The Link Between Chronic Pain and Insomnia

By Lynda Lampert

I was awoken by a pounding on the bed. My husband lay beside me, his leg thrashing against the mattress from a painful cramp. It wasn’t the first time and wouldn’t be the last. I could hear his heavy breathing, the slight whimper that came from him. I reached out to touch him, but there was nothing I could do to stop the pain.

Later that night, I awoke again and he wasn’t there. I looked for him and found him slumped in front of his computer slightly snoring. He awoke instantly and turned to me with bleary eyes. Dawn was only two hours away, and he had only nodded off shortly throughout the night.

My husband isn’t alone. is closely linked to disturbances, and can even lead to chronic if the issue isn’t addressed. Sleep and pain can create a terrible feedback loop that can take a lot of effort to break, explains Dr. James McGowan, a pain management specialist at Mercy Medical Center in Baltimore. Lack of sleep often causes an increase in pain intolerance, which leads to more difficulty sleeping. When we have chronic pain affecting the ability to sleep, the physical and emotional fatigue can increase pain awareness, he said. On the flip said, says Dr. McGowan, the better rested the body is, the less mental and physical fatigue there is, and the more a patient is able to deal with chronic pain.

Sleep specialists see this problem on a regular basis, and working in conjunction with pain management specialists, they can devise a plan to help chronic pain patients get sleep. Mark Buchfuhrer, medical director of the Comprehensive Sleep Center at Good Samaritan Hospital in Los Angeles is an expert in the field of treating both pain and sleep.

Chronic pain affects sleep in a number of ways, Dr. Buchfhrer explained. “First, the pain interrupts sleep. Second, if you get up at 3AM to go the bathroom, it is much more difficult to fall back to sleep. Any extra unpleasant stimulation will make it hard to go back to sleep. And those who suffer from chronic pain experience an increase in anxiety and depression that stems from their inability to sleep.”

Some medications can help with this cycle of pain and insomnia. Dr. Buchfuher suggests a number of options. He uses sleeping pills for short term insomnia because it prevents short term insomnia from becoming long term insomnia. But there is a high risk of tolerance and dependence associated with sleep meds. Antidepressant drugs can also help with sleep and pain, Dr. Buchfuher says. “We find the drugs raise the pain threshold and are a good adjunct to pain and sleep.” And it helps lower anxiety and depression from chronic insomnia.

Some therapies can also add to the success of sleep and pain management, like cognitive behavior therapy, physical therapy, and sleep hygiene changes. There is even a new field called Cognitive Behavioral Therapy for Insomnia or CBTI. “Behavior therapy is important in retraining patients to sleep,” says Dr. Buchfuhrer.

But none of these have helped my husband, who still doesn’t get much sleep.

Tags:  Chronic Pain Insomnia Sleep

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