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 !!!
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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?
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