Dr. Mark Kestner (crop)

Kestner

Throughout my career of caring for patients with chronic pain, I have noted that poor sleep is associated with greater levels of pain.

It is also notable that when we begin treatment for patients with chronic pain, one of the first positive comments is often that they are sleeping better than they have in years. It is not unusual for patients to report improved sleep even before they notice improvement in their pain.

Many pain clinicians have noted the relationship between poor sleep and increased chronic pain.  Patients that report more sleep issues also often report the worst pain.

A recent study has yielded findings that may begin to answer the question of why poor sleep is associated with greater levels of pain.

Researchers found that following a single night of poor sleep, subject reported significant increase in their level of pain the following day. Conversely, when they slept relatively well, pain relief was significantly improved.

What is happening in the brain to cause more pain when sleep is disturbed?

That was the topic of a study recently published in The Journal of Neuroscience. Interestingly the researchers were able to determine that a change results in the way the brain works immediately following a night of poor sleep. The following day the subjects tested were significantly more sensitive to painful stimuli.

There are areas of the brain that process pain and determine whether you feel pain or not and to what degree the pain is a negative experience for you. Different people will experience pain very differently from one another. Each individual person has a wide range of possible experiences of pain that depend on factors within our bodies and outside our bodies. 

Our emotional state affects our pain experience. Our health status, nutritional status, energy level, immune system, the presence of various drugs and many other factors play a role in how we experience pain.

One example I use that most people can identify with to understand the role of our emotions is that of someone just falling in love. In such an emotional state, humans are less sensitive to pain. A decreased sensitivity to pain occurs in similar states of euphoria, such as when your team wins a championship.  Conversely, in emotional states that are very negative, such as the loss of a loved one, pain can play a much bigger role in our lives.

Fatigue makes a person more sensitive to pain. Emotional, mental or physical fatigue or stress can all accentuate the experience of pain.

What did the researchers learn about how sleep affects the experience of pain? What happens within the brain to cause the effect?

It turns out that sleep deprivation immediately causes the part of the brain that is sensitive to pain be more reactive. It also results in the part of the brain that suppresses reaction to pain to be more subdued.  Therefore, immediately following a night of sleep deprivation, subjects in the study would be more sensitive to painful stimuli.

It is interesting that the effect does not require several nights of sleep deprivation to develop. That finding lends light to the condition of patients that are experiencing chronic pain and poor sleep.

Just as in our experience with our chronic pain patients, as they begin to experience better, healthier sleep almost immediately after beginning our treatment, their pain level soon begins to improve.

What about the reverse effect?  If a person experiencing chronic pain begins to have less pain, will they sleep better? In our experience over the past 32 years we have consistently seen that as we are able to help a patient begin to have less pain, they also report improved sleep.

Sleep quality and level of pain are intricately linked.

It would seem that if a person experiencing chronic pain were to take sleep enhancing drugs then their pain would diminish. In some cases, sleep drugs help chronic pain; in some cases, it can make matters worse. It has also been found that opioid drugs for pain tend to make sleep worse, thus leading to more chronic pain.

Sleep drugs may not provide healthy sleep. It may be that the patient experiences longer, deeper sleep, but the sleep is not truly healthy normal sleep.

In our clinic we work to help patients accomplish better sleep and less pain without using drugs. That way we know that the improvements that they see are the result of true positive changes in their body functions and not the artificial result of a pill that will go away as soon as the pill wears off. 

Knowing that better sleep results in less pain, it makes sense to consider any factor that might be disturbing the normal, natural sleep and address those issues. Healthy sleep is essential for good health.

Dr. Mark Kestner is a licensed chiropractic physician in Murfreesboro. His office is at 1435 NW Broad St. Contact him at mkestner@DrKestner.com.

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