![Sleep as a new treatment for pain "It is well known that chronic pain [1, 2] and poor sleep [3–5] are enormous and growi...](https://img4.findhealthclinics.com/775/653/1010399507756530.jpg)
23/08/2024
Sleep as a new treatment for pain
"It is well known that chronic pain [1, 2] and poor sleep [3–5] are enormous and growing health problems. Less recognized, how- ever, is the relationship between the two. Poor sleep cooccurs with chronic pain in up to 90% of cases and is associated with pain severity [6–9].
Contrary to the traditional view that pain interferes with sleep, emerging studies including our own preclinical work, suggest the opposite—poor sleep increases pain [6, 7, 10–12]. Moreover, our group has shown that poor sleep predicts a clinically relevant increase in next-day low back pain symptoms (i.e. “flare”) [13] and, when in conjunction with specific immune profiles, the transition from acute to chronic pain [14]. This body of work opens the enticing, yet under-investigated, possibility that interventions aimed at sleep could improve and perhaps even prevent chronic pain. "
"One likely explanation involves the capacity for poor sleep to drive inflammatory mechanisms that sensitize pain pathways [16]. Sleep is a powerful modulator of systemic inflammation [17, 18]. The different stages of sleep (i.e. rapid eye movement and the three stages of non-rapid eye movement) differently regulate nocturnal levels of inflammatory factors (e.g. cytokines), and this lays the foundation for inflammatory levels throughout the day [19–22].
Sleep loss or disturbance can alter this immune balance via activating the “stress response” (i.e. hypothalamic-pituitary-adrenal axis and sympathetic nervous system activation, see [18, 23–25]) and/or inflammatory signaling pathways (e.g. those involving nuclear factor-κB [NF-κB], activation protein-1 [AP-1], and signal transducer and activator of transcription [STAT] family proteins [17, 26–28]). This can result in a transient shift in the temporal pattern of inflammatory responses, with increased levels of pro-inflammatory cytokines during the day rather than during the night"
"Sleep as a first-line treatment for pain is within sight. Confirmation of mechanisms of sleep-induced changes in pain would likely guide clinical advice and self-management strategies for pain relief, and provide an evidence-based basis for developing, refining, and testing sleep interventions for improved prevention and management of chronic pain. One “ready-to-test” sleep intervention that has been shown to concurrently improve sleep and pain is cognitive behavioral therapy for insomnia (CBT-I) [53–58]. A major advantage of CBT-I is its potential to benefit a substantial proportion of pain suffers given insomnia is the most common sleep disorder [59] and 50% of those with insomnia experience chronic pain [60, 61].
Sleep interventions may also have an additive effect on pain relief when combined with core first-line treatments such as exercise, which is also thought to contribute to pain relief by reducing inflammation [62, 63]. Closely related to this line of inquiry is our preclinical work showing exercise protects against the negative effects of poor sleep on pain and the transition to chronicity [11]. "
Ref.:
Klyne DM, Hall M. Is sleep the new treatment for pain? Two issues need resolving before deciding. Sleep. 2024 Jun 13;47(6):zsae089.
