg, causing pain and stress for you at night.
If you can it is important to get out of bed and walk or stretch this will improve the blood flow in the veins.
If you are unable to walk, it helps if you can exercise by stretching your legs in bed at night.
4️⃣Pain medication may stop working overnight.
When you have a fracture, you will be on medication to help with your pain until your recovery fully.
Over time, you may find that the pain reliever you are given becomes less and less effective, which is called tolerance.
When the medication stops working you will feel pain increase more at night.
You may need higher doses or more frequent doses to help with your pain or change the time you take your medication.
5️⃣Sleep disturbances after post fracture treatment causing more anxiety at night.
When you have had a fracture, it is very common to have sleep disturbances or pain perception.
What you should know is that pain is both physical and psychological.
During the day you are involved in various activities, for example the presence of friends, family and co-workers distracts you away from pain, so the pain perception is lesser.
At night, in sleep, there are no such distractions, so the awareness or perception of pain increases.
Sleep deprivation is a common complaint among patients after bone injuries. Patients I see in x-ray sometimes tell me that they find it hard to sleep. We call this painsomnia or insomnia in medical terms.
The pain in the night can keep you awake or disturbs your sleep. The disturbed or incomplete sleep at night causes tiredness.
The lack of exercise worsens symptoms of those conditions, which in turn increases the pain at night, creating a vicious cycle of insomnia and pain.
Depression
We must agree that when you fracture a bone it causes a physical toll on you, but the emotional pain associated with a broken bone is often overlooked.
I often see patients who are injured often feeling sad, depressed, or even angry after their injury and most of the time, they can’t explain why.
This is attributed to broken bone depression.
When you combine pain and insomnia can induce depression in some people or worsen the symptoms for those already suffering from depression.
Frequent sessions of depression bring down the levels of positive hormones such as serotonin, dopamine and endorphins in the body which are so important for healing.
The delayed healing sustains the pain at night creating a vicious cycle of depression and physical pain.
Incidentally, the person may experience all the above simultaneously, which sustains and heightens the bone pain at night.
6️⃣How do we manage and reduce pain at night
The discussed reasons may look gloomy.
Rest assured, however, both pain at night, and its underlying cause can be managed well with proper care.
You should always consult your doctor and explain the symptoms you are experiencing at night.
Depending on the underlying cause of your pain your doctor may be able to prescribe some pain medication to help relieve pain in the night such as Inflammation, antibiotics in case of infections.
Hormones, if there is a hormonal imbalance and pain relievers.
Hormones are essential for regulating most major bodily processes. This means a hormonal imbalance can affect many bodily functions. Hormones help to regulate mood and stress levels.
Always ask your doctor to check the cause of your pain, if it’s hormonal imbalance you may be given something to help with your pain and sleeping problems.
Exercises that improve flexibility, acupuncture, massage, and relaxation techniques help reduce physical pain.
Scientific studies done in different trials concluded that most of the relaxation techniques can help reduce pain.
Relaxation is one example of a non-pharmacological treatment which is increasingly accepted as an intervention for pain reduction and pain coping. (Bushnell.2023)
However, relaxation techniques should not be used as a stand-alone treatment, but rather supplement established treatment programs to help pain management.
Relaxation techniques are probably most effective in the long run, when used regularly over time.
Cognitive Behaviour Therapy (CBT) helps reduce psychological pain.
There have been previous meta-analytic studies showing the effectiveness of cognitive behavioural therapies for improving pain and sleep quality.
Cognitive behaviour therapy is rooted in the idea that the way you perceive situations influences the way you feel, and that you can change your thought patterns to feel better.
How does Cognitive behaviour therapy (CBT) work?
The mind-body approach of CBT isn’t just about talking on a psychologist’s couch; it’s about acting to ultimately change your thinking and behaviour.
“CBT is different from talk therapy in that the primary goal is to provide you with strategies and skills to learn to self-manage your pain, depression, and sleeping problems.
So, if you feel you need this kind of therapy, always contact your health care providers, they always have CBT services to help you deal with pain.
What to remember: whatever you do, the pain will eventually fade away over the months and weeks. Better selfcare, adaptation of your medication and finding what works for your sleep will help relieve pain at night.
We have come to the end of this article, any questions, comments see you in the comments!
📚Sources:
Swanson C. Sleep Disruption and Bone Health. Curr Osteoporosis Rep. 2022 Jun;20(3):202-212. Doi: 10.1007/s11914-022-00733-y. Pub 2022 Apr 30. PMID: 35488985; PMCID: PMC10108658.
Bushnell C.M., Čeko M., Low L.A. Cognitive and emotional control of pain and its disruption in chronic pain. Nat. Rev. Neurosis. 2013; 14:502–511. [PMC free article] [PubMed] [Google Scholar] [Ref list]
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