How to sleep with severe pain in the early hours?

[OhYouBadBadKitten]

I'll try to be a bit vague as to not out myself, but what else can I do to help myself?

Awaiting surgery for painful condition. I'm on co-codamol and anti inflammatories. I'm coping in the day time, but at night I wake up crying in pain around 4am. I guess the painkillers are wearing off by then.

I'm reaching the end of my tether after3 months of this. Pain before, but not on this level.I literally don't know what to do. I asked my gp via e consult for help. was written a prescription for the same thing. Now it's nearly Christmas, so Ive probably left it too late.

I feel like an utter drama queen, but it's affecting my ability to think clearly. I don't want Christmas to be even crappier than it is.

Maybe purple.
Perhaps I should switch to tramadol? I do have some in.

@OhYouBadBadKitten

Chris DeBurgh.

I usually try and lie in bed so I don't disturb dh, but that can be a bit miserable.

I'm the opposite, I get up as I start to toss and turn and disturb my wife. On the bright side for her, she gets coffee in bed every morning.

I used to hate being up at that time, but really don't mind it now, so peaceful and quiet.

Tramadol is still an opiate so could also cause withdrawals. But you shouldn't suffer in pain. Would they offer patches for this sort of problem? I'm not very knowledgeable about arthritis!

Hope you can sleep

Is it worth trying an Epsom salt bath before bed, or magnesium spray to relax the muscles around the area? Perhaps other MNers can say if it helped them.
You mentioned whiskey. I don't want to encourage you to drink alcohol with painkillers, but when I have a cold, I find diluting whiskey with hot water is very soothing and helps me sleep like a log. Obviously check it's allowed with your pain killers. I hope you sleep well tonight. 💐

@OhYouBadBadKitten

I should try that over Christmas I think, when there isn't the alarm pressure. I'm going to have a go at sleeping. Thank you for all the advice and kind words.

If the pain is going in to your hand and causing you a lot of distress then you should absolutely get a medical opinion ASAP! Especially considering you have psoriatic arthritis and are on MTX. Do you feel heard by your GP surgery when you attend? If not perhaps OOH would be a plan to get a fresh pair of eyes It's so much better to ask for help rather than suffer (easy for someone else to say I know) I'm awake with pain from shoulder subluxation, I've held off bothering to ask for help for years but have the promise of specialist physio after I gave up and went private (I've hyper mobility but in the past 18m developed severe psoriasis and have had 5 ops on my spine this year, what a hoot!) My only takeaway from it all has been that the squeaky wheel gets the grease which isn't how things should be, but are.

You're not a drama queen. If you're taking two co codamol tablets at 7am and 7pm you've got another 4 tablets allowed in 24hrs. I'd set an alarm every 4 hours, have tablets and glass of water on your bedside table. You'll end up barely waking to take them then straight back to sleep. But that leaves you with no spare paracetamol capacity for the daytime, so TBH I think you need better pain relief. Then you can use the co codamol for top up if necessary and not using them daily means you won't get addicted to them.

You could ask for pregabalin or gabapentin or tramadol or whatever they'll offer you! IME you have to push quite hard to get pain meds, if they can fob you off they will, stoical people tend to suffer for this reason. Make it clear how often you wake and how it makes you feel, how the sleep deprivation affects you the next day etc.

If amitriptyline is effective for you, you could always medicate the side effects. If your heart is racing from anxiety, anti anxiety meds such as pregabalin (it's a drug with several purposes) can help.

Do you seize up with cold or lack of movement at all? It might help to keep the central heating on at night if you don't already. Or to set an alarm after a few hours, get up and move around (do the dusting or ironing?) for half hour then go back to sleep for another few hours. Broken sleep is better than no sleep.

Hope your operation comes through soon OP.

I misunderstood what you are saying purple, I don't think you get withdrawal symptoms between doses, I was thinking more, that the cocodamol makes me a bit sleepy and perhaps that element was wearing off.

