There’s something strange about pain that waits until night. You can get through the day mostly fine, distracted by work, noise, movement, people. And then the lights go off. You lie down. And suddenly, there it is. Aching. Throbbing. Sharp. Persistent. Pain that feels louder because everything else has gone quiet.This kind of pain is common. Almost weirdly common. Yet it’s brushed off so easily. “Pain that develops or increases during the night can be much more than just a nuisance. While there may have been more than enough distractions to draw attention away from the discomfort during the day, the stillness of the night often magnifies the perception of pain. However, chronic nighttime pain may also indicate conditions that should be closely assessed,” Dr. Akhilesh Yadav, Director – Orthopedics & Joint Replacement, Max Super Speciality Hospital Vaishali.

So why is this kind of pain ignored?

One reason is timing. Pain at night feels inconvenient rather than urgent. Doctors’ offices are closed. Friends are asleep. By morning, the pain might ease just enough that you question whether it was “real” or serious. You tell yourself it’s fine. You move on. And then the cycle repeats the next night.There’s also a cultural thing. Night pain doesn’t fit the image of injury or illness we’re used to. There’s no dramatic moment, no visible cause. It doesn’t happen while lifting something heavy or falling down stairs. It just… appears. That makes it easy to dismiss. Even by the person feeling it.And honestly, people are tired of being told their pain is normal. So they stop mentioning it. They don’t want to sound dramatic or needy. They assume everyone deals with this, that it’s just part of getting older, part of stress, part of life. So they lie there, staring at the ceiling, waiting for sleep that doesn’t come easily.But pain that shows up at night isn’t meaningless. It’s information. It’s the body saying something isn’t quite right, or that it hasn’t had the space to be heard during the day. Ignoring it doesn’t make it disappear. It just teaches the body that nighttime is the only moment it’s allowed to speak. And that’s why it keeps coming back.“The causes of chronic nighttime pain can often be attributed to muscle and/or joint degeneration. Examples of these conditions include arthritis, muscle strains, or simply having a bad sleeping position. These pain-producing conditions are typically due to the fact that the body is at rest when we sleep. Thus, they tend to flare up more severely at night due to lower levels of naturally occurring anti-inflammatory hormones, resulting in greater degrees of stiffness and pain, particularly in the lumbar, cervical, shoulder, and knee regions,” says Dr. Akhilesh Yadav as he mentions about the various reasons that cause pain during night time.The expert says nerve-related pain is another factor that can contribute to chronic nighttime pain. Examples of conditions that can produce nerve-related pain include sciatica, carpal tunnel syndrome, and peripheral neuropathy. In these cases, sleep can be disrupted due to burning, tingling, or shooting pain. Additionally, when we are in certain sleeping positions, we can compress some of the nerves and exacerbate the pain.

He adds, gastrointestinal issues can also occur at night causing pain. Lying down can make some gastrointestinal problems (e.g., Acid Reflux, Stomach Ulcer, Gallbladder problems) painful in your upper abdomen or chest area. Other gastrointestinal issues (e.g., Kidney Stones, Urinary Tract Infection) can cause pain in your flank or lower back area when lying down; Pain in your flank or lower back will feel even worse when lying down than when standing or sitting.“Occasionally, persistent or recurrent nighttime pain can indicate a more significant issue (such as a Tumor or Infection), especially if you experience other symptoms such as being fatigued, feverish, or losing weight. If your nighttime pain consistently interrupts your sleep or does not improve with mild treatment options like rest, stretching, or pain relief, seeking medical advice from a healthcare provider is crucial,” he urges. Medical experts consulted This article includes expert inputs shared with TOI Health by: Dr. Akhilesh Yadav, Director – Orthopedics & Joint Replacement, Max Super Speciality Hospital VaishaliInputs were used to explain why certain pain occur at night and why one should not ignore it.