The presentation which you describe sure sounds like gout. Since gout is caused by an overconcentration of uric acid in the blood, your doctor will probably want to do a blood test for uric acid. But testing serum uric acid, which can be highly variable, at a time other than just before the attack begins has little meaning. The definitive test for gout is to examine some fluid removed from the affected joint under a polarizing microscope. But most doctors who are not rheumatologists are not able to perform that test. So meaningless blood test it will be.

Have you thought about why that pain would develop while you were asleep? The answer is that you probably had stopped breathing frequently in your sleep for many seconds at a time without realizing it. The resulting lack of oxygen in your body leads to perfect storm conditions for a gout attack to occur.

The cessation of breathing during sleep is called sleep apnea. In an ironic sense you had the good fortune to suffer a gout attack because it has alerted you to the very high likelihood that sleep apnea was the cause. Now you can pursue the right physicians to allow you to overcome your sleep apnea before it leads to much more serious life-threatening diseases. Not only will overcoming your sleep apnea greatly reduce your risk for developing these more serious diseases (eg. heart disease, high blood pressure, diabetes, kidney disease, cancer, to name a few), it will also prevent future gout attacks.

interesting...i didn't know that sleep apnea and gout were related. i never like using my cpap machine sometimes i am afraid of putting that mask on me. i also suffer from anxiety.

But to the point...i suffered from a knee injury and was told to elevate my knees and rest. the next morning i had a pain in my left toe and realize it was gout. i took my colchicine but was wondering why the heck i got a gout attack now. because i havent had an attack for months. i have been trying to lose weight but i will resolve to use my cpap machine.

A week ago pain in my left big toe woke me up at around 3:00 AM. I'm no stranger to chronic nerve pain; got a SCS three years ago for arm & hand RSD (ahhhhhh, finally relief...).

I also sleep with CPAP. I didn't know of the connection there, but it makes sense. I'm using Lidoderm patches on my foot, as well as Alieve, 2 tabs twice a day per my doc's recommendation. I almost didn't want to go to bed, knowing that the pain in my toe would get really bad and wake me up, with nothing to really relieve it.

But thankfully, it is feeling better (whew!). I so hope that I'm the one-in-a-million that has one flare and then never has another one. Don't we all wish that?

Do you think I should keep taking Alieve, or just wait and see if I have another flare?

I am a doctor of bioengineering and have had moderate gout pain for decades, but in May of 2012 it hit in full force with many excruciating gout attacks until January 2016, when I realized how to prevent them. It has been over a year since January 2016, and I have had many possible episodes, which I stopped before they progressed to a full-blown gout attack

Most of what you hear about gout is that uric acid crystals cause it from purines in foods. The fact is, if you have gout attacks it’s too late, there is little you can do about it with diet. I did a 450-day study testing the correlation between daily purine intake, blood uric acid levels, and level of pain. Each test lasted from 10 to 20 days having the exact same diet every day during the test. I ingested from 10 purines/day to 800, taking anywhere from two to eight uric acid blood samples/day and cataloging the purines vs. uric acid level vs. pain. Over those 450 days, the gout pain went from 0 to 10, lasting from five to 30 days. Bottom line, yes, there was a direct correlation between my purine intake and uric acid blood levels, but no correlation between the uric acid levels and a gout attack. I also did a 15-month test of Allopurinol; the first three months it lowered my uric acid level, but after that it went back up.

Realizing that diet had no effect on gout, I took another route—trigger point therapy. Being interested in alternative therapies to disease (since I organized the American Holistic Dental Association in 1980) I found trigger point therapy useful for relieving shoulder and back pain—so I thought that maybe it would help with gout pain. By the way, gout pain IS bone joint pain that can occur in any joint in the body, but usually in the lower legs and feet. But before getting into resolving your gout, you need to know what causes it—the series of events that lead to a full-blown gout attack.

A gout attack takes days for that minor pain to elevate to excruciating pain, inflammation and swelling. An attack starts out with a little pain or numbness, say in the big toe. Then that pain increases, causing the immune system to send blood and fluids to the area, causing swelling and tophi, the deposit of crystalline uric acid and other substances at the surface of joints, causing greater swelling, redness and increasing pain. You can use drugs and ice baths or removal of the tophi from the joint, but the best way to relieve that slight pain or numbness before it escalated into a gout attack using trigger point therapy.

Due to your daily habits you fatigue certain muscles that develop trigger points. When a muscle’s sarcomeres are shortened, but do not relax back to their normal longer state, a trigger point is created. This shortened muscle pulls on it's ligaments, pulling the bone joint it is attached to out of position and bone on bone pain. In order to get that joint back into a normal state, the trigger point needs to be erased. This is done by applying pressure on the shortened sarcomeres. This pressure, which crushes the sarcomeres back to their natural length, can be as painful as the gout itself. Fortunately, if you can get make it through that pain for about 10-20 seconds, the gout pain will eventually be eliminated, but it will take numerous 10-20 seconds sessions to do it over days or weeks. But once the initial trigger point is erased, erasing it in the future is much less painful and relieved in minutes, if not seconds. But, you have to be aware that a trigger point is re-developing, by being aware of the pain developing in the joint that muscle is attached to. If you wait too long, the more painful it will be to erase it. Trigger point therapy has been around for many decades, but the best reference I have found is The Trigger Point Therapy Workbook third edition that you can get at Amazon or most bookstores. What also helps is riding a stationary bicycle for 5-10 miles a day to strengthen the leg muscles to avoid fatigue and trigger points.