Why Does Chronic Pain Get Worse at Night? The Brain’s Role in Pain Perception

It's been a long day. You're finally in bed. And that's when the pain hits.

Your back aches. Your neck throbs. Your joints hurt worse than they did all day.

You wonder: why does this always happen at night? What is it about lying down in the quiet that makes everything hurt more?

The answer has to do with your brain. Not because the pain isn't real. But because how your brain perceives and creates pain changes depending on what else is happening around you.

Understanding this connection can help. And for many people, chronic pain therapy addresses the patterns that make nighttime pain so much worse.

How the brain amplifies pain signals when we're quiet

During the day, your brain is busy. It's processing dozens of things at once. Work tasks. Conversations. Traffic. What to make for dinner.

All of this activity takes up space in your brain's attention. And when your brain is focused on other things, it turns down the volume on pain signals.

This isn't about distraction in the way people usually mean it. It's about how your brain prioritizes information.

Your brain receives thousands of signals from your body every second. It can't pay attention to all of them. So it filters. It decides what's important enough to bring to your conscious awareness.

When you're busy, pain signals get filtered out more. Not because they're not there. But because your brain is focused on other things that feel more urgent.

At night, everything changes. You lie down. The house gets quiet. There's nothing competing for your attention.

Now your brain has space to notice every signal from your body. And if your nervous system is already sensitized to pain, those signals get amplified.

It's like turning up the volume on a radio. The signal was always there. But now you can hear it loud and clear.

This is why people with chronic pain often say nighttime is the worst. Not because the pain is objectively worse. But because there's nothing else to focus on.

The relationship between sleep, pain, and anxiety

Sleep and pain have a complicated relationship. Pain makes it hard to sleep. And lack of sleep makes pain worse.

When you can't sleep because of pain, your nervous system stays activated. You're tense. You're frustrated. You're worried about how tired you'll be tomorrow.

All of this keeps your body in a stress response. And stress makes pain worse.

Many people also feel anxious at night. When you're lying in bed with nothing to do, your mind starts racing. You think about everything you have to do. You worry about your health. You replay conversations from the day.

Anxiety and pain feed off each other. When you're anxious, your muscles tense up. Your breathing gets shallow. Your nervous system goes into high alert. All of this amplifies pain signals.

And when you're in pain, you get anxious about whether you'll be able to sleep. Whether tomorrow will be as bad as today. Whether this will ever get better.

This creates a cycle that's hard to break. Pain and emotion collide in ways that affect your whole system—not just your body, but your mood and sleep quality too.

Breaking this cycle doesn't mean just trying to sleep through the pain. It means addressing why your nervous system is so activated at night in the first place.

Why distraction during the day helps (and what that teaches us)

You've probably noticed that you feel better when you're busy. When you're focused on something engaging, the pain fades into the background.

Some people feel guilty about this. They worry it means the pain isn't real or that they're somehow making it up.

But that's not what's happening. The pain is real. What changes is where your brain puts its attention.

This tells us something important: your brain's perception of pain is flexible. It changes based on context. And that means we can work with it.

When you're engaged in something meaningful, your brain doesn't interpret every signal as dangerous. It's calm. It's focused. And when your brain feels safe, it turns down the pain volume.

At night, you're not engaged in anything. Your brain has nothing else to focus on. So it zeroes in on every sensation from your body.

This isn't a problem to solve by just staying busy all the time. That would be exhausting. And it wouldn't address the underlying issue.

The real insight here is that your brain can learn to feel safe even when you're quiet. When you're not doing anything. When you're just lying in bed.

That's what therapy for chronic pain helps with. Teaching your nervous system that rest doesn't have to mean ramping up pain signals.

Nighttime pain management strategies

There are some practical things you can do that help with nighttime pain. Not because they fix the problem overnight. But because they start to shift the patterns.

First, pay attention to your pain without judgment. This sounds counterintuitive. But when you notice pain and immediately tense up or panic, you're adding fuel to the fire.

Instead, practice just noticing. Where do you feel it? What does it actually feel like? Does it change as you pay attention to it?

This isn't about accepting pain or giving up on feeling better. It's about not making the pain worse by adding fear on top of it.

Second, notice your breathing. When you're in pain, your breathing often gets shallow and fast. This keeps your nervous system activated.

Slow, deep breaths signal to your brain that you're safe. They help your nervous system calm down. And when your nervous system calms down, pain often eases.

Third, find something to focus on that's not threatening. This might be an audiobook, a meditation app, or gentle music. Not to distract from pain, but to give your brain something else to attend to.

The goal isn't to never notice pain. It's to notice pain without immediately catastrophizing about it.

Fourth, check your thoughts. If you're lying there thinking "this is terrible, I'll never sleep, tomorrow will be awful," your nervous system stays on high alert.

Thoughts like these are normal. But they keep the pain cycle going. You don't have to believe every worried thought that shows up.

Finally, be patient with yourself. These strategies don't work instantly. They work over time as your nervous system learns new patterns.

When to seek therapy for chronic pain and sleep issues

If nighttime pain is regularly disrupting your sleep, therapy can help.

This isn't about learning to live with pain or just accepting it. It's about changing the patterns in your nervous system that make nighttime so much worse.

Therapy for chronic pain teaches your brain that it doesn't need to amplify every signal when you're quiet. It helps you break the connection between lying down and expecting pain.

Many people find that as they work on their relationship with pain during the day, nighttime naturally gets better. Their nervous system calms down. Sleep improves. And the cycle starts to shift.

Living with chronic pain affects every part of your life—including sleep. Addressing the brain's role in pain doesn't mean ignoring the problem. It means working with your nervous system to create change.

At Aspire Counseling, we work with people throughout Missouri who struggle with chronic pain and sleep issues. We offer therapy both in person at our Lee's Summit office and through telehealth.

Our approach is grounded in neuroscience. We help your brain learn that it's safe to rest without ramping up pain signals. And we give you tools that work whether you're dealing with back pain, migraines, fibromyalgia, or other chronic pain conditions.

Nighttime doesn't have to be the worst part of your day. There are things we can do to help.

You can learn more about our approach or reach out to schedule a free consultation. We'll talk about what's going on and whether therapy might help. No pressure, no commitment required.

Call us at (573) 328-2288 or schedule online.

You don't have to keep lying awake in pain. Your nervous system can learn new patterns. And we can help you get there.

Related reading:

• Is Chronic Pain All in Your Head? Understanding How the Brain Creates Pain and What Helps

• When Pain and Emotion Collide: How Chronic Pain Affects Mood, Sleep, and Mental Health

• Living With Chronic Pain: When Good Medical Care Isn't Enough

About the Author:

This post was written by Jessica (Tappana) Oliver, LCSW, founder of Aspire Counseling. Years ago, Jessica regularly worked with clients experiencing chronic pain and sleep disruption—she saw firsthand how the two amplify each other. These days, she focuses her clinical work on offering trauma therapy intensives at Aspire, but she remains passionate about helping people understand the mind-body connection. After countless conversations with Adam White, LPC, one of Aspire's chronic pain specialists, she's convinced he's the go-to expert in the Kansas City metro area for treating chronic pain through therapy. This post reflects Adam's approach and clinical expertise in helping people break the nighttime pain cycle. Adam practices at our Lee's Summit, Missouri location and also offers online therapy throughout Missouri.