Are Insomnia and Chronic Pain Linked?

Are Insomnia and Chronic Pain Linked?

Insomnia and PainDoctors who treat pain have known for a while that their patients seem to have higher rates of sleep disorders from insomnia to sleep apnea.

“The question,” said pain specialist Richard Radnovich “is there a cause and effect relationship.”

Radnovich made his comments in the wake of a report out of Norway that says people who have problem sleeping may also be more sensitive to pain, thus potentially worsening the effects of chronic pain conditions.

Researchers measured pain sensitivity in more than 10,000 adults, who were participants in the Tromso Study, an ongoing public health study in Norway that began in 1974.

Out of all of the participants, 10.5 percent had what the researchers considered an insomnia disorder, Live Science reported.

The participants were asked to place their hands in cold water for a set period of time.

People who remove their hands early show a decreased tolerance to pain.

The results showed that 42 percent of patients who had insomnia took their hands out of the water before the 106 seconds were up, while only 31 percent of all participants lasted the stipulated period.

This increased sensitivity to pain was greater in those with severe insomnia.
People who were experiencing chronic pain and who also had insomnia showed increased sensitivity to pain.

Pain sensitivity was also linked to the amount of time it took to get to sleep.

Radnovich calls the study “interesting” but added “it does not address which is the chicken and which is the egg.”

The study only asked people to report on the impressions of their sleep patterns. And researchers found that people who reported more trouble falling asleep did not tolerate painful stimulus as well as those who did not report trouble falling asleep.

“Of course it could be that those patients really did have more trouble with sleep,” said Radnovich.” But it is also possible that researchers were really measuring people’s awareness of sleep – maybe their actual sleep patterns are no different at all; maybe the people that are intolerant to painful sensations are also more intolerant to subtle changes in sleep patterns.”

A follow up study to objectively measure sleep would be helpful to further understand this phenomenon, he concluded.

Radnovich runs a pain clinic in Boise, Idaho which is one of the leading clinical research sites in the nation for treatments for musculoskeletal disorders and pain. I

The Mayo Clinic describes insomnia and says there are two kinds. Primary insomnia is where inability to sleep is the main problem and secondary insomnia where inability to sleep may be caused by a disease or medication, so it’s more likely that chronic pain inducted insomnia (or vice versa) is secondary insomnia.  Insomniacs have difficulty falling asleep, wake up during the night or wake up too early.

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Authored by: Ed Coghlan

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Kurt W.G. Matthies

I’ve lived with pain induced insomnia for many years, ever since the appearance of lumbar DDD, spondylosis, and spinal stenosis.

I have problems falling asleep, and staying asleep.

By the end of the day, any movement nvolving the lumbar area causes moderate or severe pain, which wakes me up. I have to get up and pace the house, or sit in a chair for a while to get the pain to settle, sometimes falling asleep in the chair, or sometimes returning to bed for another two-three hour cycle.

So, I average 3-4 hours of sleep a night. I’ve tried all kinds of medication — z-drugs and benzos, melatonin, trazodone, and others — nothing works, and I also feel under medicated as today’s pain doctors seem more interested in keeping doses within “safe” limits rather than effective pain treatment.

These “safe” limits have no relationship to my pain syndrome. When my pain problems derived from cervical DDD, I used much higher daily equivalent doses of opioid analgesics that allowed me to function as a professional engineer, a father and husband, within my community, and in other aspects of a “normal” life.

These days, with daily maximum limits on opioids designed to prevent opioid poisoning in the opiate naive, long-time COT patients like myself are chronically undermedicated.

During the decade of pain — the 2000s — I was treated with large doses of methadone, up to 200mg / day, with hydromorphone for breakthrough pain. This regimen gave me the analgesia needed to function and also permitted me to sleep throughout the night.

Today, I can’t find a pain physician to prescribe this regimen. I’m aware of some of the research that points to a possible link between methadone and and elongated Q-T interval, but then I’ve read of most SSRI medications, prescribed freely for the past 15 years, causing the same phenomenon.

The practice of medicine is supposed to be a collaboration between doctor and patient that is based upon informed consent. Anyone who’s ever read a PDR understands that most of our medications come with some measure of risk. Doctors inform those patients of that risk (ideally), and between them, both doctor and patient decide is the benefit of medication is worth the risk.

Yet, when it comes to using an effective medication like methadone that both moderates my pain better than any of the other opioids, and also allows me to get a full night’s sleep, my opinion and my willing acceptance of risk has been irrelevant.

I’m not asking for anything out of the ordinary, but a return to a mediation regimen that was effective for cervical DDD, spondylosis, and stenosis. Today, seeking that treatment for lumbar disease is like finding a needle in a haystack.

So, my pain feeds my insomnia, and my insomnia feeds my pain. It’s a vicious cycle of disease that is wreaking havoc with my nervous system.

How much more can I take? None of the physician’s I’ve seen in the past few years seem interested resolving these problems.

Mark Ibsen

Sleep is the foundation of well being


In regards to the pain linked to insomnia…I have told my neurologist over and over again that I CANNOT sleep!! The only time I have a fitful sleep at night, is when I have gone a few days of a severe lack of sleep, then I finally have my ‘crash day’, the day and night when I simply cannot stay awake due to the severe lack of sleep! I have pain issues from a variety of problems, along migraines. My former main doc (he had since retired), wanted me to do a sleep test. My question was why?? What was the point of going further in debt for people watch me sit up and NOT sleep?! Made no sense to me. Since then, I was told to take melatonin at night to help sleep, versus being prescribed sleeping aids. All I can say is some nights I sleep, others it is the same story….I don’t sleep at all, even with the melatonin. So, what is the answer? I don’t know.