Chronic Pain
Chronic pain is a type of pain that lasts longer than three months, or beyond the normal healing time for an injury or recovery from a surgical procedure. The pain may be continuous or intermittent and varies in intensity. In many cases, the pain level increases over time. One of the most common types of chronic pain is low back pain. Headache and arthritis are other common causes of chronic pain.
The American Pain Foundation estimates 56 percent of people with pain have symptoms lasting three months or longer (in most cases, lasting longer than one year). Pain is the second most common reason for medically-related lost work time, causing about 50 million lost days of work each year in the U.S. The annual cost to patients and employers is about $100 billion.
Chronic Pain and Sleep
Chronic pain can have a negative impact on a patient’s quality of life and the ability to participate in daily activities. It can lead to problems with concentration and memory, anxiety and depression.
Another important consequence of chronic pain is sleep disruption. People in pain may have difficulty falling asleep or staying asleep. In fact, researchers report chronic pain is the leading cause of insomnia in the U.S. Roughly 65 percent of patients with pain report they wake up during the night and 62 percent report waking too early. In turn, the sleep problems lower the ability to tolerate pain and can interfere with the effectiveness of pain treatments.
Helping Patients with Chronic Pain Sleep Problems
Carla Jungquist, F.N.P., Ph.D., with the University of Rochester Medical Center in Rochester, NY, says restorative sleep is important for the body. During sleep time, the body recharges, the immune system becomes stronger and memories are consolidated. Previous research showed cognitive behavioral therapy is effective for improving sleep in patients with insomnia. Jungquist and her colleagues wanted to find out of the technique would work for sleep problems in patients with chronic pain from osteoarthritis.
Participants were asked to keep a sleep diary, recording how much time they spent in bed (defined as sleep opportunity) and how much time they actually slept. During the next week, patients were told to stay in bed for only the average total time they actually slept each night from the previous week. A journal was used to record and confront irrational nighttime fears. In addition, patients were given instructions on how to improve sleep hygiene. After eight weeks, participants were sleeping about 79 minutes longer/night and reported lower daytime pain levels.
Jungquist cautions that sleep problems in pain patients can be caused by medical problems, in which case, cognitive behavioral therapy won’t be very effective. So each patient underwent a sleep study to rule out other health problems interfering with sleep, like sleep apnea.
AUDIENCE INQUIRYFor general information on pain or sleep problems:
American Chronic Pain Association, http://www.theacpa.org
American Pain Foundation, http://www.painfoundation.org
National Institute of Neurological Disorders and Stroke, http://www.ninds.nih.gov
BIBLIOGRAPHYDeardorf, William, Ph.D., “Chronic Pain and Insomnia: Breaking the Cycle,” Spine-Health, accessed at http://www.spine-health.com, October 19, 2010.
Edinger, Jack, Ph.D., et al., “Cognitive Behavioral Therapy for Treatment of Chronic Primary Insomnia,” Journal of the American Medical Association, April 11, 2001, Vol. 285, No. 14, pp. 1856-1864.
Hurley, Deirdre, et al., “Physiotherapy for Sleep Disturbance in Chronic Low Back Pain,” BMC Musculoskeletal Disorders, April 16, 2010, Vol. 11, p. 70.
Jungquist, Carla, et al., “The Efficacy of Cognitive-Behavioral Therapy for Insomnia in Patients with Chronic Pain,” Sleep Medicine, March 2010, Vol. 11, No. 3, pp. 302-309.
Lunde, L., et al., “Characteristics of Sleep in Older Persons with Chronic Pain,” Clinical Journal of Pain, February 2010, Vol. 26, No. 2, pp. 132-137.
Vitiello, Michael, Ph.D., et al., “Cognitive Behavioral Therapy for Insomnia Improves Sleep and Decreases Pain in Older Adults with Co-Morbid Insomnia and Osteoarthritis,” Journal of Clinical Sleep Medicine, August 15, 2009, Vol. 5, No. 4, pp. 355-362.
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