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Linking Sleep Deprivation to Increased Pain Sensitivity : New Insights and Solutions

Lack of adequate sleep is a pervasive global issue, affecting a significant portion of the adult population. Studies suggest that approximately two-thirds of adults experience occasional symptoms of insomnia, and an estimated 50 to 70 million Americans are dealing with recurring sleep disorders like sleep apnea or insomnia.(1,2)

The consequences of insufficient sleep are far-reaching, with its association to seven out of the 15 leading causes of death in the U.S. alone, including serious conditions like cardiovascular disease, accidents, and diabetes.(3,4) Moreover, individuals who consistently fall short on sleep often endure a range of physical discomforts, including headaches, migraines, body aches, lower back pain, and sometimes even persistent, unrelenting chronic pain.(5,6,7) 

Researchers at Massachusetts General Hospital have now delved into the underlying mechanisms, positing that a particular neurotransmitter experiences a decrease during episodes of insufficient sleep.(8) These findings, recently featured in the journal Nature Communications, shed light on the intricate relationship between sleep deprivation and physical discomfort.(9)

Can Sleep Loss Actually Increase Pain Sensitivity?  

While it is widely acknowledged that there is a strong connection between sleep deprivation and heightened pain perception, the precise mechanisms underlying this relationship are not clearly understood. According to the researchers of this study, despite this common understanding, the exact reasons for how sleep loss promotes pain have actually not been fully clarified. 

To delve deeper into this phenomenon, the research team conducted studies using a mouse model. Their aim was to uncover the specific mechanisms linking sleep deficiency and increased pain sensitivity. Their investigation revealed that a crucial neurotransmitter called N-arachidonoyl dopamine (NADA) experiences a decrease in levels within a region of the brain known as the thalamic reticular nucleus (TRN) in response to sleep deprivation.(10,11) This, in turn, leads to a heightened sensitivity to pain, a condition medically termed hyperalgesia. 

The lead researcher provided insight into the significance of the TRN, explaining that it plays a crucial role in regulating the flow of information between two vital brain regions: the thalamus and the cerebral cortex, both of which are integral in the experience of pain. The deficiency of NADA in the TRN, induced by lack of sleep, can result in TRN malfunction. This dysfunction, communicated through its connections to the thalamus, ultimately amplifies pain sensitivity.

In essence, this research sheds light on the intricate neurochemical processes that underlie the association between sleep deprivation and heightened pain perception, offering valuable insights into potential avenues for addressing both sleep-related issues and chronic pain management

The Complex Relationship between Chronic Pain and Sleep Issues

Chronic pain, defined as persistent discomfort lasting beyond three to six months, is a common experience for some individuals. Unlike typical pain, chronic pain lingers and can have a significant impact on daily life. This type of pain encompasses conditions like arthritis, neck and back pain, fibromyalgia, headaches, and even pain associated with scar tissue or certain medical conditions.

Past research has established a reciprocal relationship between chronic pain and sleep disturbances, with each potentially exacerbating the other.(12) Some pain management specialists have emphasized that this as dynamic, describing it as a “vicious circle,” where chronic pain can both stem from and lead to issues with insufficient sleep.

Essentially, chronic pain can act as a catalyst for sleep disturbances, making it more difficult for individuals to achieve restful and rejuvenating sleep. The discomfort and discomfort associated with chronic pain can lead to difficulties falling asleep, staying asleep, or achieving deep, restorative sleep stages. This compromised sleep quality, in turn, can exacerbate the experience of chronic pain, as it impairs the body’s natural healing and recovery processes.(13,14)

Conversely, inadequate or poor-quality sleep can also contribute to heightened pain sensitivity and the persistence of chronic pain. Sleep deprivation can lead to alterations in pain perception, potentially amplifying the intensity of pain experienced by an individual. Additionally, disrupted sleep patterns can negatively impact mood, cognition, and overall well-being, all of which can further exacerbate the experience of chronic pain.(15,16)

This reciprocal relationship underscores the importance of addressing both chronic pain and sleep disturbances in a holistic manner. Comprehensive treatment approaches that target both aspects of this complex interplay are crucial for effectively managing and improving the well-being of individuals grappling with chronic pain and sleep issues. By breaking free from this “vicious circle,” individuals can experience significant improvements in their overall quality of life.

Looking at Pain Stemming from Sleep Deprivation: Insights from Research

In light of the recent findings, the research team remain optimistic about the potential implications for tackling chronic pain induced by sleep loss. Their research provides a solid foundation for examining the intricate interplay between chronic pain and inadequate sleep. Moreover, the identification of the neurotransmitter N-arachidonoyl dopamine (NADA) offers a promising avenue for further exploration, suggesting that this molecule, or similar ones, may hold the key to alleviating pain stemming from sleep deprivation.

