I don't know if it is just me, but my pain is lesser in the morning, but by 4 oclock or so, it seems to really flare and burn more, and stays like this for around 4 hours. Do you find that your pain is worse in early evening? Why would this be? do y'all take breakthrough pain meds to deal with this?

thank you

Jess - I am not sure why the pain is more severe in the evenings but that does seem to be the case for many of us. I only have a little pain in the morning and the more I move around, work, etc., the pain increases and it's pretty rough by bedtime. I do know that the supplements do decrease my pain as I went out of town on business for a week and left behind the bag of supplements. I did have my presectiption meds with me and took those but I had more pain while not taking supplements.

I do take tramadol for the breakthrough pain.

increase around 4pm because that is when the first dip in your natural cortisol occurs. This is why people often have tea and a snack at that time. (this raises cortisol faster). Cortisol levels are highest at around 8am, and/or after breakfast.

There are two major dips per 24 hrs. 1 around 3:30-4am, and the one at 4pm (this one is smaller than the 4am one). This is called the diurnal cortisol cycle. It is commonly seen in hospitals that severely ill people die in greater numbers at around 4am than at other times, for this reason.

I always have more pain at night, too.

I,m another who has more pain at night..Sue

Me too. My pain is worse at night. Perhaps while i am sleeping i am not aware of the pain. When i wake up i am almost pain free, but little by little pain starts waking up with me. I wonder if it is actually me who wakes it up. I think there may be some kind of programing in my mind and not really pain.

mrsD.

Is there a supplement or something that we can do to naturally to level out these cortisol levels?

disease states affect the normal rhythm. Cushing's syndrome
is one. When cortisol remains high all day, there are huge
negative effects on the body.

When cortisol remains elevated, memory suffers too, as hippocampal cells get over stimulated in the brain and die.

In fact at one time the drug pipeline was investigating
anti-cortisol drugs...but they must have failed, since I have not seen any press releases on them.

I just wanted to say be careful with the tramadol. They told me you couldn't become addicted to it. So when I was in dire straights and got no response from any of my Dr's I took a half an extra pill every dose. (I did call my Dr. and left a message telling him I was doing this.) And of course the prescription ran out before it was supposed to, and I was in a lot of trouble because I ended up having to go through withdrawal (apparently you can become physically dependent) and the Dr who prescribed it never called me back and I ended up in the ER, and then a new Pain Dr.

I'm sorry if that came off preachy or something. I just want to make sure you know your body can become dependent on it and you can build up a tolerance for it quickly.

I just joined tonight. Thank you all for the posts .I thought I was alone with the pain getting so much worse at night. It keeps me up late. The ONLY way I can sleep at all is to take the Tramadol.and usually I also need a Vicodin. My legs are very bad. I never take the same amount of Tramadol in a day. Right now, I am only taking it at bedtime. But in the beginning I took it four times a day. Then I cut back to twice a day.....at 10:00 AM and at bedtime. But, I have decided I really only need it to sleep. I have been on it for a couple years. If I don't take it I do not sleep and lay there until 4:00 AM exhausted..and that doesn't help me much the next day. BTW, I am post liver transplant and nerves can be severed in the process of opening you up. Again, thank you all for your help. Joanne C.

Hi JoAnne,
good to meet you.
so sorry to hear about your pain. Thanks for the responses. i guess I too need to prepare for those times. I try to add the hydrocodone when it is very bad as I dont want to build a tolerance.