Why is pain so much worse during the night and in the morning?

, I'm sorry you're experiencing worse pain during the nights and mornings - you're definitely not alone in this experience.

I have a few theories on why this might be (bearing in mind that I'm not a medical professional). Firstly, I wonder whether the fewer distractions at night/during the early hours of the morning means that we are simply more aware of our pain during these times? Secondly, perhaps using our bodies during the day makes the pain worse at night, and then lying down all night, not moving much, makes the stiffness and pain worse in the morning? I also wonder whether there could be something physiological going on. This isn't quite the same, but somebody over in the psoriasis community asked why the itching was worse at night, and this prompted the team over there to write the following article: https://plaquepsoriasis.com/clinical/itching-night - you'll notice that cytokine (some of which are pro-inflammatory) levels may rise at night, and cortisol (which works to lessen inflammation) levels may be less concentrated at night. So perhaps this also plays a part in the pain being worse at night? As I mentioned, these are just my personal thoughts on the topic.

Thank you for reaching out with the question - it's such an interesting one and I'd be really curious to hear others' thoughts on this. Have you been able to ask your doctor this question? And is there anything that helps you cope with the pain? Hoping you've been able to get some sleep. Warmly, -Catherine, Community Moderator

Thank you so much Cathy for the thoughtful and detailed answer. I’m drawn to the cytokine explanation. It makes sense that immobility would allow toxic cytokines to puddle up in pockets of active inflammation and cause increased pain. That would also explain why the pain slowly dissipates after I’m up moving around. Increased circulation probably clears the cytokines away from the sore spots.

If cortisol concentrations drop at night, I’m wondering if it would be better to take my prednisone in the evening instead of the morning?

As for asking my doctor about this, honestly I have not. I only get 10-15 minutes twice a year with him and there are always so many other pressing issues to discuss. I was just diagnosed a few months ago after suffering for 35 years. But I think I will ask the next time I see him.

As for coping mechanisms, it’s difficult. My current issue is left SI joint pain that makes it extremely painful to move in bed and when getting up, the pain is unbearable, the leg gives out and the foot goes numb. I keep a cane nearby for walks to the bathroom, but it’s not enough. I have a bed which can be adjusted for firmness and position, which has helped quite a bit. I find that a pelvic belt also helps to splint the sacrum. I rub four different pain creams and ointments on it and take acetaminophen. I also use ice followed by heat. Still, night time is a nightmare. I’m waiting to start Humira next month, so there is hope, I think.

Does anyone have experience with Humira helping with SI joint, anxial, issues?