Caring Medical - Where the world comes for ProlotherapyHow important is sleep in helping to avoid surgery?

Danielle.Steilen.ProlotherapistDanielle R. Steilen-Matias, MMS, PA-C

In this article we will discuss one of the important components of healing chronic joint pain – sleep.

Before you read on, if you have questions about sleep problems and chronic joint pain, get help and information from Caring Medical

Robert Bonakdar of the Scripps Center for Integrative Medicine wrote in the journal Medical clinics of North America. Continuing medical education supplement, September 2017 that:

Chronic pain is one of the most common conditions seen in the (pain management) clinic, and it is often one of the most frustrating for both clinicians and patients. This condition stems from common comorbidities, including depression, insomnia, fatigue, and physical deconditioning, which often create barriers to recovery.

In addition, chronic pain has had divergent approaches for treatment, including an overemphasis on analgesia (pain medications) and curative treatments (treatments thought to provide a cure i.e., surgery that do not achieve those goals) while under emphasizing the biopsychosocial needs of those in pain.(1)

One of those biopsychosocial needs is sleep.

Many of our patients’ insomnia issues are due to pain. Get rid of the pain and sleep is improved.  As simple as that sounds inadequate or poor sleep is often an overlooked factor in health and healing. Sleeplessness has a cause. Find the cause and the insomnia typically goes away. If the cause is chronic joint pain, Comprehensive Prolotherapy can help.

How important is sleep in preventing back surgery?

Writing in the American Journal of Preventive Medicine, 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.(2)

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

  • Poorer sleep quality was significantly related to higher pain ratings,
  • higher negative affect,
  • lower positive affect,
  • poorer physical function,
  • and higher pain catastrophizing.

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

  • Poorer prior night sleep quality significantly predicted
    • greater next day patient ratings of pain,
    • poorer physical function
    • higher pain catastrophizing
    • and negative mood and low function uniformly across the day,
  • Good good sleepers reported relatively good mornings, but showed pain, affect and function levels comparable to poor sleepers by the end of the day.(3)
    • (It is interesting to note that the good sleepers start the day off well but as the day wore on, the pain caused similar issues of physical function pain catastrophizing.  This should clearly show that sleep is an important part of a comprehensive program to reversing back pain).

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.

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

Poor sleep quality is highly prevalent in patients with low back pain and is associated with high levels of pain, psychological distress, and physical disability. Studies have reported relationship between sleep problems and intensity of low back pain. Accordingly, effective management of low back pain should address sleep quality.(4)

Pain and insomnia

Doctors at the Norwegian University of Science and Technology wrote in the Journal of sleep research that 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.(5)

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 other words their suggestion was to address the sleep problems to improve the neck pain.

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

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.

  • Eighty-two percent showed an improvement in sleep.
  • Seventy-four percent of patients had trouble sleeping prior to Prolotherapy with 82% saying they could sleep much better after Prolotherapy.
  • Ninety-two percent stated that the improvement in sleep has at least mostly continued after Prolotherapy (50% or greater).(7)

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

  • In regard to sleep, 53% of patients felt their foot/toe pain interrupted their sleep.
  • After Prolotherapy, 90% of this group had improvements in their sleeping ability.8

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

  • In regard to sleep, 80% of patients said that their shoulder pain affected their ability to sleep before Prolotherapy.
  • After Prolotherapy, 88% could sleep much better.9

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

1 Bonakdar RA. Integrative Pain Management. Medical Clinics of North America. 2017 Sep 30;101(5):987-1004. [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]


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