Why does Bone Pain get worse at night?

August 04 11:32 2021 by admin Print This Article

Bone pain is one of the symptoms of various ailments. The pain is most prominently felt in the large bones of the hands and legs but can occur in other bones of the body too. The pain can occur any time of the day, and anywhere but seems to get worse at night. This is true for most conditions causing bone pain, and for most people suffering from that condition, irrespective of their age, gender, profession, lifestyle etc. In this article we will examine reasons for the same.

Causes of Bone Pain

To begin with, why does bone pain even happen in the first place? What are the conditions that cause them?

• Age: With advancing age, muscle size starts shrinking and bone density starts reducing. Even routine tasks can lead to overuse injury and stress to bones and bone joints.
• Bone fractures: Needless to say, a bone that has fractured and is healing under treatment will cause pain till complete healing has happened. Even trauma or injury to bones without a fracture can cause bone pain.
• Overuse or repetitive movement injury: This can happen to people of any age group who indulge in repeated movements that are stressful or hurtful. Sportspersons and weight-trainers who are training excessively, people in professions that demand lifting, pulling or pushing heavy weights can undergo bone strain and hence mild pain.
• In women, menopause can cause wide fluctuations and deficiency in hormones causing weakened and hence aching bones
• Arthritis, which is marked by inflammation of bone joints
• Osteoporosis: Deficiency in Vitamin D and calcium can cause bones to become porous and lose density, making even routine movements painful
• Primary bone cancer or cancer that originates in the bone causes tenderness initially, slowly leading to bouts of pain and then persistent pain
• Secondary or metastatic bone cancer which starts in other parts of the body and spreads to the bones
• Infections in the bone, such as osteomyelitis
• Leukemia which is basically blood cancer but originates in the bone marrow
• Sickle cell anemia which is marked by interruption in blood supply to the body, including bones
• Other conditions: Pain in the shoulders appears like bone pain but this could be caused by bursitis, tendonitis or rotator-cuff injuries.

Why does it get worse at night?

There are a few reasons for this, which are all closely inter-related. But for sake of technicality, we will separate them here:

• Drop in Cortisol levels: Inflammation caused by any of the above conditions cause healing to occur, whereby healthy cells are brought to the fore to work on damaged cells. This is what happens during the day. During the night, there is a drop in the stress hormone cortisol which has an anti-inflammatory response. There is less inflammation, less healing, so the damage to bone due to the above conditions accelerates in the night, with pain as the side-effect.
• Swelling due to inactivity: Synovial fluid is a liquid present in all bone joints of the body that helps in lubricating movement of the joints. It also helps reduce swelling and pain when its flowing around. This is why, during day time, the person’s activity keeps the fluid flowing reducing bone pain due to the above-listed conditions. But at night, since there is no activity, movement of this fluid is limited, so symptoms like pain and swelling only increase.
• Pain perception: Pain is both physical and psychological. During the day, the various activities and hustle-bustle of life, the presence of friends, family and co-workers around distracts the person 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 heightens.
• Vicious cycle of sleep deprivation: Bone pain at night, is such a common occurrence that there is even a name for it – Painsomnia, or insomnia caused by pain. The pain keeps the person awake, or disturbs the sleep. The disturbed or incomplete sleep at night causes tiredness and sleepiness during the day. It robs the person of motivation to exercise actively which helps relieve symptoms of the above conditions. 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: Both pain and insomnia can induce depression in some people or worsen the symptoms for those already suffering from depression. Frequent bouts of depression bring down the levels of positive hormones such as serotonin, dopamine and endorphins in the body which are so important for healing, in any disease or condition. The delayed or diminished healing sustains the pain at night creating a vicious cycle of depression and physical pain.

Incidentally, the person may experience all of the above simultaneously, which sustains and heightens the bone pain at night.

Diagnosis

While the above reasons may look gloomy, in reality, both the bone pain at night, and its underlying cause can be managed well. People who are experiencing pain or swelling in the bone and bone joints must consult a reputed hospital. An experienced orthopedic doctor or surgeon will do a thorough diagnosis.

This includes an understanding of the person’s medical history and family medical history. He/she will then come to the specifics of your bone pain which includes the chronology or when the pain began, its location, the level of pain and whether it is increasing or decreasing, what are the activities that trigger this pain. He/she will also look at other symptoms you may have.

This may be followed by X-rays of the bone, CT scan and MRI scan of the affected area. These will detect fractures or any abnormalities such as cancer. This is followed by blood and urine tests, hormone level tests and function tests of the pituitary and adrenal glands.

Treatment

Depending on the underlying cause, there is a wide range of treatment options. This includes drugs that relieve inflammation, antibiotics in case of infections, hormones, if there is a hormonal imbalance and pain relievers. Exercises that improve flexibility, acupuncture, massage, and relaxation techniques help reduce physical pain while Cognitive Behaviour Therapy (CBT) helps reduce psychological pain.

Joint replacement is an option when none of the above work out. And in case of cancer, radiation and chemotherapy are the most common options. The person will also be educated on tips, tricks and techniques to sleep better at night which goes a long way in overcoming the problem.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801

Updated on 22^nd Jan 2024