The Link Between Chronic Pain and Insomnia

chronic pain insomniaThe following guest article was written by Katrina Rice.

Anyone who suffers from chronic pain from health issues like rheumatoid arthritis or osteoarthritis knows the drastic effects it has on their way of living – whether it be restricted mobility, increased medical expenses or reduced social life, accomplishing tasks seem to become quite unbearable every single day. And at night, sleep is disrupted due to the aching hips, back, knees and legs.

According to medical experts, arthritis sufferers are highly likely to suffer from insomnia as well. But recent studies show that restless nights and arthritis symptoms are a “two-way street” problem. Chronic pain can lead to a lack of sleep, and sleep deprivation can make chronic pain worse.

Doctors have recently become more focused on treating insomnia to improve the health conditions of patients suffering from chronic pain. One important note to remember is pain and insomnia work in a cycle. According to Professor Alan Silman, a medical director of Arthritis Research UK, “Pain induces insomnia and insomnia induces pain”.

Arthritis and Insomnia

Osteoarthritis is the wear and tear or degradation of bone tissues whereas rheumatoid arthritis is when the immune system attacks the joints. Much of the pain patients feel is due to the inflammatory responses of their body whenever it travels to their joints. It is fully understood by experts that disrupted sleep does increase the number of inflammatory markers and further aggravates the joints.

Inflammatory compounds in the body play a vital role in sleep disturbance. This disturbance will then alter the natural cycle of hormones in the body and affect the underlying levels of inflammation. Other cytokines (pro-inflammatory messengers) may also be involved in this activity. While insomnia releases more damaging inflammatory chemicals in the body, it also means the body misses out on the opportunity to heal when sleeping. After all, sleep is the longest time when the body is at rest and has low inflammation levels. So it is really the best time for the damaged cells to heal.

Effects Of Sleep Deprivation On Chronic Pain

The most notable effect of sleep loss in chronic pain is the low production of growth hormones. The growth hormone is vital in many body processes including cell development, weight regulation of the body and tissue repair, as well as replacement of collagen and bone cells. Though the growth hormone is released in the body at any time of the day, the biggest bursts come from the moment our bodies fall into deep sleep. But if deep sleep is not achieved, the body may not produce enough growth hormones. Furthermore, lack of sleep makes patient irritable and weary – this makes them even more sensitive to pain.

There are a number of treatments and alternative remedies that can be used to help ease the pain, but NSAIDs are usually prescribed for those who experience severe pain. Other forms of treatment come in natural supplements like glucosamine, chondroitin and curcumin supplements.  Patients with osteoarthritis usually choose glucosamine, but curcumin pills are also becoming more popular among arthritis patients. As for side effects, you can easily search reviews and testimonials in Google.

The bottomline is that chronic pain sufferers are stuck in a vicious cycle and they need to get out of it. In order to help them increase their pain threshold and reduce chronic inflammation, getting enough rest is a must. Here are six tips to use to help achieve a good night’s sleep.

  • Avoid taking afternoon naps. No matter how much you want to rest, it only gives you more energy in the evening. Keep yourself occupied when you start feeling sleepy in the afternoon.
  • Use lamps with warm light instead of ceiling lights. Warm lights have a soothing effect and can help you feel calmer and sleepier.
  • Avoid coffee, tea or any caffeinated products after 3:00 p.m., and never drink alcohol after 9:00 p.m.
  • Keep your waking and bed time consistent every day. This helps your biological clock get used to the routine and will eventually follow that pattern on its own.
  • Eliminate midnight snacking.
  • Do not gain weight, and instead, try to lose more pounds. Excess body fat can put more pressure on your joints. Gaining more weight means your fat cells will expand and your body will eventually start producing more cytokines – a fuel for inflammation.

Katrina Rice is a mom and a freelance writer. She strongly believes in the concept of holistic wellness through healthy and natural living, traveling and immersing one’s self in new activities. A self-proclaimed health enthusiast, she hopes to inspire more people to turn to natural treatments in addressing health issues.

Opioid Dependency and Prescription Length

opioid dependencyA new study conducted by the University of Arkansas on opioid use has been recently published by the Centers for Disease Control. It is somewhat of a curious study since it was based on record analysis of prescription records for opioids. The results will likely be twisted by the press soon to announce how bad these drugs are and how addictive they can be.

The question the study sought to answer was – “If a patient gets a certain amount of drug prescribed on a first visit, will they still be taking that drug a year later?” The numbers are somewhat surprising, but in reality it does not really say anything about opioids, addiction or pain. All it really says is that for some people there may be limited options to treat pain, and maybe it is very effective for some people.

