3 Reasons Why Pain Levels Change [+What To Do About It]

Why Pain Levels Change Throughout the Day

The Clearing Team
The Clearing Team

Many of us have been asked to rate our pain on a 1-10 scale before. Pain rating is part of a care team’s overall tracking system to give the team a clearer picture of each patient’s particular pain. The picture emerges over time as the team continues to collect ratings. 

Suppose, for a moment, your pain rates as a 7. Is that a steady, across-the-board 7 that remains consistent from hour to hour, or is it an estimated average resulting from a 9 first thing in the morning, a 6 around lunchtime, a 4 after a nap, spiking to another 9 as evening approaches? 

For many of us, it’s rare for pain to stay fixed at just one level throughout an entire day. For people with inflammation-related chronic pain, the pain can be higher in the morning after waking up, when inflammatory pathways that were suppressed while sleeping crank up again. Nerve pain, on the other hand, can worsen in the evening. And sometimes pain varies, cycling through patterns or shifting in sometimes unpredictable ways. Why is this? 

Why pain levels shift 

Many reasons could help account for why chronic pain levels can shift in perplexing, sometimes troubling ways. According to a Stony Brook University study, some of these reasons include:

  • Depression: Negative emotions and the sense of helplessness that often characterizes depression can contribute to feeling that you can’t predict as much as you would like to in your life, or that you can’t control what’s going on. This may cause pain levels to vary throughout the day. In the study, tracking a set of depressed patients indicated they were experiencing more frequent pain variations during the day as well as more pronounced highs and lows.
  • Focusing on what could go wrong: Also called catastrophizing, this behavior refers to taking a “glass half empty” view while concentrating on the worst potential negative outcomes. People with this style of handling chronic pain also have more variable levels of pain during their average days. 
  • Confidence: When patients are confident they can cope with their pain (which is known as self-efficacy), they often have less pain variations during their days and weeks, and also feel more satisfied with what they’re able to do and with their average quality of life. 

Findings like these help normalize pain fluctuations and establish how some people with chronic pain deal with them. While an averaged number is thought to represent an overall level, some researchers and specialists believe it is more precise and helpful to track pain fluctuations, since this helps capture details about patterns that could help improve care and lessen the burden on patients who have to deal with these changes.

What to do about shifting levels of pain

Do pain fluctuations apply to you? If you’re not sure, try tracking your pain levels hour by hour. Also note if increased pain seems to be related to any heightened stress or low moods you may be experiencing throughout the day. Once you know what seems to change your pain levels, you can start to plan how to offset these changes, to try to keep your pain steady and manageable.

A few strategies to try include:

Prioritize depression management

If you’re going through depression, we hear you. That’s very hard. If you can help the depression lift even a little, however, you may notice more consistent, manageable pain levels. Talk to your doctor or psychologist to see what specific strategies might work. In general, Cognitive Behavioral Therapy (CBT) can help reframe the negative thought patterns that often accompany depression. Exercise boosts natural endorphins that can help buoy you through low moods. Adhering to a schedule gives you a good foundation as well. 

Cope with catastrophizing

If your brain tends to swerve toward what could possibly go wrong, it could be a coping mechanism that’s trying to help you plan for any eventuality, so that you feel more in control. Unfortunately, catastrophizing can also lead to feeling out of control or swamped with overwhelming possibilities. To cope, some people set a timer on how long they’re “allowed” to invest in negative thoughts. Others practice mindfulness (a way of staying in the moment by focusing on your breath, on body sensations, and on what’s around you). Even sleeping a full seven to eight hours, if possible, can help cut down on catastrophizing.

Support your self-efficacy

Set goals for your day, even if they seem small. When you succeed, reward yourself and don’t forget to praise yourself. When you don’t quite complete a goal, remind yourself that perfection is impossible, that you’re human, that you’re doing your best, and that it’s OK to not complete everything. Take a break to regather yourself and then focus on the next goal. If the day seems particularly challenging, try to come up with one positive statement, not to falsely goad yourself into feeling better (which can feel fake), but to start developing a habit of viewing adversity as a challenge you can face with creativity and resilience instead of something that just seems to be happening to you. 

Remember, changes in pain throughout your day, week and month are normal. Understanding these changes in severity and timing can help you and your care team also understand what strategies for living with chronic pain will likely work for you, particularly as the sometimes-stressful holiday season approaches. The bottom line, fortunately, is that you have some control over pain variability, and that there are ways to help pain levels stabilize.

This article is for informational purposes only and does not constitute professional medical advice. Always seek the advice of your healthcare professional with any questions or concerns you may have regarding your individual needs and medical conditions.