How important is sleep in helping to avoid surgery?

Ross Hauser, MD  | Caring Medical Florida
Danielle R. Steilen-Matias, MMS, PA-C | Caring Medical Florida

How important is sleep for helping to avoid surgery?

Often a patient will come into one of our clinics and present themselves as not only a person suffering from chronic pain, but one that suffers from chronic insomnia. The connection is obvious, many of our patients’ insomnia issues are due to pain. Get rid of the pain and sleep is improved. Improve sleep, improve the body’s ability to heal.

As simple as that sounds inadequate or poor sleep is often an overlooked factor in health and healing.

A well-cited 2004 study from the Johns Hopkins University School of Medicine, published in the journal Sleep Medicine Reviews (1), makes for a simple understanding of a very complex subject:

Clearly, sleep impacts pain, pain impacts sleep.

We usually do not have to take much time convincing patients that our treatments will be more effective if they work on strengthening their immune system and push themselves towards a more healthy lifestyle. Active, generally healthy people, heal very well.

But it is hard for people in chronic pain to get themselves to a point of healthy well being if they can’t sleep: These are the things we hear all the time:

The best recommendation we can offer is to get better sleep, get rid of your pain.

In our clinics, we may make general recommendations for what you can do to help your sleep. But we do emphasize that sleep is a component of healing, not THE component of healing and the best recommendation we can offer is to get better sleep, get rid of your pain.

For example: How important is sleep for preventing back surgery?

Now let’s look at some research. Here we have some studies that suggest that if you can get to sleep you may be able to prevent back surgery.

Writing in the American Journal of Preventive Medicine,(2) doctors at the U.S. Army Research Institute of Environmental Medicine studied risk factors for low back pain and spine surgery. One of the risk factors is sleep deprivation which the doctors found was associated with increased risk of back pain becoming chronic/recurrent and causing the patient a faster time to surgery.

Poor sleep quality among people with chronic low back pain appears to be related to worse pain, poor physical function, and pain catastrophizing.

Doctors at Rush University Medical Center did a further analysis which they published in the Annals of Behavioral Medicine. (3This analysis, averaged across the day, revealed that:

Doctors at the University of Sydney (4) in Australia are conducting studies to connect low back pain and poor sleep. In published research they wrote:

Clearly, we can produce studies that will show how poor sleep negatively affects patients with knee, hip, shoulder, neck, and all joints. But the point is clear, sleep and chronic joint pain are connected.

Pain and insomnia

Doctors at the Norwegian University of Science and Technology wrote in the Journal of Sleep Research (5that chronic musculoskeletal pain increases the risk of insomnia, particularly among those who report several pain sites. Although there was no clear evidence of modifying effects, these results suggest that a healthy active lifestyle (weight loss and exercise) reduces the risk of insomnia in people with chronic musculoskeletal pain.

Doctors in Spain investigated whether sleep quality is associated with improvement in pain and disability. In their study published in The Clinical Journal of Pain, of 422 patients with neck pain  the doctors were able to conclude: “neck pain is less likely to improve in patients with poorer sleep quality, irrespective of age, sex, catastrophizing, depression, or treatments prescribed for neck pain.”(6)

In our opinion, the permanent cure for neck pain and instability is not long-term narcotic medications or steroids, though sometimes a prescription or nerve block is necessary to get a person through the most acute phase of pain. Decreasing the acute pain allows the patient to sleep and rest while the Prolotherapy stimulates the ligaments to tighten and properly restore vertebral alignment.

Prolotherapy research – pain reduction – sleep improvement

When patients come into our clinics and they ask, “what can I do to help me sleep at night?” The answer, as we stated above, is “get rid of your pain.” If we can get rid of the pain, the patient will not need to take extra or super strength pain pills before bedtime. If we can jump-start the healing process for them, start reducing their pain, the patients find that they can sleep better and that better sleep in helping them heal.

