Why does my pain keep me up at night?

As a physical therapist I often have my clients complain about pain keeping them up at night. There complaints sound something like this.... "I think it is time to contact my surgeon because last night [my knee] kept me up all night. I just cannot sleep no matter how many times I tossed and turned last night." Does this sound like you? How about this part...."I tried to put ice/heat on [my knee] but that only helped for about [30 minutes]. I hate taking pain medication because the ones that my MD gave me [has some sort of side effect] and I really hate putting something in my body if I can help it." Then I start to share with my patient's my collective understanding of pain. It kind of goes like this.... Before you decide to contact the [MD/surgeon] just know that pain post-surgery is very common. It is common to believe that any pain that is deemed intolerable post-surgery to be a sign that something went wrong with the surgery. Most of the time it is a more of a sign of your pain tolerance/intolerance, surgery, recovery time and quality of life expectations about pain post-surgery.

Here are a few considerations that may help you better understand your pain.

1. Pain does not start at [your knee]. It starts in your brain. This means that based on your perception of pain from past trauma whether emotional or physical and other psychosocial, socioeconomical issues it may enhance or decrease your perception of pain. An ex-marine that believes that no pain equals no gain or that pain is weakness leaving their body would often score their pain lower than the average person that has pain regardless of loss of function. Whereas another individual with a low pain tolerance would often rate their pain as high. A person who felt unfairly treated/injured in a car accident at work would often rate their pain higher. A CEO that decided to have surgery to get their life back in order and does not worry about getting paid from a job often has better pain ratings throughout.

2. Pain starting in your brain also gives an understanding of ways to modify the painful experience. Pain can be modified by not thinking about it, keeping yourself busy, taking pain medication to alter the transmission of the pain signal in the body, ice, heat, TENS unit, gentle massage, deep breathing, relaxation, medication, prayer, stretching, postural adjustments and sleep (to allow the body to heal).

3. The Central Nervous System consists of two divisions the Sympathetic and Parasympathetic Nervous System. In response to increases to heart rate, blood pressure and respiratory rate the Sympathetic Nervous System is often active. Some people are naturally overactive in the Sympathetic System and we would say their system is in over drive. In America we are often too busy and overworked which places us into a world of Sympathetic Overdrive. Parasympathetic Nervous System does the opposite and tends to relax and lower our heart rate, blood pressure and respiratory rate. To experience pain, it can often be perceived to our body as life or death which we would naturally want to increase our vitals in order to protect our life. Now sleep is an active process that requires relaxation. It is a process that if your vitals are taken would often be the lowest numbers experienced throughout the day. Do you see where this is going? Why is it so hard for people to sleep at night that has pain? Well their Sympathetic Nervous System is active and they need their Parasympathetic Nervous System to over power and be dominant to sleep. Relaxation is often appreciated when there is no emergency. So, the fight, fright or freeze response often wins or relaxation hence NO SLEEP. Also, other stimulators to our Sympathetic Nervous System are pleasure-based activities and experiences, worry, stress, anxiety, depression just to name a few.

Holistic approach to addressing pain at night includes the following:

1. Understanding the source of your pain. Is it really the surgery? Are you afraid of losing your job? making a bad choice? Not being able to get back to your previous life? Is a full recovery possible? Will I ever really get back to my best? Is my best behind me?

2. Maintaining compliance with the recommendations of healthcare professionals that are working on your case. Yes, that means performing exercises, activity modification and taking medication if needed.

3. Take your pain medication if needed. Do not get behind on your pain medication if severe levels (7+/10 to 10/10). If there are side effects that you do not like then speak with your MD right away.

4. Know your pain reducing strategy if you are not going to take pain medication. If you are an ice/heat, gentle massage, vibration/massage gun, deep breathing, relaxation, TENS unit type person then utilizes those tools.

5. Find pleasure in the small victories in your recovery.

6. Find moments to be thankful and grateful for what you are getting back versus what you lost.