Continued Opioid Use

The patients studied were all 18 and over, cancer free, studied June 2006 through September 2015 and did not have a history of opioid abuse. Here’s a look at the results:

  • A person who received 1-day supply of medication had a 6% chance of being on opioids for a year or longer.
  • With a 5-day supply, they had a 10% chance of being on opioids in a year.
  • With a 10-day supply the odds go to a 20% that they will be still using opioids in a year.
  • A 30-day supply had about 30% chance of being on the medications a year later.

So if you start on opioids, and have it for over 10 days, 1 in 5 of those people may still be on those medications. However, it also means that 80 percent will not still be on those drugs.

Interpreting The Results

Several messages can be inferred from this data. First, acute pain should be treated with the least amount of medication for the shortest length of time. If at all possible, avoid the use of opioids for acute pain and find other less addictive and dependency causing medications. Second, many people do not use these medications long-term and can use them responsibly. Lastly, pain is very complex, and since some medications are highly addictive, try to avoid them and use the multiple other ways to treat pain including everything from chiropractors, to physical therapy, to exercise, and to injections.

The study also may be an analysis of the treatments available for severe pain. Some of the most effective treatments sometimes are the least healthy and can cause dependency. Opioids have been around for hundreds of years. Our knowledge of pain is limited, as are the solutions. Since it is such a huge medical problem, we really need to spend more on research and solutions. We know there is an opioid crisis with addiction. We need research solutions and new treatments. Now is the time to spend on research, as it may provide better solutions for more people than some of the recent government spending recommendations.

Why Chronic Pain Patients Feel Targeted By Opioid Crackdowns

pain pill overdoseAs opioid overdoses continue to rise in the US, the government, lawmakers and medical personnel are all trying to figure out the best way to reduce these unnecessary deaths. Obviously restricting access to opioids would reduce the number of people who can get their hands on them, and in turn reduce overdose deaths, but it would also unfairly target people who need the pills. People like those suffering from chronic pain. So it’s understandable to see why when lawmakers propose strict rules for who can access these medications that chronic pain sufferers feel like they are being targeted and singled out.

It’s a tough balance to strike, and unfortunately it seems that as a nation we are more focused on what is easy and cheap instead of what will really address the root problem. Putting a band-aid over a large gash might stop some bleeding, but the wound won’t close correctly without stitches. Simply restricting access opioids and painkillers might stop some abusers from getting the pills, but it won’t solve the whole problem. We need to put some stitches in place.

Solving The Opioid Crisis

We’re not going to sit here and pretend we have all the answers for solving the problem of opioid addiction and overdose, but like we said above, simply restricting access is not going to solve the problem, and many innocent people who rely on those medications may no longer be able to access them. Instead, here are some steps that will help address the root problem.

1. Doctor Education – The vast majority of doctors understand that opioids do not address the root problem, but sometimes they are confused by a diagnosis or have seen other treatments fail and they fall back on them. Other doctors cut corners and prescribe pills freely and dangerously. We need to provide better understanding at the top level of how these drugs should be used, how to spot signs of abuse and how to ensure patients are safely taking their medications so that overdoses don’t occur.

2. Systemic Pressure – This problem will be harder to solve, but in many cases doctors are told to see as many patients as possible. If a doctor is feeling overwhelmed or rushed to see a number of patients, they can sometimes fall back on easy solutions like opioids. Doctors need to take their time with each and every patient and ensure they are giving them the best care possible. It’s possible the best care will involve opioids, but it should also involve therapy, exercise and regular abuse checks.

3. Patient Education – Patients also lack understanding of opioids and their abuse potential. Opioids are not a magic pill that will cure your pain, but they can provide temporary relief so other rehab techniques like exercise, swimming or physical therapy are more bearable. Opioids are a passive treatment, and they need to be paired with an active treatment option for best results. Patients also need to learn the warning signs of abuse for themselves and for loved ones who may have access to their pills.

4. Pill Technology – Medical researchers are looking into new abuse-deterrent opioids. They are creating pills that can’t be crushed or that become gooey if a user tries to extract the solution for injection. Other pills come in an extended release form and can’t be manipulated to give an elevated or intense high. More research into abuse deterrent options could prove useful.

Simply saying we need to restrict access to opioids will not solve the problem, and many chronic pain sufferers will be affected instead of those who are actually abusing the pills. That’s why so many patients feel targeted by these proposals. It won’t be easy to reverse this trend, but if we put in the time and money, it can be done.

Shared Reading Helpful For Chronic Pain Patients

Shared Reading Chronic PainNew research suggests that shared reading may help ease discomfort and provide cognitive benefits for individuals battling chronic pain.

Shared reading, as the researchers defined, was the act of of gathering with others and reading short stories, poetry or other literature out loud. Researchers said by reading literature that triggers memories of experiences throughout life, like happy childhood memories or relationships, patients can experience benefits similar to or that outweigh the effectiveness of cognitive behavioral therapy for chronic pain.