I'm sorry LadyDoc that pain is keeping you awake too. It sounds like you've had a really rough time of it.

I did actually sleep better last night, though woke up in ridiculous pain. I clearly can't really go down the route of mixing meds and alcohol. I've missed the cut off time for contacting the gp today. That was really stupid of me. I've taken some tramadol, so less pain, more queasiness. I feel a bit more zen now!

I'm kind of loathe to start new medication over Christmas itself. (maybe that means I can't be in that much pain?) I just don't want to spoil it further. But if I can line something up with the gp, I could start it afterwards?

I think the getting up is a good idea and the epsom salts. Sometimes it's the smaller things that make a massive difference.

Im also definitely going to switch my medication timings around and set an alarm to cover that witching hour.

I've found if I press in my arm pit (where it joins the shoulder) I can locate the nerve that is causing the hand pain. Massaging that seems to help a little bit.

Thank you. Even just having people being sympathetic has helped. I don't really talk about irl very much, co's who wants to be the boring person.

Oh I literally feel your pain! I had shoulder surgery a few years back and still have ongoing problems as it’s wrecked.

What’s your sleeping position like? I have to be very careful with that or it can trigger nerve pain down the arm and up the neck.

Cocodamol is good but it’s worth trying co-dydramol. Amitriptyline is definitely worth a go - it also knocks you out a bit so good for night pain. Be careful with tramadol as it has some interactions so always check those first. Ant inflammatory meds are always good if you can take them; if not, see if you can use something like voltarol gel, that works a treat as it’s direct.

When it kicks off - and I know that pain, it made me physically sick - get up and try moving it around a little. ‘Walking’ your hand gently up a wall gives a good stretch and you can control it. Do you have a heat pack? They work a great - those wheat bags - or ones you can stick on.

When I went for my surgery they gave me sedation just to have the nerve block as the anaesthetist said shoulder pain is one of the worst pains. It’s unreal how bad it can be

My sleeping position is all over the place. I just can't get comfy at all.

I wonder if I can up my dose of naproxen. I'll have a look.
I do have co-dydramol in too from last year I don't think there's any danger of me getting addicted. I hate feeling spaced out so tend to be really resistant to taking opiates.

I do have a wheat bag. Getting it ready for shoving in the microwave in the middle of the night is a good idea too.

As I'm sat here, the shoulder isn't too bad, the pain through my elbow and into my hand is horrid. Im going to get off my arse and contact the gp.

If you have a hot water bottle, I found you can make them up with boiling water from the kettle and put it under your pillows and it stays insulated and warm til you need to pull it out later at night. Alternatively a heat pad (like a tiny plug in electric blanket) can be good.

RE the painkillers, make sure you are taking paracetamol (with on its own or with cocodamol) at 6 hour intervals during the day.

I think I would probably be thinking for example:

Naproxen 7pm, Cocodamol 10pm, Cocodamol 4am, Naproxen 7am, paracetamol 10 am, paracetamol 4pm.

That means you can fit two doses into the night, still take your full paracetamol allocation (avoiding overdose as the maximum safe dose and the maximum dose per the box are very close), but avoiding taking opiates during the day?

If you take paracetamol in the day, you could ask your GP to prescribe simply codeine tablets without the paracetamol - then you can take the codeine at night without exceeding your paracetamol dosage?

Sympathies. Night time pain is the worst (my shoulder pain had me awake at 4am this morning). I find a wedge pillow is helpful as it seems to support my shoulders in place.

Long term could you get (or have you been) referred to a pain management clinic?

PS thank you for your weather threads - I am still hoping for snow for Christmas

Also, a lot of people recommend relaxation or mindfulness exercises but they don't work for me - I like to be distracted from the pain so read normally. I have to go to bed really early though to balance the awake early hours!

That sounds like a brilliant plan Nacreous. Thank you! I'll do exactly that with both the medicine routine and the hotwater bottle.

