Thursday Thoughts: Explaining Back and Neck Pain in Bed

Patients in pain often have difficulty sustaining prolonged positions, especially at night. A reader recently asked me how I explain this to patients.

Points I often make to patients

your brain normally filters out more input than you perceive
having pain at night or certain lying positions is your brain being protective over the area that is bothering you
rarely this is a mechanical sensitivity but it seems so as we can change this threat perception and thus make the pain "go away" by moving around or changing position
example of left cervical and radiating arm pain

normally the patient favors sleeping on the left side
however, since the onset of pain, they are only able to lie on the left side for 1-2 hours before pain increases, forcing them to sleep in a less comfortable position
I explain to the patient that under normal conditions, when the brain is not being vigilant, the sensation of your bed and pillow are normally filtered out
upon first lying down, you feel them, then that sensation is lost, much like putting your clothes on
however, since there is an active "alert" for the area that is painful, the continuous sensation of the pillow and bed are meeting the pain thresholds, which are set lower due to the alarm going off in the brain
thus the preferred lying position now becomes threatening
lying in this position is no more damaging to any tissues than it previously was
once we reset the nervous system with education, movement, and manual therapies, these pain and movement thresholds raise, and you will be able to sleep on your preferred side

in effect, your goal for Pain Science Education is to treat this functional loss as a type of Allodynia, or a painful response to a normally non-noxious stimulus
we know that patients who are unable to lie prone, supine, sidelying, often rapidly regain this ability after their pain and movement thresholds are raised from our active treatments
encourage them to avoid testing this position too much until their ADLs are at least 50-75% improved
the more you avoid setting off the alarm, the less vigilant the CNS will be
it's a balance, they can try lying in their preferred position as they start to feel better, and they can work there way to lying for longer periods