Researchers Find Improved Sleep Helps With Treatment of Chronic Pain

A study conducted at the University of Warwick is revealing that among other positive impacts of improved sleep, when chronic pain patients are provided with tools that improve the quality and quantity of their sleep, it has a dual benefit on their wellbeing.

Not only does the extra time spent sleeping help patients physically, it also has the added benefit of enabling them to be more physically active the next day, thus creating a positive cycle of increased activity followed by high quality sleep. Though this may make sense for those living without pain, the relationship between sleep, activity and pain is a little less clear when it comes to those suffering from chronic pain, but the study’s lead author Nicole Tang, Ph.D. of the University of Warwick explains.

“Engaging in physical activity is a key treatment process in pain management. Very often, clinicians would prescribe exercise classes, physiotherapy, walking, and cycling programs as part of the treatment, but who would like to engage in these activities when they feel like a zombie?”

So in other words, the fact that the pain patients had gotten a good night’s sleep enabled them to have the energy that they needed to get through exercise classes, thus enabling them to exert enough energy that it made them tired and get another good night’s sleep. This served the patients in two different ways. First, there is a significant amount of research pointing to the idea that improved levels of sleep can decrease a patient’s experience of pain, and that inadequate sleep actual lowers a chronic pain patient’s threshold for pain and increases their sensitivity. Second, one of the biggest health problems that face chronic pain patients is their inability or unwillingness to get the exercise or physical activity that they need when they are in pain. Getting enough sleep and having good energy reserves makes pain patients more willing to engage.

Pain is a hidden problem in American society. Among adults, there are reportedly 15% who experience chronic pain, and as we age that number increases to over 50%. Looking at that number and then asking sufferers about their ability to sleep, and scientists have found that roughly two thirds of those who suffer from chronic pain report unrefreshing sleep at best, poor sleep at worst. Far too many turn to pain medications and sleeping aids as a result, so finding novel answers to chronic pain is essential.

The most common causes of pain that interrupts sleep are back pain, headaches, and jaw pain from temporomandibular joint syndrome. Arthritis is also a major contributor, and finally pain that results from primary illnesses such as cancer is also prevalent.

Tang published her study in PLoS One, an online medical journal. She collaborated with co-author Adam Sanborn, Ph.D., in researching the every day association between the amount of sleep that their patients got and the amount of physical exertion that those same patients were willing to invest during the day.

“Many of the patients struggled to stay physically active after the onset of pain and we found that chronic pain patients spontaneously engaged in more physical activity following a better night of sleep. The research points to sleep as not only an answer to pain-related insomnia but also as a novel method to keep sufferers physically active, opening a new avenue for improving the quality of life of chronic pain sufferers.”

The pair conducted their study by having chronic pain patients outfitted with devices called accelerometers. These instruments accurately gauge motor activity, monitoring how active the patients were throughout the course of a one week period in their typical living and sleeping environment. Their activity was monitored round the clock so that the researchers could not only tell how much physical activity the patients were getting during the day but also how their sleep quality was at night. Patients were also asked to provide feedback about their own experience of their quality of sleep, how intense their pain was and how they felt in general, including what kind of mood they were in. They were asked to keep track of these inputs in a mobile electronic diary every morning when they woke up.

By keeping the timing consistent for each of these measures, the researchers were able to get a sense for the true quality of sleep that each pain patient had experienced, as well as how they were feeling each day as a result.

Despite the fact that there were a number of different factors that were weighed during the course of the study, the researchers found that there was only one variable that could consistently be relied upon to predict the level of physical activity that each patient was willing to participate in, and that predictor was how much sleep they had gotten the night before and whether or not it was of good quality.

Sleep quality even proved itself to be a better predictor of participation in exercise than how much pain a patient had reported themselves to be in or whether or not they were in a good mood.

Tang was very energized by the results of her study because they were somewhat unexpected. She said that “the prospect of promoting physical activity by regulating sleep may offer a novel solution to an old problem. The current study identified sleep quality, rather than pain and low mood, as a key driver of physical activity the next day. The finding challenges the conventional target of treatment being primarily focused on changing what patients do during the day.“

She went on to say, “Sleep has a naturally recuperative power that is often overlooked in pain management. A greater treatment emphasis on sleep may help patients improve their daytime functioning and hence their quality of life.”