Sleep deprivation and chronic pain - chicken and egg?

Pain ruins sleep. No childhood is complete without an episode of earache and a tearful, midnight trip to your parents’ bedroom. So it isn’t surprising that persistent or "chronic" pain can interfere with normal sleep. So far - so obvious. 

Sadly, growing up doesn't seem to help much. Middle-age brings a basket of woe. A reduction in the hormone melatonin, an accumulation of work and life stress, bodily wear and tear, aches and pains all conspire to rob us of the refreshing powers of adequate sleep.

But could it be worse than we thought? Could insomnia in turn exacerbate the perception of chronic pain? Are we witnessing a “vicious circle” here? Chicken and egg? The acknowledged authority is Professor Stefan Lautenbacher, from Bamberg, Germany.

Pain research may take many forms. Experimental data in animal models are plentiful. Clinical observational studies can be helpful but the absence of a "control group" is a problem. Medical students often willing to volunteer for research purposes - so human studies have shone more light on this phenomenon. However, ethics committees are loathed to sanction experiments involving prolonged sleep deprivation. So there are limitations.

Lautenbacher reviewed all the literature and published his findings in Sleep Medicine Reviews (2006). His conclusions were clear. Poor sleep causes an increased perception of subsequent pain. This appeared to be particularly so for fibromyalgia sufferers.

Edwards confirmed the same phenomenon in burns patients. He published his paper, “Duration of sleep contributes to next-day pain” in the prestigious journal, Pain (2008).

The evidence is beginning to point in one direction. Effective chronic pain relief is undermined when sleep quality and duration are inadequate. The simplest, quickest thing we can do to maximise comfort is to address poor sleep quality.

"Sleeping tablets" might seem an obvious answer. However, all drugs carry the potential for side effects and interactions (e.g. with alcohol or other sedative agents). Moreover, tolerance gradually builds and addiction and withdrawal phenomena are potential issues. Next day "hangover" is a real problem for some.  

Hypnotherapy can really help. Learned techniques for anxiety reduction predictably transform sleep quality. Audio recordings are particularly effective in this regard - the patient can listen in bed and be confident of improved sleep. Optimism and expectation flourish. Pain related behaviours and beliefs begin to fade. Life returns!

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