So sleep is devastatingly important. We all know this but unfortunately we don’t always value it. I know atleast for me I tend to put my career in front of sleep frequently and am probably paying the price in the long run.
After recently reading Matt Walker’s “Why We Sleep” (which you should definitely read) it became abundantly important how important sleep is for health. Matt talks a lot about sleep’s role in:
- Memory and Learning
- Prevention of Alzheimer’s Disease
- Logical Decision Making and Emotional Regulation
- Immune System Health
- Regulating Appetite and Metabolism
As a physical therapist it got me thinking about sleep and pain. Some of my favorite chronic pain mentors (like Adriaan Louw) have always mentioned that sleep is a game changer for rehabilitation of patients in chronic pain. Recently at the APTA orthopedic conference one of the speakers and prominent pain researchers Kathleen Slutka also mentioned just how closely linked the neurophysiology of pain and sleep are. I’ve always wanted to delve a bit more into the medical literature and see if we have some more evidence to support the importance of sleep in individuals with pain.
After a brief stint on pubmed.com I stumbled upon this gem of an article “The association of sleep and pain: An update and a path forward” The article was a literature update (Just what I wanted) that brought together some great information about sleep and pain. Turns out we have quite a bit of research to help us understand the link between sleep and pain. I’d recommend reading the study yourself (click the link above) but here are some extremely interesting tidbits from reading:
- Patients with episodic tension headaches were more likely to go on to develop chronic tension headaches (12 years later) if insomnia was present.
- Norwegians with frequent sleep problems were more likely to develop fibromyalgia 10 years later.
- A headache free population in Britain went onto develop new incidence of headache if they had baseline insomnia (at 1 year follow up). In the same study, individuals with headache were more likely to remit at 1 year if insomnia symptoms were absent at baseline
- 1 population-based study found that insomnia symptoms at baseline significantly increased the risk of developing chronic musculoskeletal pain (both widespread and regional) at 17-year follow-up
- Quality sleep has also been shown to predict chronic widespread pain symptom resolution over 15 months
- Recent micro-longitudinal studies have shown sleep disruption to linearly predict next-day pain reports in patients with depression and older adults.
- Sleep disruption also predicts next day responses to pain in rheumatoid arthritis and fibromyalgia patients (less sleep = more pain)
So, does lack of sleep predict who goes on to get pain or does pain predict who goes on to get a lack of sleep?
A large cross-sectional cohort study of cancer patients utilized structural equation modeling to suggest directionality in the sleep/pain association. In a series of analyses involving associations between depression, fatigue, sleep, and pain, the best fitting structural equation model included a path in which sleep predicted pain; inclusion of the reverse path—pain predicting sleep—produced a poorer fitting model that was dropped from final analyses.
In other words (and atleast for these patients) poor sleep predicted who acquired pain. This correlation was stronger then pain being a predictor of those who go on to have poor sleep.
So we have quite a bit of good information there. It seems that:
- Sleep disturbance increases the risk for new-onset cases of chronic pain in pain free individuals
- Sleep disturbance worsens the long-term prognosis of existing headache and chronic musculoskeletal pain
- Sleep disturbance influences daily fluctuations in clinical pain (worsens)
- Good sleep appears to improve the long-term prognosis of individuals with tension-type headache, migraine, and chronic musculoskeletal pain.
Wow, after reading this article it really solidified the importance of sleep for my patients. I might also recommend them to use vape cartridge with CBD before sleeping so their minds and bodies will be at ease because it lowers stress levels. I’ve asked patients about sleep in the past but this reinforces it to another level. I should probably be asking about sleep more often! Do you talk to your painful patients about sleep and pain? If so, how do you integrate sleep hygiene into your rehabilitation or coaching practice?
Currently asleep,
Dan Pope DPT, OCS, CSCS