New Findings On Why Poor Sleep May Lead To Chronic Pain

January 27, 2023 / Thomas Cohn, MD

sleep A new study involving mice may have provided some more insights into why poor sleep and chronic pain may be linked.

According to the study, nerve injuries may cause certain brain cells to act excitedly during sleep, and this sudden excitement may lead to chronic pain onset. On a positive note, researchers say that stopping this hyperactivity during sleep could help provide significant pain relief

As we’ve talked about on the blog in the past, sleep disorders and chronic pain are closely related, but the exact nature of why certain sleep problems increase the risk of different types of chronic pain is not well understood. We’ve talked about how it can be hard to break out of the sleep-pain cycle, which theorizes that chronic pain makes it hard to fall asleep and stay asleep, and poor sleep quality can intensify pain sensations, but this recent study wanted to learn more about the exact connection between the two.

Sleep And Chronic Pain

For the study, researchers honed in on neuropathic pain, which is pain that derives from an injury or disease in the nerves that relays sensory information from the body to the brain. Researchers studied mice with injuries in one of the sciatic nerves, the large nerve that branches from the spinal cord through the hind legs. The team analyzed brain activity in the mice both before and after the sciatic nerve injury in order to see how the brain responded to this new pain. The team found that there were significant changes after the injury in the wrinkled cerebral cortex, which is the area that receives and stores sensory data from the hind legs. Moreover, certain brain cells became progressively more active in the weeks after the injury as the mice’s pain became chronic.

Perhaps most interestingly, this brain cell activity peaked during non-rapid eye movement sleep (NREM), which is when deep sleep occurs. Researchers said these neurons became hyperactive during NREM sleep as a result of an issue with the anterior nucleus basalis, a cluster of neurons located deep in the front of the brain. Researchers noted that the activity of the anterior nucleus basalis also increased after the nerve injury, and this triggered the cells to send a chemical response to the cerebral cortex. As a result of this chain reaction, the previously mentioned brain cells shifted into overdrive during NREM sleep.

This increase in brain activity was linked to an increase in pain sensitivity in mice, as researchers stated that once-painless stimuli suddenly became painful. In follow up experiments, researchers were able to relieve this pain by blocking cell hyperactivity along certain neural pathways during NREM sleep.

“Inhibition of this pathway during NREM sleep, but not wakefulness, corrects neuronal hyperactivation and alleviates pain,” the researchers concluded.

So while the study only examined mice, it does provide insights into how neural action during sleep can lead to increased pain during wake periods, and researchers are hoping that some of the findings would be similar in a human population. Future studies are sure to follow, and hopefully we continue to learn more about the connection between poor sleep and chronic pain onset.

For now, do what you can to prioritize healthy sleep if you have a chronic pain condition. Avoid caffeine late in the day, get regular exercise, go to bed around the same time each night and keep electronics out of the bedroom so that you have an ideal sleep environment. You may not be able to control what happens during NREM sleep, but you can work to break out of the sleep-pain cycle by making it easier for your body to fall asleep and stay asleep.

If you’re dealing with sleep issues as a result of your chronic pain condition, or you want help with a different pain issue, reach out to Dr. Cohn and his team today.

How Much Sleep Is Chronic Pain Costing You?

June 19, 2018 / Thomas Cohn, MD

In order to fall asleep, we usually need to have a calm physical and mental presence, and that can be very difficult to achieve if you have chronic pain. Chronic pain conditions can make it difficult for patients to not only fall asleep, but stay asleep. In order to get a better understanding of how chronic pain affects the amount of sleep we receive, we turn to two recent studies on the matter.

Chronic Pain and Sleep Deprivation

For the first study, the National Sleep Foundation wanted to see how chronic pain impacted sleep duration and sleep quality. After looking at the data, researchers found that individuals with chronic pain had an average of a 42-minute sleep deficit between the amount of sleep they need and the amount they are getting.

“The relationship between pain and sleep is complex, as the consequences of sleep problems can affect perception to pain and, in turn, pain can interfere with sleep quality,” said Professor Robert Landewe, Chairperson of the Scientific Programme Committee, EULAR. “This is why these studies are important as they help elucidate the role of sleep in chronic pain and highlight it as a potentially important modifiable risk factor for alleviating the distress in these patients.”

Researchers also wanted to see if sleep problems could predict the eventual onset of chronic pain. The four sleep factors they analyzed were:

Initiating Sleep
Maintaining Sleep
Early Morning Waking
Non-Restorative Sleep

According to researchers, all factors except early morning waking predicted the onset of chronic widespread pain at 18 years.

“Our results demonstrate that sleep problems are an important predictor for chronic pain prognosis and highlight the importance of the assessment of sleep quality in the clinics,” said Katarina Aili, PhD, of the Spenshult Research and Development Center in Sweden.

Anxiety and Chronic Pain

In the second study, researchers explored the link between chronic pain, anxiety and the inability to achieve restful sleep. When compared with a normal population, individuals with chronic pain were much more likely to report both anxiety and severe sleep problems.

“Although the relationship between sleep and pain is complex, our results clearly indicate a strong association which needs to be explored further,” said Julia S. Malmborg, PhD student at Halmstad University. “As both problems affect the physiological and psychological well-being of sufferers we hope that these results will be used by school health professionals to promote student health.”

Getting good sleep is hard enough before chronic pain gets in the way, but if you want to give yourself the best chance to fall asleep and stay asleep, consider the following tips:

Avoid caffeine within three hours of going to bed.
Avoid working out right before bed.
Make the bedroom as dark as possible.
Turn off distractions like the television or your phone.
Invest in a supportive mattress and pillow.
Keep the bedroom temperature cool.

For more tips on maintaining healthy sleep if you have chronic pain, reach out to Dr. Cohn today.

The Link Between Chronic Pain and Insomnia

April 20, 2017August 3, 2017 / Thomas Cohn, MD

The 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.