This is how Prolotherapy treatments can positively impact chronic pain:

In the Journal of Prolotherapy, our Caring Medical research team reported on sleep and knee pain:

Prolotherapy helps decrease pain and improve the quality of life of patients with unresolved knee pain. Decreases in pain, stiffness, and crunching levels reached statistical significance with Prolotherapy. The percentage of patients with less knee pain was 95%, and 99% reported long term improvements in stiffness after Prolotherapy. Eighty-six percent of patients decreased their need for additional pain therapies, including medication usage by 90% or more, after Prolotherapy.

In the Journal of Prolotherapy, our Caring Medical research team reported on sleep and foot and toe pain

In the Journal of Prolotherapy, our Caring Medical research team reported on sleep and shoulder pain

In July 2018, researchers publishing in the medical journal Scientifica (10), that in test subjects with shoulder pain, Prolotherapy injections significantly improved patients’ range of abduction and improves sleep within 12 weeks of treatment compared to conventional physiotherapy management.

 

If you have questions about sleep problems and chronic joint pain, get help and information from Caring Medical

References:

1 Smith MT, Haythornthwaite JA. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep medicine reviews. 2004 Apr 1;8(2):119-32.  [Google Scholar]
2 Kardouni JR, Shing TL, Rhon DI. Risk Factors for Low Back Pain and Spine Surgery: A Retrospective Cohort Study in Soldiers. American journal of preventive medicine. 2016 Nov 30;51(5):e129-38. [Google Scholar]
3 Gerhart JI, Burns JW, Post KM, Smith DA, Porter LS, Burgess HJ, Schuster E, Buvanendran A, Fras AM, Keefe FJ. Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects. Annals of Behavioral Medicine. 2017 Jun 1;51(3):365-75. [Google Scholar]
4 Pinheiro MB, Ho KK, Ferreira ML, Refshauge KM, Grunstein R, Hopper JL, Maher CG, Koes BW, Ordoñana JR, Ferreira PH. Efficacy of a sleep quality intervention in people with low back pain: protocol for a feasibility randomized co-twin controlled trial. Twin Research and Human Genetics. 2016 Oct;19(5):492-501. [Google Scholar]
5 Skarpsno ES, Nilsen TI, Sand T, Hagen K, Mork PJ. Do physical activity and body mass index modify the association between chronic musculoskeletal pain and insomnia? Longitudinal data from the HUNT study, Norway. Journal of Sleep Research. 2017 Jul 26. [Google Scholar]
6 Kovacs FM, Seco J, Royuela A, Melis S, Sánchez C, Díaz-Arribas MJ, Meli M, Núñez M, Martínez-Rodríguez ME, Fernández C, Gestoso M. Patients With Neck Pain are Less Likely to Improve if They Experience Poor Sleep Quality. The Clinical journal of pain. 2015 Aug 1;31(8):713-21. [Google Scholar]
7 Hauser RA, Hauser MA.  A Retrospective Study on Dextrose Prolotherapy for Unresolved Knee Pain at an Outpatient Charity Clinic in Rural Illinois. Journal of Prolotherapy. 2009;1:11-21. [Google Scholar]
8 Hauser R, Hauser M, Cukla J. A retrospective observational study on Hackett-Hemwall dextrose prolotherapy for unresolved foot and toe pain at an outpatient charity clinic in rural Illinois. Journal of Prolotherapy. 2011;3(1):543-551. [Google Scholar]
9 Hauser RA, Hauser MA. A retrospective study on Hackett-Hemwall dextrose prolotherapy for chronic shoulder pain at an outpatient charity clinic in rural Illinois. J Prolotherapy. 2009;4:205-16. News117 [Google Scholar]
10 George J, Li SC, Jaafar Z, Hamid MS. Comparative Effectiveness of Ultrasound-Guided Intratendinous Prolotherapy Injection with Conventional Treatment to Treat Focal Supraspinatus Tendinosis. Scientifica. 2018;2018. [Google Scholar]

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