sleep for chronic pain

Sleep for chronic pain? Do you talk about it enough?

I had previously written about components of an effective pain management programme. As professionals we are trained to focus on the physical aspect of an injury e.g. a fracture whether it has healed or not or mental health aspects if we note signs of anxiety or stress in clients. We focus on movement and activities and perhaps we ask them whether they are sleeping well. But do we focus enough on sleep for chronic pain patients?

Teemu et al 2021 conducted an observational cohort study patients with chronic pain treated in 3 multidisciplinary tertiary pain clinics in Finland to identify the most important attributes or problems specific to different pain attributes including sleep for chronic pain. They also analysed demographic factors, pain etiology, comorbidities, lifestyle factors, psychological variables, and treatment-related factors. These data were analyzed using unsupervised and supervised machine learning methods with the aim of (1) identifying and interpreting patterns arising from different pain phenotypic parameters and (2) selecting among the further parameters those that were informative in associating a patient with a particular pain phenotype.

The authors concluded that among the several psychological, lifestyle, and other variables included in the study, sleep problems for chronic pain best capture the association with the extreme phenotypes of pain. Sleep problems thus warrant priority in the treatment of chronic pain.

Aspects of sleep for chronic pain that need exploring perhaps even at initial needs assessment include:

  1. How long does it take for you to fall asleep?
  2. How many times do you wake up in the night? Is that every night?
  3. How long are you awake if you wake up?
  4. How do you rate sleep quality?
  5. How does it affect you mood, energy and relationships? Do you wake up refreshed or tired?
  6. How does it impact on concentration, productivity or ability to stay awake?

Developing a good understanding of client’s sleep patterns and how their sleep quality impacts their life will help us then devise strategies to manage sleep better for clients with chronic pain. Usually sleep hygiene activities are enough to bring about a significant change in sleep patterns but further detailed assessment may be warranted in more complex cases.

You can undertake a brief sleep assessment here.