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Nighttime Pain

rugmankcrrugmankc Posts: 131
edited 06/11/2012 - 8:43 AM in Back Surgery and Neck Surgery
A recap of my surgery was decompression and interbody fusion L5-S1. This was done from back side with 8 inch incision. Surgery was needed to fix a grade 2 (18mm) slip of those 2 vertebrae. The slip occurred due to fractured pars, which hold the vertebrae together. During the slip the nerve coming out between the 2 vertebrae was pulled forward and crushed between the 2 vertebrae, worst on left side. Dr actually said nerve was badly mangled, one of the worst he has seen. The pars/lamina (I don't know the right names) bones were removed to get to the nerve and reposition it and give it room. A complication was the the 2 vertebrae had started to fuse/sacralize together and had to be sawed apart before they could actually be decompressed to insert the spacers and apply whatever material they now use to aid in fusing of the vertebrae.

Now 3.5 weeks post op. Some days are getting better. Last two was out shopping a lot, not the driver. Most my daytime pain is on the left hip a little to the rear with left leg sciatica down to foot and some numbness. Worse after sitting for a while. Actually, that one spot on left rear hip is my only pain source, maybe because that is the side of most of the nerve damage. Pain runs from 4-8 depending on activity. Dr says several months to get somewhat better with the nerve damage, but will never be 100% or pain free. Still there are marked improvements as far a pain levels during the day are getting better. Flexibility and no need for toilet risers anymore are other indicators. Can walk even without cane for short distances.

Sounds like a good recovery at face value. But my main question after the above recap is my pain at night while sleeping.

I will liken it to a sprained foot or heel spur, I have had both numerous times. They are worse overnight and when first getting up. But improve dramatically during the day with movement.

Overnight I get very stiff across the entire lower back and cannot move much at all from my lying on my back to trying a different position or just log rolling over to get water off of a table by the medical bed I am renting. The pain level while doing these things is a 7-8. Once I am up and active for 20min things start to improve. Of course I start to get pain meds into me also. I do usually take one percocet around 3am each night.

How common is this for anyone with operations similar to mine and when should I expect to see improvement. I am sure it is also related to the previous days activity level. I need to start to make notes on that.

My impression it is like the the sprain/heel spur, but just looking opinions from those who experience similar pain at night.



  • Go back and read - 3 1/2 wks post op! You are doing fantastic. To be up and out and so active is wonderful. You can expect another decrease in pain in the next 2 weeks and will then probably plateau for a while.

    Most people do better with gentle movement so sleeping is always tough at the beginning when it hurts to move. There are two ways to handle it. Either sleep through it (with help of meds) or when you wake up get out of bed and walk around for 15-30 mins.

    Trust me in a few weeks you will forget all about this time. When someone asks me about the post-op now I find it hard to remember.
  • I know it is hard, but you are still so early in your recovery. Everyone is different, but at 3.5 weeks, I was definately taking meds through the night. I wasn't sleeping through the night, even though I took a benedryl to help me sleep. I only stopped taking the benedryl a few nights ago.

    A couple thoughts that I had is, I think having more pain at night is very common. I wake up feeling pretty good. As the day goes on, the pain increases and by evening it is awful!

    A week ago today, I went in to PT ready to put it on hold for a while as I was feeling so bad at night. I talked with my PT. She was able to manipulate my pelvis trying to create the core stability I am missing due to surgery. With stability, my pain is much less. What this told her is that it is structure I am lacking ie muscle strength. So, I just have to hang in there, give it time, keep walking and going to PT.

    The other thing she suggested is several times a day, for me to decompress my spine and ice. I have been doing this and I have to say, it has helped!
    I can't get on the floor so I decompress laying on my sofa.

    Maybe try to not go shopping on back to back days. How is your walking going? maybe trying to improve your strength and endurance by walking shorter distances more times.

    But the bottom line is, it just takes time. Give yourself permission to take your pain meds, rest, walk, walk, rest. Unfortantly, we can't hurry this along. I am only just realizing this and it is so hard for me! We're here for you!
  • If you stop to think about it, getting into and out of a car is one of the more awkward, stressful things we do during the day.

    I think when I had a fusion two years ago, I had been in a car twice at 4 weeks post-op. I was definitely not out shopping. I don't even remember when I went on my first shopping excursion, even to the grocery store. So from my perspective, you are doing very well!

    I never worried about not sleeping at night. I operated on a 24-hour schedule and probably slept as much during the day as I did at night. I think I could only sleep for about 3-4 hours, so that's what I considered the normal amount of sleep time. Then I'd be awake until I tired, then would sleep another 3-4 hours...and I just repeated that pattern round the clock. That way, I never had those long blocks when I was in bed or trying to sleep, and I was walking every 3-4 hours, too. Anyway...that's what worked for me.

    Remember not to push yourself too much. It is best to avoid a flare if you can!

  • Thanks for the reply, I do sometimes walk around 15-20min before I lay back down. Does help to loosen up a little. Most of the time at my age I NEED to get up to visit the bathroom, so can't sleep thru it. :)))

  • I start PT mid May. Didn't understand what you meant by manipulating pelvis to help with pain. Is she a chiropractor or back specialist.

    I did not do much laying down the last couple days so will work on that. I think at night it is the core muscles stiffening up. I am walking several times a day, and will increase that. Probably getting too active too early. I will monitor the back pain and see if it is any better on light days.