Shared Reading And Chronic Pain

There are hundreds of different treatment options for chronic pain, because chronic pain is unique to the individual. Some people experience pulsing pain in their lower back, others battle waves and waves of headaches, while others have nerve damage that sends pain signals to the brain when their is no painful stimulus present. What works for one person will not always work for another, and unfortunately that’s the problem that many pain sufferers are running in to. In turn, they are looking into alternative options, one of which is shared reading.

For their study, researchers compared the benefits of shared reading to cognitive behavioral therapy, which is a technique that aims to change the way people think and behave in order to better manage physical and mental issues related to chronic pain. To do this, patients with severe chronic pain were asked to participate in either five weeks of CBT or 22 weeks of shared reading. At the conclusion of the five weeks of CBT, individuals in that group joined the shared reading group for the remainder of the 22 weeks. The shared reading sessions incorporated literature that was designed to prompt memories of family, relationship, work experiences or other happy memories throughout their lifetime. Participants were required to report their pain severity and emotions before and after each session, and they were asked to record their pain and emotions twice a day in a personal journal.

Study Results

At the end of the study, researchers wrote:

  • While CBT helped to manage a person’s emotions, shared reading appeared to help patients address the painful emotions that might be contributing to chronic pain.
  • Pain severity and mood improved for up to two days after shared reading sessions.

“Our study indicated that shared reading could potentially be an alternative to CBT in bringing into conscious awareness areas of emotional pain otherwise passively suffered by chronic pain patients,” researchers wrote. “The encouragement of greater confrontation and tolerance of emotional difficulty that sharing reading provides makes it valuable as a longer-term follow-up or adjunct to CBT’s concentration on short-term management of emotion.”

Researchers want to conduct future studies with larger sample sizes, but it’s an interesting approach to treating chronic pain. We’ll certainly keep tabs on shared reading as a potential treatment option.

Would Mandatory Opioid Registry Checks Solve Painkiller Abuse?

Mandatory Opioid ChecksThe Minnesota legislature has a proposed law to make checking the Minnesota Prescription Monitoring Program database (PMP) mandatory prior to prescribing any opioid medication. The purpose of the law is to help identify people abusing medications and to prevent the explosion of overdose-related deaths.

Unfortunately, this is another oversimplification of the opioid problem in our country. Abuse of opioids is a very real problem. The solution is much more complex then checking a database for the number of prescriptions being taken. Mandating this step will only have a very minor effect on the problem of opioid abuse.

Opioids Abuse And The Database

Opioid abuse is a very complex problem. There are many people who have very difficult to treat pain problems that are dependent on these medications, and they take them on a very reliable basis without abuse. Currently, most pain physicians, including my practice, have a variety of steps they take to reduce the potential for abuse. One of the easiest is to look at the PMP database. We sometimes find abnormalities of behavior there, but it is not that common. Most often we find the patient is using both an opioid and a drug for anxiety that can cause a significant interaction. Then we need to advise a patient on these issues.

Other steps taken include a comprehensive medical exam for appropriate problems to be treated and finding alternative treatment plans. Believe it or not, the worst problem is obtaining insurance company approval for more expensive options with better outcomes and less risks to the patient. Other steps taken include drug testing, checking state criminal databases and evaluating psychological stability before prescribing. For those wondering, our practice does check the PMP for everyone for each refill.

Mandatory Checks?

Mandatory checking of the PMP does not significantly help solve the opioid abuse problem. It is only a feel good step for politicians to say they are doing something. The problem runs much deeper. First off, a lot of people who are abusing opioids should probably never have been placed on the medication. The next step is that they should not be on them for any length of time – they may be okay for a very acute problem – but then they need to be stopped. Addiction is a medical condition. It is tough to treat and programs to help with addiction need funding and staff, and this needs to be promoted.

If the legislature wants to have a positive role in the addiction crisis, then they should be mandating insurance coverage for alternative treatments for pain besides opioids. Alternative treatments include everything from prolonged physical therapy, massage, chiropractic, and different medications, to comprehensive pain programs and implantable pain control devices. Obtaining insurance approval, especially from Medicaid or Medicare, is time consuming and often almost impossible. Physicians are extremely frustrated by the obstacles put up by insurance companies when better and cheaper alternatives are routinely denied in managing pain.

The last difficulty in understanding pain and the opioid crisis goes beyond the problems of addiction. Pain is extremely complex and one of the main tools to control symptoms is opioid medication. This is the same tool we have used for over 150 years. A third of the world population struggles with pain problems. Virtually no dedicated funding goes to research on pain compared to other medical problems. Our knowledge level in regards to pain as a disease is at the level where cancer was in about 1950. If the world wants to tackle the problem of opioid abuse, it really needs to fund research on all aspects of pain to solve the issues suffered by a third of the world population.