Have you noticed that your pain is worse at night after a fracture ?
You wonder if this is normal, when to worry, could it be the sign of a complication?
I can assure you of that!
Summary: It’s very common to feel more pain at night after a fracture. This is due to hormonal fluctuations, immobility or, on the contrary, involuntary movements, the cessation of effectiveness of medication and the more frequent anxiety at night.
♻️ Last update: November 3, 2025
Written by Nelly Darbois, physiotherapist and scientific editor
1- Hormones fluctuate at night: inflammation is higher
When we fall asleep, our body enters a state of recovery and regeneration. During this period, many biological functions change, including our hormone production.
This is also due to the alternation of day and night : our hormones are also regulated according to luminosity and other signals that our body perceives.
After a fracture, our body triggers an inflammatory response to help heal the injured area. This inflammatory response is an important part of the healing process, as it sends immune cells and growth factors to the fracture site to help repair damaged tissue.
Some of these hormonal changes can influence inflammation in our bodies.
In particular :
- the production of certain anti-inflammatory hormones, such as cortisol, naturally decreases at night,
- the production of certain pro-inflammatory cytokines may increase. These amplify the inflammatory response in the body.
This can lead to increased pain and discomfort associated with the fracture. Particularly in the second half of the night.
2- You can move the injured limb unintentionally
Another cause of pain at night after a fracture is involuntary movement of the injured limb during sleep.
When we sleep, our bodies go through various sleep phases, including involuntary movements and changes of position.
If you have a fracture, you may unconsciously move the injured limb during the night, which can increase your pain. For example, by changing position, or turning to one side.
🟢 Rest assured though : in the 12+ years since I obtained my DE in physio, I’ve NEVER been in contact with someone who’d aggravated their fracture while asleep.
Even if you make a “bad move”, it doesn’t last long. The increase in pain is transient, and you’re not going to “break everything” by moving in your sleep if you have surgical material, nor aggravate the fracture site.
💡 You can call yourself with cushions under your limbs or behind your back to find more comfortable positions.
3- Immobility can increase pain
When you have a fracture, it’s often advisable to limit movement of the injured limb to promote healing. But there’s a fine balance to be struck , because prolonged immobilization isn’t good either!
1️⃣ Prolonged immobility can lead to stagnation of blood flow in the fracture area.
There may be an accumulation of fluids, toxins and other inflammatory substances around the injured area. This can lead to increased pain.
2️⃣ Lack of movement can lead to stiff joints and muscles.
This can aggravate pain and make it more difficult to move the limb when it’s called upon, especially at night when we change position while sleeping.
💡 Some people relieve their pain by going for a few steps or stretching at night.
4- Pain medication may stop working during the night
Your doctor or surgeon has probably prescribed medication to relieve your pain in the weeks following the fracture: paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) or even opioids.
Most of these drugs take effect only a few hours after administration.
If you take pain medication just before going to bed, it often stops working in the middle or at the end of the night.
💡You may want to think about the timing of your pain medication in relation to your difficulty sleeping. You might decide to take less during the day and more at night (respecting the prescribed doses, of course).
5- We are often more anxious at night
During the day, your activities and social interactions can act as distractions, reducing your sensitivity to pain.
However, at night, when you’re at rest and alone with your thoughts, you’re more likely to notice the pain more pronounced or have negative thoughts and fears about recovery and the future, which can amplify your anxiety.
In addition, certain hormones, such as serotonin and dopamine, which regulate mood and provide a sense of well-being, may be less active at night. This can lead to increased anxiety and a heightened perception of pain.
💡 More than 1,000 people who had suffered a fracture of the humerus, radius, tibial plateau or ankle were asked about their sleep in the months following their fracture [Shulman 2015].
- 2 to 4 out of 10 people, depending on the type of fracture, described sleep disorders in the 3 months following the fracture;
- less than 2 out of 10 people still had sleep problems 1 year after the fracture;
- people who described themselves as the most anxious were those who had the most trouble sleeping. More so than those who described having more physical after-effects from their fracture.
📝 What to remember: whatever you do, the pain will fade over months and weeks. Settling in better, adjusting your medication and applying cold to the injured area can help relieve pain at night.
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That’s all I wanted to say on the subject! Any questions or comments? See you in comments!
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📚 SOURCES
Lu K, Barron JO, Israel H, Cannada LK. Sleep disturbances in orthopaedic trauma patients. OTA Int. 2019 Jul 9;2(4):e040. doi: 10.1097/OI9.0000000000000040. Erratum in: OTA Int. 2019 Dec 27;2(4):e063. PMID: 33937668; PMCID: PMC7997085.
Swanson C. Sleep Disruption and Bone Health. Curr Osteoporos Rep. 2022 Jun;20(3):202-212. doi: 10.1007/s11914-022-00733-y. Epub 2022 Apr 30. PMID: 35488985; PMCID: PMC10108658.
Shulman BS, Liporace FA, Davidovitch RI, Karia R, Egol KA. Sleep disturbance after fracture is related to emotional well-being rather than functional result. J Orthop Trauma. 2015 Mar;29(3):e146-50. doi: 10.1097/BOT.0000000000000217. PMID: 25072285.
Written by Nelly Darbois
I enjoy writing articles that answer your questions, drawing on my experience as a physiotherapist and scientific writer, as well as extensive research in international scientific literature.
I live in the French Alps☀️🏔️, where I enjoy the simple pleasures of life (+ I’m a Wikipedia consultant and the founder of Wikiconsult).