  • I am going to go back to more naps for a couple weeks, see if that helps. Things felt good out shopping. I guess you get lulled into thinking everything is going great then BAM. I need to start back to work 1 June, so hopefully another couple weeks of rest and PT will allow me to do that. Job is not physical.

  • That' how I structured my day too, in blocks of 4-6 hours periods of time.

    My therapist is a PT. She was trying to help me figure out where my pain source was coming from. I am small or shall we say "petite" so she was able to use her arms to give my pelvis stability while I was laying on my back. By doing this, as long as I had "stability" I would raise both legs (mimicing walking) with minimal pain. When she let go the pain returned. So....what this showed us is that a lot of my pain comes from my 3 incisions ~ front, back, and hip graph all on the left side. Presumably, as my strnegth improves, my pain should decrease. But, there is no magic fix it pill, just lots of hard work for me!

    I am so stiff when I wake up in the mornings or the middle of the night, I walk hunched over for the first several steps, then I'm better.

    Hang in there! We're pulling for ya! I'm off to PT and nervous! I'm in the pool today and it usually kicks my b*#^. A grown woman scared of the pool! How's that for a afternoon laugh! Careful not to laugh too hard, it'll hurt your incision!
  • I now understand about the pelvis. Sounds like you got good PT going on. Hope my PT folks are as good. Our nights sound identical.

    I am fairly happy with the progression except for the nights. We will see how they go with more daytime rest.

    If I could look into a crystal ball and know my fusion will take and my left leg nerve issue will get to a minor inconvenience, I would feel a lot better. But, there is no crystal ball.

    Good Luck on your continued recovery and PT today.

  • I'm 3 months post-op from pretty much the same operation and I still have some discomfort after sleeping for a few hours. I find using the heating pad for 10 minutes and walking is what helps me unstiffen and get over the discomfort. I actually just started sleeping in my bed about 2 weeks ago. Was in a recliner the entire time prior to that because I just could not get comfortable in bed.

    It sounds like you're doing great for how short a time ago you had surgery. At 3 1/2 weeks it was all I could do to do my short walks each day and not be exhausted. Good luck on your recovery.
  • You are doing great! I am 4 months post-op L4-L5 anterior/posterior fusion---I still take hydrocodone when I get up in the morning.I take Benedryl to sleep---I didn't start sleeping much at night until about 3 months.I discovered our couch is more comfortable to sleep on than my bed,so that helped.Part of my problem is arthritis and osteoporosis,but I can tell you,after 2 spinal fusions,it really does take a while before you can sleep comfortable,and not be miserable in the morning.It does,however,get better every day,and then the time comes when you realize:Hey,I slept!There are no tears in my eyes because I hurt!!!!Hang in there,you are doing great-and it also helps so much to talk about it with your fellow spineys. Jeannie
  • I only sleep for an hour or so at a time, then have to turn to another position or get up for a walk.

    Actually even during the day I have to keep changing my position. Sit for a bit, walk for a bit, lie for a bit, repeat

    I look forward to the day when I can just sit for as long as I want to.
  • i have horrible nighttime pain i can nor=t sleep for more than 3 hours then pain wakes me .i have not had a fusion but i have had 2 other back surgeries and now they want to do a multi level fusion ..my only advice for you is to get an electrically adjustable be with a high quality mattress and take your pain killers and sleeping meds before you go to bed you should be able to get comfy on an electrically adjustable bed rather than a flat bad .i know that they cost a lot of money but they are worth it{A good recliner is an option too
  • I am be sleepless tonight....PT kicked my *#@*. I guess the only way to get stronger is to constantly challenge yourself, but oh my!!

    Pain meds will be needed tonight! Hope you rest well!
  • Sorry about the rough PT, hope they aren't too aggressive on you. Good luck on sleeping tonite.

    I will talk to my Dr after I meet for the initial PT consultation on the 11th and make sure they are both on the same page in regards to level of activity and where I am on the healing scale.

  • ..and as Gwennie suggested, try not to even attempt to log more than 3-4 hrs @ a crack right now. I took both AM & afternoon naps (in addition to trying to sleep @ night) for about the 1st 4 months out. Get up & move around if you are stiff...that stiffness is a killer, isn't it?!

    Your back muscles are still very weak @ 3.5 weeks out--it takes a long time to heal them. Go easy. Listen to your body--trite, but true. A busy day will reap a restless night, at your stage yet.

    At 2.5 yrs now, I still only sleep about 5 hrs b4 I need to get up & move around a little. Meds still needed to even get to sleep! Benedryl is great + a little valuim PRN for those tight back muscles that seem to tighen up more when you lie down...

    Hey, you ARE doing great! At 3.5 weeks, I was still a zombie! You are doing just fine!

    It's a long haul--you'll never be the same, but soon you'll rest better & that will help you feel stronger also. You hurt more when you're tired.

    Try lying on your left side, a small pillow under your lower back, bottom leg straight, upper leg bent @ knee w/ another small pillow under your knee. Wrap your upper arm around another pillow---! This is a good restful position, allows your whole spine to remain straight & by hanging onto the pillow w/ your upper arm, you can regulate where you want your hip weight to go. Hard to explain..give it a try..squiggle around until you feel "weightless"...

    Getting up, well, that's another topic!

    Keep us posted! Great to hear you're otherwise doing so well!


  • Thanks for the pillow tips, I will experiment.

    Yes, the nights are worse than the days unless I sit way to long in one position which I tend to do at my laptop. Then the one spot on the left rear hip hurts bad. Same place when I bend to much. It may be where most the work was done since the left side nerve was the most damaged.

    Thanks Again,

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