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Why do I feel more pain at night?

Q) Why does the pain in my arms, feet and legs increase as the sun goes down and become more and more severe as the night progresses? I usually regard the approach of dawn with a mixture of relief and dread as getting out of bed is agony. Any information or advice you can give me will be really welcome.
June, Norbury, London (Autumn 2012)

A) Physicians are generally interested in the periodicity of patients' symptoms as it may provide a clue to the underlying illness. Inflammatory arthritis is generally much worse in the morning and late in the evening. Patients with inflammatory arthritis also complain of stiffening up overnight and may be woken with night pain. This may in part be linked to the natural rhythms of the body, and how much of our own cortisone we make (generally less at night). Inactivity also probably contributes but one of the more significant factors at night is that there is nothing else around to distract you from your joints and muscles! How can you deal with this? It is your doctor's job to ensure that your arthritis activity is kept well under control, and this is the prime concern. In addition, it might help to take a hot bath before retiring, to relax your muscles and sooth your joints. Try taking a long-acting (12 hour) painkiller or anti-inflammatory tablet in the evening to ensure adequate control of your symptoms overnight. Some patients of mine even plan to get up during the night to reduce the amount of morning stiffness but that's taking things a little far I think!

This answer was provided by Dr Philip Helliwell for the Autumn 2012 edition of our magazine, Arthritis Today, and was correct at the time of publication.

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