I've sent a message to my gp too. Even if I can't get anything this side of Christmas, it means that hopefully afterwards I'll have something different to try.

Maybe I should just drink my way through Christmas

I've got a weird shoulder neck pillow thing. I'm not sure it helps. I could try a wedge pillow.

Hopefully, if my surgery goes ahead, I should be much better once I've gone through the horrid recovery bit. I think our pain management clinic locally has a very long waiting list. I found them really good for sorting out my back pain.

I had a subacromial decompression for my shoulder pain. When they got in there it was nothing to do with the subacromial area it was a big bone spur from long term inflammation. They lopped it off, did the decompression anyway and I swear I never looked back from that day. That shoulder is one of my best joints now. Just thought a positive surgery tale might help. Also they did some sort of nerve block so my whole shoulder arm area was numb for about twice hours after the op. I found the sensation quite weird and it freaked me out. I had been late into theatre so had to stay overnight and couldn't sleep because I was so freaked about the numbness. I just watched stuff on laptop. All in all was well worth having that surgery and last years hip arthroscopy.

Last night my arthritis was giving me hell, left arm and shoulder I had to have my painkillers I have paracetamol and ibuprofen,

Lovely, lovely gp has prescribed pregabalin and was really very kind about it. I feel much better for being understood.
It might be a slightly druggy sort of Christmas!

Covid that is really positive, thank you! It's good know that when it happens I've got a good prognosis. I've got a lot going on in my shoulder, so the surgeon is going to tackle the lot.

Dear Kitten, I'm really sorry you are suffering like this. I can sympathise - shoulder pain referring down your arm etc is really awful, and being awake in the night in pain likewise. You've had lots of good advice on here about pain relief so I won't add anything, but just wishing you well. And thank you for all you do on the weather board - your threads are my go-to for winter weather - but feel free to step away while you are feeling so rubbish.

@OhYouBadBadKitten I’m glad you’ve got something to try. Hoping you get some sleep for Christmas!

Have you tried sleeping sort of sitting up, its likely the sleeping position that has the nerve compressed by 4am. Do you have a guest room where you can build a nest of pillows on the bed to support you? Other things to try (alongside medication changes) are full RDA of magnesium before bed, the PP was right about it helping a lot with nerve and muscle pain. A heating pack is a great idea and look at ulnar and median nerve glides online. They are exercises that help get the arm nerves less caught up on the muscles around them. They cant fix the problem, but they can help mitigate the pain. Lastly have you tried one of those massage machine thingies you can hang around your neck.

Kitten, I know this wouldn't suit everybody and it will disrupt your sleep patterns for a bit, but could you try setting the alarm for 3am to take another dose of something before the pain gets out of control, if you're not already maxed out on dosage?
A relative did it that way - you can have a slice of toast and a cup of tea before the tablets, so they're not going into an empty stomach. Then back to bed for a few more hours' sleep.

Disadvantage is, you have to readjust your sleeping patterns afterwards when the problem is resolved.

Can you get on the list for a pain clinic if you're not already on it? You can always come off the list if the problem gets sorted before you reach the top.

I'm sorry, I hope you get sorted out soon.

The pregablin will help xx it gets a very bad press for side effects but I haven't really had an issue with it. I think it made me put on weight but I was on steroids so they are probably as much to blame. Everything seems so much better after a nights sleep. Even one gifted by painkillers.

I agree with the pillow ‘nest’! My GP laughed when I described it as that but honestly it was and it worked, as it takes the pressure off the joint. So glad you have pregabalin, it may well be a game changer!!

As soon as I read your post I KNEW it was going to be shoulder. Is it frozen? God it’s awful. Try ice to take it down when it’s really bad. I have a support that I got from amazon that has an insert for a heat or ice pad. Also an orthopaedic pillow will help. Finally, biofreeze gel. I totally feel your pain, shoulders are the worst. RA and FS here x