Coastal Orthopedics Blog

How chronic pain can interfere with sleep and how poor sleep can increase pain perception

By:Rob S Williams, MD July 10, 2019

Sleep plays a critical role in our lives, regulating mode, learning capacity, and memory. Studies show that sleep also plays vital roles in how the body interprets pain. According to an article in the Journal of Physical Therapy Science, poor sleep showed a 55.4% prevalence in people with higher pain and disability levels and a lower quality of life if left untreated. The findings from the Journal of Physical Therapy means that the pain that may be keeping you up at night may also be leading to a cycle of even more pain if left untreated.


Acute vs. Chronic Pain 

Pain is a signal in your nervous system, saying that something might be wrong. The sensation of pain is an unpleasant one, such as sting, burn, ache, prick, or throbbing feeling. 

Primarily there are two types of pain, Acute pain, and Chronic pain. Acute pain is anything from short burst of pain to pain lasting up to 6 months. Acute pain is there to let you know your body has suffered an injury or encountered something that isn't operating correctly. Doctors call this useful pain as it is there to stop you from doing further damage to yourself and help recognize  that something isn't quite right. If you suffer from acute pain its good to take it easy and if the pain persists or fails to subside consider getting checked out by a your local orthopedic to make sure that everything is okay.

Chronic pain, on the other hand, is different. The pain can last from a more than 6 months to years. Chronic pain suggests there may be an ongoing pain generator such as arthritis, or lasting injury that needs attention. While it is true that there may be an underlining cause for your chronic pain, sometimes there may be nothing bio-mechanically wrong and still the pain persists. Chronic pain by nature, is not always curable, treatments can help such as physical therapy, chiropractic care, pain management and sometimes even surgery.

The backwards correlation between sleep and pain

Feeling pain makes it harder to sleep

When you are in pain it can make your mind more active and cause you to focus on the cause of what is making it uncomfortable, i.e. the pain, this, in turn, makes it harder to relax and fall asleep.

Psychologists have found that the more one focuses on trying to sleep, the harder it becomes to sleep. The battle does not stop there though, once you finally fall asleep pain can disrupt the sleep you were fighting so hard to get. With arthritis moving in your sleep can cause pain and awaken you; restarting the struggling cycle of trying to sleep with pain.

Poor sleep, increases pain perception in the brain

While pain can make it harder to sleep, studies show that sleep deprivation can increase the perception of pain, which caused problems with sleep in the first place. Studies show that lack of sleep does this through reducing tolerance levels, increase in  pain receptor activity in the brain, and disrupting the bodies natural healing process.

In a study directly covering the association of sleep and pain, Sleep complaints were present in 67-88% of all chronic pain disorders. In addition 50% of individuals with insomnia noted complaints of chronic pain “the development of pain as a side effect coincides with the development of sleep disturbance, and vice-versa” According to the Journal of Pain.


Factors that can cause chronic pain


  • Bone fractures / improperly healed fractures
  • Torn ligaments
  • Osteoarthritis or degeneration of the knee, spine, or hip
  • Low back pain
  • Paget's disease: condition involving remodeling and deformity of one or more bones
  • Rheumatoid arthritis: is a long-term autoimmune disorder that primarily affects joints.
  • Osteoporosis if there is a broken bone.
  • Arthritis
  • Multiple sclerosis
  • Fibromyalgia
  • Nerve damage

There are other injuries or diagnoses, which can be the cause for your chronic pain, and above is just a list of a few which we commonly see at Coastal Orthopedics. If your sleep problems are caused by other symptoms non-related to chronic pain, it may be time to see a Sleep Specialist in your area.


Drug Therapy for chronic Orthopedic Conditions


While Drug Therapy is not by any means the only pain treatment, an orthopedic specialist can offer it may provide some significant relief while you decide if going in for an office visit is right for you or while treatment starts. Drug Therapy may also help if your Orthopedic Specialist prescribes physical therapy and help to mitigate pain during sleep or as you attempt to resume any normal daily activities.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) Asprin, ibuprofen, Naproxenstoryblocks-conceptual-hand-writing-showing-nonsteroidal-anti-inflammatory-drugs-business-photo-showcasing-class-of-medicine-that-reduces-pain-blank-rectangular-shape-sticker-sitting-on-a-swivel-chair_rSkl-OncIbN
  • Acetaminophen
  • Muscle relaxants
  • Viscosupplementation
  • Opioid pain relievers


While opioids can help with some chronic pain instances, they can lead to a slippery slope and should be the last resort and only under the direct supervision of a physician. If further pain management is needed, an orthopedic doctor may refer to a pain management specialist


What can people do at home to help get to sleep ?


Good sleep practices are key to achieving a good night's sleep, even with chronic pain. Some tips sleep are:

  • Stop or limit caffeine consumption, especially within 8 hours of bedtime.
  • Limit alcohol intake, particularly in the evening.
  • Use of pain killers or sleeping pills are effective but should be used under the supervision of a physician.
  • Practice relaxation techniques, such as deep abdominal breathing.
  • Ensuring a comfortable environment for sleep – Cool temperature
  • As needed add support (if you can add support to the part of your body which is causing pain in an attempt to mitigate some of it)
  • Limit bright screens before sleeping, warm milk or tea can also help


When is it time to see a doctor?


If the pain continues after several nights or this has been a long term issue which you’ve been unable to resolve, it might be time to consult a local professional. At Coastal Orthopedics, we treat all muscular skeletal problems as Dr. Williams is a board certified Sports Orthopedic Physician he can help asses what’s wrong and aim to provide the best solutions possible.

It is time to find a professional and stop letting chronic injuries dictate how you sleep, call us today or book an appointment online for any further questions.


Article written by: Rob Williams, MD


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