The study authors emphasized the broader significance of these discoveries, underscoring that chronic pain is a complex and multifaceted condition. This recognition underscores the need for a comprehensive, multidisciplinary approach to effectively address chronic pain and its various underlying factors. Looking ahead, the team has ambitious plans to conduct further mechanistic studies, delving into the intricate workings of different cell types within the thalamic reticular nucleus (TRN) and their collective impact on pain induced by sleep loss. Additionally, translational studies are also on the horizon, aiming to determine the potential therapeutic benefits of NADA, or other molecules, in the treatment of pain brought on by sleep deprivation. 

This research represents a significant stride towards unraveling the intricate relationship between sleep quality and chronic pain. By exploring novel avenues for pain relief, these findings hold promise for improving the lives of individuals struggling with the debilitating effects of chronic pain exacerbated by sleep deprivation. With a multidimensional approach, there is hope for more effective and targeted pain management strategies in the future.

Exploring Non-Narcotic Solutions for Improved Pain Management

According to some sleep experts, the study’s emphasis on utilizing a naturally occurring substance like N-arachidonoyl dopamine (NADA) to alleviate pain, rather than habit-forming narcotics, presents an intriguing and desirable alternative. Experts noted that the research underscores the profound impact of sleep deprivation on pain levels, as it leads to reduced levels of NADA, subsequently contributing to heightened pain sensations. This underscores the critical role of sleep in the body’s healing and regenerative processes.

It is also important to realize that NADA might also be implicated in chronic conditions such as Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, and epilepsy. Exploring this avenue in populations with these diseases could potentially yield more effective treatment options.

Other experts have also echoed the same sentiment, expressing a hope for pharmaceutical companies to take this research further. They envision the development of treatments that address the deficiency of NADA in the central nervous system, effectively modulating its function and potentially mitigating nighttime hyperalgesia in chronic pain patients. Such advancements could, not only enhance the quality of sleep for these individuals, but also help prevent an escalation of pain levels during this vulnerable state. Many other medical experts have also advocated for the extension of this research to human subjects and the subsequent development of pharmaceutical interventions in pursuit of this goal.

Proven Tips to Better Sleep Quality

Here are some tips to get better sleep: 

  • Establish a Consistent Sleep Schedule: Try to go to bed and wake up at the same time every day, even on weekends. This helps regulate your body’s internal clock.
  • Create a Relaxing Bedtime Routine: Engage in calming activities before bed, such as reading a book, taking a warm bath, or practicing relaxation techniques like deep breathing or meditation.
  • Limit Exposure to Screens: Avoid screens (phones, tablets, computers, TVs) at least an hour before bedtime. The blue light emitted by screens can interfere with your ability to fall asleep.
  • Create a Comfortable Sleep Environment: Ensure your bedroom is conducive to sleep by maintaining a cool, dark, and quiet atmosphere. Invest in a comfortable mattress and pillows.
  • Limit Intake of Caffeine and Nicotine: Avoid consuming caffeine and nicotine close to bedtime, as they are stimulants that can make it harder to fall asleep.
  • Indulge in Regular Exercise: Engaging in regular physical activity can help promote better sleep. However, avoid vigorous exercise close to bedtime, as it may be too stimulating.
  • Limit Naps: If you need to nap during the day, keep it short (20-30 minutes) and avoid napping late in the afternoon, as it may interfere with your nighttime sleep.
  • Watch Your Diet: Avoid heavy meals, spicy foods, and excessive liquids close to bedtime, as they can cause discomfort and disrupt your sleep.
  • Manage Stress: Practice relaxation techniques, such as mindfulness or yoga, to help calm your mind and reduce stress levels, making it easier to fall asleep.
  • Seek Natural Light Exposure: Get regular exposure to natural light during the day. Natural light helps regulate your body’s internal clock and improves sleep quality.
  • Avoid Watching the Clock: Staring at the clock can create anxiety about not being able to fall asleep, making it even harder to do so. Turn the clock away or remove it from view.

Remember, though, if you are consistently having trouble falling or staying asleep, it is important to consult a doctor to rule out any underlying sleep disorders or medical conditions.

