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January 28, 2019
Pain and sleep are poor bedfellows. According to a National Sleep Foundation survey, two-thirds of people with back pain, arthritis and diabetes report having sleep problems.
Many studies have found badociations between pain and insufficient sleep, including a study published in 2018 in the journal Frontiers in psychiatry this suggests that the relationship is bidirectional – people report more intense pain after a bad night's sleep and people report sleeping more when they are in pain.
New research published today, January 28, 2019, in The journal of neuroscience suggests for the first time that part of the explanation for this link is due to the fact that sleep deprivation makes some centers of brain pain more active than they would after a good night of sleep.
"Our results provide the first evidence that the already known effect of sleep deprivation on pain is related to changes in the pain-sensitive and pain-modulating regions of the brain, caused by sleep loss," says the co-author. author Adam Krause, PhD student at the Center for Human Sleep Science at the University of California at Berkeley.
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Identify neural defects in the brain without sleep
Dr. Krause and colleagues measured pain sensitivity in a group of 25 healthy young adults aged 18 to 30 years. Using functional magnetic resonance imaging (fMRI), scientists examined participants' brains under two conditions – once after eight hours of healthy life. sleep and once after having a night of sleep deprivation. During both fMRIs, participants received uncomfortable heat levels in the legs.
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Limiting sleep lowered the participant's pain threshold compared to what he had reported after a good night's sleep, and fMRI scans showed that the parts of the brain responsible for sending pain signals were significantly more active. after a night of restricted sleep only after one night. enough sleep.
"We were not surprised to find that sleep deprivation increased sensitivity to pain because anyone with chronic pain knew it," Krause says. "But we were surprised by the strength of the effect."
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Once study participants were deprived of sleep, the researchers recorded a 120% increase in somatosensory cortex activity at home. The somatosensory cortex is the part of the brain that processes the sensory inputs, interpreting for the brain what something (such as pain) feels. These results indicate that the pain signal was therefore amplified after sleep deprivation.
However, lack of sleep attenuated the response in the striatum and insula, two areas of the brain involved in the treatment of pain, including badessing its severity and controlling our emotional response. The data showed that there was a 60-90% drop in activity in these areas after a restless night, suggesting that the brain was less well-armed to handle a painful response after a bad sleep.
"I like to think that the striatum and the insula are the guardians of pain," says Krause. They initiate the natural mechanisms of brain pain and relieve this discomfort. But that does not seem to happen as well (or almost) after a bad sleep, he explains. "It's as if the sleep-deprived brain had left the floodgates open in the midst of a deluge of pain signals."
Subjects also badessed their level of pain in response to heat. After being deprived of sleep, some people reported having reached their threshold at a lower temperature than after having a good night's sleep.
To complete the fMRI tests, the investigators conducted an online survey of 236 people (recruited through the crowdsourcing market, Amazon Mechanical Turk). Over the course of a few days, respondents reported hours of nighttime sleep and pain levels the next day. The results revealed that even minor changes in sleep and waking patterns affected pain sensitivity: a decrease in sleep quality from one night to the next was badociated with more intense pain. , just like an increase in nocturnal awakenings.
What do the results mean for people with pain?
The data clearly confirms that pain and sleep have an intimate relationship, suggesting that if you manage to sleep well, the pain will probably not be as bad as if you had not slept well. From a public health perspective, the data point out that even a modest improvement in sleep quality in people with pain could potentially significantly reduce the burden of pain, as well as some health care costs.
"We hope this research encourages medical practitioners to bring sleep much closer to the heart of patient care," says Krause.
Taking steps to improve sleep can also be particularly helpful in hospitals.
"The hospital environment, where pain is often at its worst, is also where sleep is most disrupted," says Krause. "For example, repeatedly waking a patient to perform various tests may not be as important as allowing a patient to sleep uninterrupted all night."
If sleep can sufficiently reduce pain, patients may not need as many narcotic badgesic acts, such as morphine, heroin, oxycodone. or fentanyl, which remains a standard treatment for pain, adds Krause.
"These medications are effective in reducing pain, but they cause a wide range of side effects, including addiction and addiction," he says. "Perhaps an approach to pain including healthy sleep patterns will reduce the need for such medications."
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Steven Feinsilver, MD, director of the Center for Sleep Medicine at Lenox Hill Hospital in New York, acknowledges that hospitals could take action based on these findings.
"Humans sleep better in dark, cold, quiet and comfortable places, but we do not do a very good job in hospitals," he says. "These are problems that we could fix. Sleep is a powerful biological medicine. If you do not waste it, it tends to work. "
Dr. Feinsilver, who did not participate in the study, says cognitive-behavioral therapy is the gold standard for helping people develop good sleep habits and is recommended as a first-line treatment before to try to take a medicine to sleep.
This research starts tracking data and follow-up surveys
The authors of the study identified some limitations in the research, including the fact that the laboratory experiments were performed on healthy young adults, while those who tend to suffer more frequently from pain are more aged. In addition, the pain was measured only according to the level of heat. The results may differ depending on the type of pain. The online portion of the study was also limited because all the information was self-reported.
Krause plans future research to further badyze the most important aspects of sleep for pain management. What sleep properties seem to protect people from the worst effects of sleep deprivation? Since the immune system plays a central role in pain sensitivity, he would also like to examine the link between immune function and sleep problems to reduce pain.
Many are chronically sleep deprived, says Krause. "Just giving us enough time to sleep can go a long way in relieving pain and improving our overall health."
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