I have observed that adequate sleep seems to be a critical step in solving chronic pain. It was the first variable that I happened upon, which helped my patients begin to feel better. I took an aggressive approach and by presenting basic sleep hygiene concepts and adjusting medications, I could get most of my patients to have a consistently restful night’s sleep within four to six weeks. Real progress did not happen until this bridge was crossed.

Sleep and pain

I had thought that people in chronic pain could not sleep because of their pain. A large study out of Israel showed that it is lack of sleep that induces chronic pain. It also demonstrated that the reverse was not true – that pain caused insomnia. (1)

Another study documented that lack of sleep was a bigger predictor of becoming disabled than the severity of back pain. Even more interesting to me was that this was also true for leg pain (sciatica), which surgeons generally feel is the problem that is the most disabling. Not true. It is insomnia. (2)

Sleep is number one. The only reason that I placed the calming down of the nervous system ahead of sleep is that the same tools will help you sleep. The DOC principles will be effective if you are not getting 7 or 8 hours of restful sleep.There are medication combinations that will allow you to sleep regardless of the level of your pain.

Not sleeping is NOT an option. Not one major decision regarding your spine care should be made until you feel rested during the day.

  1. Agmon M and Galit Armon. “Increased insomnia symptoms predict the onset of back pain among employed adults.” PLOS One (2014); 9: 1-7.
  2. Zarrabian MM, et al. “Relationship between sleep, pain, and disability in patients with spinal pathology.” Archives of Physical Medicine and Rehabilitation (2014); 95:1504-1509.