This Week’s Topic:
There is actually a four way relationship between sleep and pain:
a. As you know pain can disrupt sleep onset, duration and architecture (structure of the sleep)
b. Narcotic pain medication can change sleep architecture such that sleep is not restful/restorative.
c. One of the cardinal signs of depression is a change in sleep architecture, most commonly early morning awakening and/or periods of seeking excessive sleep.
d. Deprived of sleep, the experience of pain becomes less bearable and more incapacitating.
There are, therefore, several things you should do:
a. Order a psychological evaluation to determine if the patient is depressed and the source(s) of the depression
b. Be certain that the examining psychologist is aware of the medication regimen, including pharmacy records
c. Ask the examining psychologist to obtain a sleep history from the patient including day time naps or change in sleep patterns and habits
d. Determine what assistance the patient needs with sleep (medication changes, relaxation therapies, sleep structure or even sleep studies)
The pain-medication-sleep-depression relationship may be the key element in why the patient is either not recovering or not adapting to their pain. It often also explain why the pain complaints “seem” disproportionate to the clinical findings.