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Peripheral Neuropathy Q&A: Why does PN pain bother people more at night?

Question:  Why does PN pain bother people more at night?

Answer:     

There are a couple of  explanations.  The first, is that during the day people are up and around and busy and distracted from the pain.

The other, more physiological explanation, is that during the day, most people are wearing shoes and socks, or at least socks, and they are on their feet.  The pressure on the soles of the feet from the shoes and from standing activates the largest diameter sensory axons – those that mediated pressure and vibration.  Sensory information travels up those axons to the spinal cord at about 120 miles an hour.  Pain and temperature sensation are mediated by very thin axons and that pain and temperature information travels along axons at about 20 miles per hour.  Both axons deliver their information to the same area of the spinal cord.  The idea is that the pressure/vibration information gets to the spinal cord first and modulates or blocks the input from the slowly conducting axons that mediate pain and temperature.

To relieve this pain at night, patients can take advantage of this physiological “trick” by wearing ankle length compression socks to bed or by using a warm-water vibrating foot massager for 20 minutes or so before bed.  Alternatively, some people benefit from using simple over-the-counter lidocaine cream or lidocaine patch on the feet at night.  It is recommended to try these techniques first, before moving on to pills.

Response from Dr. Janice Wiesman, MD, FAAN, Author of Peripheral Neuropathy: What It is and What You Can Do to Feel Better

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