The relationship between sleep and pain

Questioning patients about how they sleep is common in physiotherapy practice. We are not only interested in the position you sleep in but also for how long and if your quality of sleep is good. For patients who are suffering with chronic pain this is even more important as we commonly see patterns of poor sleep with chronic pain sufferers.

Pain is a physical and emotional signal of bodily harm that strongly motivates behaviour. Sleep is a behaviourally regulated drive that broadly serves to maintain homeostasis and optimise our function. Humans require both pain and sleep for survival; however, chronic impairments in the systems regulating pain and sleep can have a broad negative impact on health and well-being. Sleep complaints are present in 67-88% of chronic pain disorders and at least 50% of individuals with insomnia suffer from chronic pain. Across most medical interventions, the development of pain as a side effect coincides with the development of sleep disturbance. Further, both chronic pain and sleep disturbances share an array of physical and mental health comorbidities, such as obesity, type 2 diabetes and depression.

While researching the relationship between sleep and pain I came across a literature update titled: “The association of sleep and pain: An update and a path forward”. It’s a great article that helps bring together some information about sleep and pain.  This is just one of many articles that show there is an abundance of research evidence supporting the notion that sleep does predict who is going to develop pain and that chronic lack of sleep can equal chronic pain.

Some interesting findings from this literature update include:

• Patients with episodic tension headaches were more likely to go on to develop chronic tension headaches (12 years later) if insomnia was present.
• A Norwegian sample of people 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 headaches 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 what can we learn from these statistics and findings? For me the biggest takeaway here is that you need to prioritize sleep. This can be very hard for some due to children and work commitments however if you are suffering from chronic pain, getting the right balance of sleep will make a huge difference to your long-term recovery! In today’s society we often talk about our lack of sleep like a claim to fame – we’re encouraged to work harder, spread ourselves thinner and not needing 8 hours of sleep a night is praised. This isn’t healthy in any way and finding more balance in your life between rest and play is vital. This is of even more importance if you are suffering from pain and have been in this pain state for quite a while. There is ample evidence that living like this will not serve you – so something has to change. Goodnight!