Conclusion

Research has shown that inadequate sleep can lead to heightened perception of pain, decreased pain tolerance, and an overall heightened sensitivity to painful stimuli. This relationship highlights the importance of prioritizing good sleep hygiene for managing and preventing chronic pain conditions. Incorporating some good sleep habits into your routine can help improve the quality and duration of your sleep.

References:

  1. Suni, E. (2021). Sleep Statistics. [online] Sleep Foundation. Available at: https://www.sleepfoundation.org/how-sleep-works/sleep-facts-statistics.
  2. ‌Chattu, V.K., Manzar, M.D., Kumary, S., Burman, D., Spence, D.W. and Pandi-Perumal, S.R., 2018, December. The global problem of insufficient sleep and its serious public health implications. In Healthcare (Vol. 7, No. 1, p. 1). MDPI.
  3. Evbayekha, E.O., Aiwuyo, H.O., Dilibe, A., Nriagu, B.N., Idowu, A.B., Eletta, R.Y. and Ohikhuai, E.E., 2022. Sleep deprivation is associated with increased risk for hypertensive heart disease: a nationwide population-based cohort study. Cureus, 14(12).
  4. Van Cauter, E. (2021). The Impact of Poor Sleep on Type 2 Diabetes | NIDDK. [online] National Institute of Diabetes and Digestive and Kidney Diseases. Available at: https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/the-impact-of-poor-sleep-on-type-2-diabetes.
  5. Fernández-de-Las-Peñas, C., Fernández-Muñoz, J.J., Palacios-Ceña, M., Parás-Bravo, P., Cigarán-Méndez, M. and Navarro-Pardo, E., 2018. Sleep disturbances in tension-type headache and migraine. Therapeutic advances in neurological disorders, 11, p.1756285617745444.
  6. Vinstrup, J., Jakobsen, M.D., Calatayud, J., Jay, K. and Andersen, L.L., 2018. Association of stress and musculoskeletal pain with poor sleep: cross-sectional study among 3,600 hospital workers. Frontiers in Neurology, 9, p.968.
  7. Vinstrup, J., Jakobsen, M.D. and Andersen, L.L., 2020. Poor sleep is a risk factor for low-back pain among healthcare workers: prospective cohort study. International journal of environmental research and public health, 17(3), p.996.
  8. Sheffler, Z.M., Reddy, V. and Pillarisetty, L.S., 2019. Physiology, neurotransmitters.
  9. Ding, W., Yang, L., Shi, E., Kim, B., Low, S., Hu, K., Gao, L., Chen, P., Ding, W., Borsook, D. and Luo, A., 2023. The endocannabinoid N-arachidonoyl dopamine is critical for hyperalgesia induced by chronic sleep disruption. Nature Communications, 14(1), p.6696.
  10. Redmond, W.J., Cawston, E.E., Grimsey, N.L., Stuart, J., Edington, A.R., Glass, M. and Connor, M., 2016. Identification of N‐arachidonoyl dopamine as a highly biased ligand at cannabinoid CB1 receptors. British Journal of Pharmacology, 173(1), pp.115-127.
  11. Pinault, D., 2004. The thalamic reticular nucleus: structure, function and concept. Brain research reviews, 46(1), pp.1-31.
  12. Haack, M., Simpson, N., Sethna, N., Kaur, S. and Mullington, J., 2020. Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. Neuropsychopharmacology, 45(1), pp.205-216.
  13. Tang, N.K., Goodchild, C.E. and Webster, L.R., 2014. Sleep and chronic pain. In Treatment of Chronic Pain by Integrative Approaches: the AMERICAN ACADEMY of PAIN MEDICINE Textbook on Patient Management (pp. 203-217). New York, NY: Springer New York.
  14. Call-Schmidt, T.A. and Richardson, S.J., 2003. Prevalence of sleep disturbance and its relationship to pain in adults with chronic pain. Pain Management Nursing, 4(3), pp.124-133.
  15. Karaman, S., Karaman, T., Dogru, S., Onder, Y., Citil, R., Bulut, Y.E., Tapar, H., Sahin, A., Arici, S., Kaya, Z. and Suren, M., 2014. Prevalence of sleep disturbance in chronic pain. Eur Rev Med Pharmacol Sci, 18(17), pp.2475-81.
  16. Morin, C.M., Gibson, D. and Wade, J., 1998. Self-reported sleep and mood disturbance in chronic pain patients. The Clinical journal of pain, 14(4), pp.311-314.
Sheetal DeCaria, M.D.
Sheetal DeCaria, M.D.
Written, Edited or Reviewed By: Sheetal DeCaria, M.D. This article does not provide medical advice. See disclaimer
Last Modified On:November 27, 2023

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