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Worse pain at night from musculoskeletal injury?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by matthew malone, Sep 18, 2009.

  1. matthew malone

    matthew malone Active Member

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    An observation that has recently started to puzzle me is why patients with Musculoskeletal Injuries either bone or soft tissue often complain of night pain? Some patients would ask why is it worse at night. I would reply...Because it does!! I have also asked this question to other colleagues who replied...Your the specialist Podiatrist..You tell me !!!

    Why do people with pathologies to bone or sof tissue get increased pain at night. Is there any science that we actually KNOW contributes to this.

    Some thoughts i have are:

    At night when your in bed there is decreased stimulus from other things, therefore more pain receptors / messages are interpreted by the brain, where as for expamle with distraction from other stimuli many messages are sent to the brain, which then selects which to interpret - pain or no pain signals? A common example is distraction techniques used for pregnancy?

    Other thoughts are to do with things like osteoclast / Osteoblast activity - Is there any evidence suggesting that this increases at night. Is there any evidence that suggests that when a joint / limb / bone or tissue structure is loaded like when weightbearing that osteoclast / osteoblast, Histomine etc.. activity reduces. Therefore when the limb is not loaded does this cuase some chemical recptor to say- ok start repairing?? An example is an Osteoid Osteoma- Nearly all of the patients often report that the pain is worse at night..Why? This is a bony related Neoplasia but the theory is of bone remodelling / Activity ?

    Any thoughts or anyone know of papers which suggest any other theories?
  2. Re: Night Pain


    Most musculoskeletal injuries to the feet hurt worse on weightbearing during the waking hours, not at night. However, at night, smaller pain levels will interfere with restful sleep than will prevent people from doing activities during the day. Therefore, pain from a foot injury can carry over into the night and interfere with sleep, if it is severe enough. If enough inflammation is present in a structure, then pain will be present until the inflammation subsides, and this takes more than a few minutes or hours off the feet while laying in bed in some cases. I would explain the night pain in mechanical injuries to the foot and lower extremities as being chronic inflammation in an injured structure that has not resolved sufficiently at night from the damage that has occurred during the weightbearing activities of the day to allow the individual to be pain-free to allow a complete, restful night of sleep.
  3. Craig Payne

    Craig Payne Moderator

    Re: Night Pain

    There is also the 'gate theory' issues at night .... less sensory stimulus (eg sound; sight; tactile; etc), so pain may be perceived as being worse.
  4. matthew malone

    matthew malone Active Member

    hi guys

    i probably worded it slightly wrong as per usual- obviously those with musculoskeletal injuries caused by mechanical issues will have the majority of pain during the weightbearing situation, i am more interested in the response to injury and how some patients complain of night pain- as kevin kindly noted the inflammatory issues arising as a result of the trauma just dont go away over a few hours. I was looking to see if there is anything in the literature which or in general about the healing process. Can healing occur or is it reduced when a tissue / bone structure is loaded, does the majority of healing occur in a non weightbearing or non loaded limb? Craig thanks for pointing out the "gate theory" i can know do a lit search on this area.
  5. matthew malone

    matthew malone Active Member

    I found an interesting paper on the study of achilles tendons..unfortunately it was in rats..but hey we have to start somewhere. The interesting relevance is that:

    Healing of the rat Achilles tendon is sensitive to mechanical loading, and the callus strength is reduced by 3=4 after 14 days, if loading is prevented. Exogenous GDFs stimulate tendon healing. This response is influenced by loading: without loading, cartilage and bone formation is initiated. This implies BMP signaling is crucial during tendon healing and influenced by mechanical loading. Mechanical loading and biochemical signaling both control tissue healing. It is unknown how they interact, and to what extent mechanics controls biochemistry or vice versa. The bone morphogenetic protein (BMP) signaling system, with its ligands, antagonists, and receptors is important for bone repair and regeneration, but its role in the healing of tendon is largely unknown.

    Based on this information we believe BMP signaling is crucial during tendon healing and is influenced by mechanical loading.


    If this model was applied to humans, considering the most lengthy of non-weightbearing occurs at night in bed, is this when the majority of healing occurs? is there any influence on healing an pain receptors? still lit searching this?

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