Sleep and its complicated relationship with pain.

If you have chronic pain, have you ever noticed your pain is worse when you don’t sleep well? Is the pain causing the poor sleep or could poor sleep be contributing to increase in pain? It is similar to the age-old question, which came first, the chicken or the egg? Which came first, problems with sleep or pain?

Research has shown both scenarios are factual. Although it is intuitive for us to understand how pain can reduce sleep, it is often difficult to fully understand how poor sleep can lead to pain.

There have been many studies that show poor sleep as the driver of chronic pain. Poor quantity and or quality of sleep on a regular basis leads to inadequate brain rest and thus hypersensitivity of nerve endings leading to increase in pain experienced by the individual. There have been numerous studies looking at sleep deprivation and hyperalgesia (increased sensitivity to painful stimuli) pointing to lower threshold for pain in those study participants who were sleep deprived.

One of the most common chronic pain conditions worldwide is fibromyalgia, a chronic widespread musculoskeletal pain syndrome associated with fatigue and poor sleep. In the United States, fibromyalgia affects 1 in 10 people and is the most common diagnosis in rheumatology clinics. Fibromyalgia is diagnosed after other underlying causes for pain including autoimmune disorders are ruled out. Fibromyalgia is widespread pain caused by a hypersensitivity of nerve endings between the muscle and fat layers.

Fibromyalgia is now thought to be a disorder of the central nervous system leading to pain. Sleep dysfunction has been directly correlated with development of fibromyalgia. Due to this relationship, exploration of ways to improve quantity and quality of sleep is essential in treatment of fibromyalgia as well as any chronic pain condition. Sleep apnea is a very common sleep disorder that should be investigated in all patients with chronic pain who may have otherwise unexplained reasons for poor sleep. Sleep apnea is diagnosed by a sleep study which can also in turn diagnose other sleep disorders including but not limited to restless leg syndrome and periodic limb movement disorder.

As we learn more about the relationship between sleep and pain, it is important for those who experience chronic pain and their treating providers to focus on exploring underlying obstacles to restorative sleep as well as finding remedies to help re-establish quality and quantity of sleep.

References:

2020 LAWSON, Kim (2020). Sleep Dysfunction in Fibromyalgia and Therapeutic Approach Options. OBM Neurobiology, 4 (1), p. 16.

2019 Clin J Pain. 2019 Jun; 35(6): 544–558. Sleep and Pain: A Systematic Review of Studies of Mediation. Daniel Whibley 1 2 3 4, Nourah AlKandari 1, Kaja Kristensen 1 5, Max Barnish 6, Magdalena Rzewuska 7, Katie L Druce 8, Nicole K Y Tang 9

2018 Afolalu EF, Ramlee F, Tang NKY. Effects of sleep changes on pain-related health outcomes in the general population: a systematic review of longitudinal studies with exploratory meta-analysis. Sleep Med Rev. 2018;39:82–97.

2015 Fibromyalgia has central nervous system origins May 17, 2015 American Pain Societyhttps://www.sciencedaily.com/releases/2015/05/150517071813.htm

2013 Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14:1539–52.