Atlas Osteopathy

24 September 2010

Pain patterns: what the timing of your pain tells us

When your pain is at its worst tells us a lot. Morning stiffness, end-of-day ache, or pain only on movement, each pattern points to a different group of conditions. A primer.

Pain patterns can be a useful way of working out what is happening with your body and the likely cause of your discomfort. It is not a definitive diagnosis, but it helps include and exclude conditions to land on the right one.

This piece is about daily and weekly pain patterns: when the pain is felt, when it gets better or worse, and why.

Morning pain and stiffness

These are usually inflammatory conditions such as ankylosing spondylitis and rheumatoid arthritis. Pain is worst in the morning because you have been sedentary in bed all night. The joints have not moved, so they stiffen up and become painful when you wake and start moving.

End-of-day pain and stiffness

These are conditions that cause pain when the joints have been used. The pain is felt in the afternoon and evening. Osteoarthritis and osteoporosis can produce pain after a day of walking and moving, as the joints become irritated and swollen with use.

Pain on movement

Erratic pain, related directly to movement, usually points to a muscular or ligamentous cause. Muscular pain tends to be sharp on movement. Ligamentous pain, which also appears on movement or when held in a non-neutral position, tends to be a dull ache.

Why it helps to track it

It saves time on the first visit, and it helps us tune the assessment. If you can keep a few-day diary of when the pain is worst, when it eases, and what made it change, we can move much faster on the diagnostic work and get to treatment.

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