Why Pain is Worse at Night and What You Can do about it

Most ailments get worse at night, whether you are sick, or you are dealing with pain. There’s a simple reason for it; well two. It’s from the lack of two things: cortisol and movement. 

Cortisol has a bad reputation as it’s known as the stress hormone. What that really means is that it’s the primary driver when your sympathetic nervous system is activated. This is the fight or flight response. I think of it as “on mode”. Cortisol liberates glucose from the muscle and liver into the bloodstream as a quick fuel source (as opposed to fats). When you are “on”, the body upregulates some systems of the body and downregulates others. This is a good thing as it prioritizes survival. 

The sympathetic nervous system suppresses systems that aren’t vital when there is an emergency. For example, the digestive system (which is why you shouldn’t watch the news when you eat), and the reproductive system are suppressed. The immune system, which is responsible for the inflammatory response, is suppressed. So cortisol is an extremely potent anti-inflammatory. In fact, cortisone and steroids like prednisone are synthetic cortisol. 

Remember that inflammation is the first step of the healing process and some powerful things happen during sleep to help you repair. So the combination of inflammation and repair at night is a good thing. Herein lies the problem. The body doesn’t have any vacant space so even a few cc’s of extra pressure hurts. We don’t want to suppress the immune system too much because we want healing to occur, however at a certain point, it becomes difficult to sleep which will impair healing. 

Below is an example of what the daily pattern of cortisol looks like:

As soon as light hits your eyes, the sympathetic nervous system is triggered and you get a spike to start your day. Many of my patients tell me that their pain is bad in the morning, but once they get moving, it starts to go away. In part, this is due to the anti-inflammatory effect of cortisol.

By the way, melatonin has basically the opposite effect:

I think of melatonin as the “off mode”. 

So you see that cortisol is lowest in the evening (in a healthy person). So that cold you’re fighting off, or that swollen knee gets worse. We don’t want to spike cortisol because that will inhibit melatonin production and it’ll be difficult to sleep. You may be thinking, “why not take an anti-inflammatory”? That will certainly reduce inflammation, but here is an important point. Inflammation and swelling are not the same thing. Inflammation is the initiation of the healing process, swelling is the waste product left behind. If there was a car accident on the highway, you wouldn’t want to set up a blockade before the scene of the accident; you’d want the ambulance to arrive. This is similar, you may be inhibiting the healing process. Not to mention it’s tough on the cardiovascular system and the gut. However, you do want to mitigate swelling.

So how do we do this? Swelling is handled by your lymphatic system. The lymphatic system is analogous to your cardiovascular system; where there are blood vessels, there are lymph nodes and channels. The cardiovascular system has a pump (the heart) to create circulation, whereas the lymphatic system does not. It relies on the pump action of muscles to create circulation. This is problem number 2 at night, you tend to not move as much so swelling is allowed to fester. This can also be the solution, gentle movement stimulates lymph flow. It doesn’t take much, and it works well.

Generally, you want to move the area that hurts in as pain free of a manner as possible, and then you’d want to follow up with belly breathing. The main duct of the lymph system is the cisterna chyli which rests under your diaphragm. So belly breathing presses on that duct and gets it to your upper chest where it drains. You may feel the urge to urinate after doing this and that’s a good thing, your body is getting rid of the waste. The bottom line is that you want to mitigate, rather than inhibit, the inflammation and swelling process. 

Here are some examples:

For low back pain:

For knee pain: 

For shoulder pain: 

Why You Shouldn’t Watch TV (or Phones) While You Eat

It seems crazy that we are in that point in time where we even have to have this conversation. I’m a parent of 2, and I know how much of a struggle this can be. Algorithms have improved, and companies know how to go after your limbic system (the lizard brain). We’ve all seen it, out at a restaurant, everyone staring at their phones. We’ve been guilty of it too, myself included. 

There are several reasons to avoid this. I’m going to exclude all the social ones such as the art of conversation, being an example for the young, etiquette, etc. The main thing I want to focus on is…digestion. 

You may have heard of the autonomic nervous system. This is the component of the nervous system that runs in the background and controls things like breathing so we don’t have to spend precious brain activity on things that can be automated. There are 2 divisions, the sympathetic (fight or flight) and parasympathetic (relax and digest). The sympathetic nervous system pulls levers in the body that make it advantageous for you to survive if you have to fight or run. It turns off the digestive system to conserve energy for the cardiorespiratory and musculoskeletal system. Perhaps you already see where I’m going with this. 

It’s not a light switch, but more of a gradient. There are activities that are more sympathetic than others. One of the things the sympathetic nervous system does is mobilize glucose from muscle to the bloodstream to be used for fuel. I just spent a month wearing a continuous glucose monitor and was surprised to see how my blood-glucose spiked while driving. I’m not a particularly angry driver, but it was a clear spike. 

The body has a lot of redundancies, and that’s a great thing for survival. We can breathe through our nose which is more associated with the parasympathetic nervous system, or we can breathe through our mouth, which is more sympathetic. You can belly breathe (parasympathetic) or chest breathe (sympathetic). Even vision is related. Fixed and focused vision (like staring at a phone) is more sympathetic, and a broader, more peripheral vision state is more associated with the parasympathetic nervous system. That’s why going to the beach or looking at the horizon is so relaxing. 

One of the first things I do when I evaluate a new patient is having them lay on their back. Without saying anything, I just watch how they breathe. I would estimate 75% are chest breathing dominant. This is certainly not a perfect assessment, but it gives me a rough estimate of where they are. 

But that’s beside the point. When you are eating, you obviously want your digestive system working properly. If you are looking at a tv or phone, your gaze is fixed and therefore more of a sympathetic state. Your digestion is inhibited. Not to mention, most programming on tv is geared towards stimulation. The phrenetic tik tok videos your kids are watching, do you imagine they are relaxing? 

We spend too much time in sympathetic mode, and if you have pain, and start to pay attention to the little things like this, you may just see a pattern. Dial in the simple things that you know you’re supposed to be doing, and it might just be all you need. 

Want a free consult call? Click the button below: