chronic pain and insomnia

Pain has the ability to stop sleep dead in its tracks before calm has a chance to descend. Then, if a sufferer does manage to slumber, pain has an unconscionable ability to reach its uncomfortable tentacles deep into slumber often waking someone from much needed rest. To compound matters, just as pain triggers insomnia, insomnia exacerbates pain. It’s no wonder so many Aussies are exhausted and sore.

Pain Australia shared some sobering facts. A conservative estimate reported that 3.24 million Australian adults live with chronic pain. Other stats are significantly higher. This doesn’t include the children we know suffer. More than half are afflicted to such a degree that discomfort interferes with the choices they make. Clinical depression, unsurprisingly, presents at higher than average rates. The risks of suicide are two to three-fold. And depression and pain share a vicious downward spiral, each worsening the other. This correlates in many ways with chronic lost sleep , too.

What is chronic pain, technically?

While popular notion implies that chronic in some way refers to severity, this is untrue. According to Chronic Pain Australia, “Chronic pain is defined as pain that extends beyond the expected healing time of an injury, or can accompany chronic illnesses such as arthritis or lupus.” Others place a rudimentary timeline in the sand: Pain that lasts more than three months falls into the category of chronic.

Chronic pain can affect anyone; it strikes without fear or favour. A reported 47% of people say their pain is related to a diagnosed condition like cancer or arthritis. Another 40% list a triggering event such as surgery or injury. The other 13%, though, remain in the dark. With or without a known cause, pain is not merely physical. Pain can move from acute, or short term, to long lasting in nature because of emotional challenges, poor treatment, psychological stress, and a haywire body that continues to signal discomfort long after the usefulness of such a signal has abated.

Yet, the situation for those with chronic pain seeking relief is somewhat complicated in Australia. The study Waiting in pain: a systematic investigation into the provision of persistent pain services in Australia found that, “Persistent pain management services are currently unable to meet service requirements adequately, and waiting times are more prolonged for publicly funded than privately funded services.” Add to this that best practice doesn’t support the continual use of medications for those who live with ongoing pain and we need alternatives that help.

The good news is that, even with chronic pain, there are proven ways to soothe discomfort and enable you to sleep more soundly. This empowers sufferers to turn the pain-insomnia cycle around and implement a positive feedback system that improves both of these problems. Let’s take a look at six evidence-based approaches…

1) Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy is a psychological intervention that brings awareness to negative thoughts, holds them up to the light for honest appraisal, and enables a patient to reframe the beliefs that shaped them in order to change their behaviours.

CBT has been shown to be effective for the treatment of anxiety and depression, insomnia and chronic pain. The pilot study An Online Self-Help CBT Intervention for Chronic Lower Back Pain found that participants reported a “stronger belief that they could control their pain and they less strongly believed that they were disabled by pain… [there was] improvement in self-efficacy for pain management and mood regulation as well as decreased pain catastrophising and fearful avoidance of physical activity.” Further research showed that CBT was able to reduce insomnia and pain symptoms.

2) Safe movement

Understandably, chronic pain can stop a sufferer from exercising. Yet, moderate-intensity aerobic exercise like walking, dancing or water aerobics have been shown to improve the speed an insomniac falls asleep and contribute to better quality and quality slumber. Suitable exercise requires gradual progression or pacing. When done right, it improves muscle strength, physical fitness and can reduce pain without significant side effects. As an additional benefit, safe movement can also calm the mental illness that keeps its sufferers up through long nights.

3) Social interaction

Chronic pain and insomnia may lead to social withdrawal, with research showing that the combination of these two factors can lead to restricted social activities. After all, when you’re tired and sore the safety of your own home can be more enticing than the outside world and its overwhelm of people. Yet, we humans need each other. It’s simply the way we are built. Support from another   person reduces pain. There is also a wonderful study that showed the benefits of Tango dancing extend to an enhanced mood, life satisfaction and, yes, better sleep. It’s possible this is related to, well, relating!

4) The practice of mindfulness

There is profound power in mindfulness. As we look in greater detail at what ancient cultures have known for eons, the benefits continue to unfold. Mindfulness based stress reduction can ease pain, especially for those with arthritis, and reduce psychological strain. It could also provide the safe sedative you need.

5) Sound sleep habits

In order to improve sleep it is helpful to implement habits that encourage it. Simple steps aren’t always easy, but they can make a big difference. In our article  we discuss evidence-based slumber-inducing strategies: Stop working late into the night, block or blunt your exposure to blue light, lose weight, where needed, change to caffeine free beverages, keep a worry journal, and calm your stress.

6) Supportive products

Sleeping with pain can be an awkward proposition. An inability to find a comfortable spot, to move when needed, and to block out discomfort can each lead to wide eyed frustration and slumber than just won’t come. Supportive products can calm the pain and lead to a better night sleep. Dr Lawrence Epstein, a sleep expert at Harvard-affiliated Brigham and Women’s Hospital, is quoted in Harvard Health Publishing’s article Is your pillow hurting your health? She notes, “Anything that will make you more comfortable will improve the likelihood of getting a good night’s sleep.” A supportive, premium grade, well designed pillow will do the trick nicely.

While chronic pain and insomnia often go hand in hand, each exacerbating the other, the safe and natural steps of CBT, safe movement, social support, mindfulness, sound sleep habits and supportive products will help you experience deeper restorative slumber, reduced discomfort and compound the benefits these two improvements bring.