Join Tonya Palermo discussing the One Thing she wants people challenged by pain to know about. Explore the current state of pain science research and clinical practice in this straight-to-the-point interview with Tonya.
About Tonya Palermo
Dr. Tonya Palermo is Professor of Anesthesiology and Pain Medicine at University of Washington with adjunct appointments in Pediatrics and Psychiatry. Dr. Palermo has been in Seattle since 2010 where she directs the Pediatric Pain & Sleep Innovations Lab. The focus of her research is on behavioral, psychosocial and family factors that affect pain experiences, the interrelationship of sleep and pain, and innovative psychological treatments for managing and preventing chronic pain. Here is her research profile.
Transcript
What’s the one thing that you want people challenged by pain to know?
Yeah, so I would like people challenged by pain to know not to ignore sleep and to understand the importance of good quality sleep for pain management. And it’s, it’s interesting because I think many years ago, sleep was seen as an expected consequence of having chronic pain. People who have pain know that it’s difficult often to fall asleep and to stay asleep because pain often interrupts sleep. However, over time, we’ve really learned that, in fact, sleep seems to have a bi-directional relationship where sleep loss and sleep deficiency can actually cause subsequent pain. And that’s really important for people with pain to understand because it’s not a consequence that can’t be modified. We can actually improve sleep. And we know a lot more now about this bi-directional relationship so that if we can effectively intervene with sleep, in fact, that can make a big difference in someone’s pain management. We’re really interested in helping people really understand what are those ways to manage sleep problems to then impact pain positively.
Sleep and pain share a lot of neurobiological systems that are important for both the management of pain as well as the management of sleep. And so for example, we know that there’s some shared neurochemical underpinnings. There’s also shared behavioural underpinning. We know that certain cognitions and emotions like anxiety and fear, can contribute to some difficulties with falling asleep and staying asleep. We also know those same types of emotions also can make coping with pain very difficult. So there are some definitely shared relationships. There’s also interesting laboratory studies that show that even in animals, if you sleep deprive an animal, and then you inflict pain, the sleep loss itself actually enhances pain sensitivity. So those animals respond with greater pain sensitivity, after having some nights of sleep loss. So there’s this really strong, you know, I’d call it a bio-behavioural connection between pain and sleep.
Yea, and so how do we intervene?
Yeah I think Identifying and assessing sleep problems is an important step. It’s actually not something that most pain practitioners are trained to do. We, again, have approached sleep in the past is just something that’s an unfortunate consequence of having pain. So it hasn’t always been carefully assessed to determine, you know, what is the nature of the sleep problem. There are different types of treatments, depending on the sleep problem itself. And so I think that identification and assessment is one important part. We’re also really just now learning whether or not the typical treatments for sleep problems will help patients who have chronic pain in the same way as patients who don’t have pain. Some of that work is still ongoing to really understand whether any differences or modifications are needed for those treatments.
Is there any practical tips for someone who may be watching this and has bad sleep? Like do they go and see a health professional, or should they try something first? What do you recommend?
Yeah, and so some of the most common sleep problems that individuals with pain really across the lifespan have are behavioural sleep problems. These are things that really fall under kind of an insomnia category, difficulties with falling asleep, with staying asleep, or with waking too early in the morning. And when that’s the primary sleep problem, there are very effective cognitive and behavioural strategies that can be used to help with sleep. Some of it is teaching people different habits around the actual sleep schedule that they’re keeping so that they aren’t getting into bed at times that aren’t optimising their sleep.
I’ll give you an example. One of the most common things that happens is when someone can’t fall asleep quickly, they start going to bed earlier to make up for what they know will be lost time in bed. And that habit of going to bed too early when you’re not actually ready for sleep can actually make insomnia worse and make it persist because it’s a habit, it’s really incompatible with falling asleep quickly. We’ve really worked on some of those habits around when someone enters the bed to fall asleep, and really help them kind of optimise that by working on when they’re naturally falling asleep. And then the second part of it is really lengthening the sleep period to be appropriate. Once we can break those habits and get someone actually fall asleep when they’re sleepy, then we really think about what is the optimal amount of sleep that this person should be getting, and can we help people come up with a schedule that really gives them the right amount of sleep.
Does sleep prevent pain from persisting or not?
Yeah, so there’s some longitudinal studies that really have shown that sleep problems have preceded the development of chronic pain. And this has been shown in cohorts of healthy otherwise healthy pain free individuals that those who have insomnia, for example, in childhood, actually are more likely to develop sleep problems in young adulthood. So it does seem that sleep plays a role that possibly can lead to future expression of pain. Now whether it’s protective hasn’t actually been studied; whether having good sleep, then in turn would protect someone from developing chronic pain in the future. But it’s likely that you would see both directions of that.
Wow. That’s so fascinating. Well, thank you so much for your time, and we really appreciate it.
Thank you.