When an anginal pain occurs at rest, it is labelled as ‘unstable angina’. ‘Unstable angina’ is now classified as ‘acute coronary syndrome’, where sudden death can occur, if the case is not handled properly.

Talking about rest pains, it reminds me of ‘resting joint pains’. Remember that joint pain is a very common symptom in private practice. Rheumatoid arthritis, which is a lifelong disease is an extremely common cause of polyarthritis. The distribution of the joint pains, early morning stiffness, etc. also help to diagnose rheumatoid arthritis. Besides, the presence of “resting” pains at night is of additional diagnostic help.

Backache is a very common complaint. If you see a young or middle aged patient complaining of backache at night, which interferes with sleep, you are most likely missing a disease like TB of spine or any other organic disease. Similarly, if an elderly patient complains of severe backache in the middle of the night, you may be missing a cancerous deposit in the spine. To diagnose, X-rays may not be sufficient. Imaging like CT scan or even FDG Pet scan may be required; or else the cause of pain can be due to collapse facture of the vertebra due to senile osteoporosis.

In a young patient having joint pains, complaining of backache, more at night, spondyloarthropathy is the likely diagnosis.
Osteoarthritis is extremely common in elderly population. Who should be advised knee replacement? Once the resting pain interferes with sleep, it is time to start motivating the patient.

Hyperacidity is a very common complaint in normal population. If an elderly patient complains of burning after going to sleep, chances are that he has a hiatus hernia or a severely lax hiatus or transient lower oesophagus sphincter relaxation (TLOSR).