Millions of people suffer from chronic painful conditions such as back pain, rheumatoid/osteoarthritis, migraine, fibromyalgia, oro-facial pain, post-injury, lupus etc. Any painful condition that lasts for more than six months is called chronic pain. Pain is the most debilitating symptom which can significantly compromise the quality of life and affect the physical and emotional well-being of the sufferer. Considerable research indicates increased experience of clinical pain among females relative to males.
Sleep disturbance is perhaps one of the most prevalent complaints of patients with chronic painful conditions. It’s estimated that 50-88% of chronic pain patients suffer from sleep disturbances and at least 50% of individuals with insomnia—the most commonly diagnosed disorder of sleep impairment—suffer from chronic pain.
Chronic painful conditions such as Arthritis and fibromyalgia often co-exist with other common physical and mental issues like:
· Difficult to fall asleep/maintain sleep
· Feeling hopeless
· Fear
· Depression/ anxiety/ irritability
· Stress
· Fatigue
· Withdrawal from activity
· Disability
· Weakened immune system
Across most medical interventions, the development of pain as a side effect coincides with the development of sleep disturbance, and vice-versa. Sleep is often a respite from pain but often the discomfort associated with pain is so strong that the person cannot sleep thereby, making the situation worse.
Recent studies suggest that sleep deprivation can increase the pain sensitivity (hyperalgesia) and influence daily fluctuations in clinical pain. Both chronic pain and sleep disturbances are frequently observed in a variety of medical disorders and conditions, such as depression, chronic fatigue syndrome, fibromyalgia, obesity, type 2 diabetes, gastrointestinal diseases, and rheumatoid diseases.
Sleep difficulty and the pain support each other in a vicious cycle, which is often noticed in patients with rheumatoid arthritis and fibromyalgia. However, their interrelationships are poorly understood. But Experimental studies of healthy subjects and cross-sectional research in clinical populations suggest the possibility that the relationship between sleep disturbance and pain might be reciprocal. The predominant sleep complaint reported by patients with chronic pain is multiple nocturnal awakenings or forced awakenings throughout the night due to pain. Disruption of sleep continuity and poor sleep quality further exacerbates pain.
Several large prospective studies suggest that sleep problems increase the risk of developing future chronic pain and increased mortality. Poor-quality sleep can enhance the pain perception and intensify other relevant symptoms such as fatigue, anxiety, and depression whereas, good-quality sleep may facilitate the resolution of pain complaints.
Chronic disruption in the systems regulating pain and sleep can have a negative impact on health and well-being. Aggressive management of sleep disturbance may be an important treatment objective with possible benefits beyond the improvement in sleep. Furthermore, good sleep appears to improve the long-term prognosis of individuals. From a clinical standpoint, these findings strongly suggest that sleep disruption may hold significant promise as an intervention target in efforts to prevent and treat chronic pain.
