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A neuroscientist explains: Resetting the relationship between sleep and chronic pain

Sleep

BY CHRISTINE OZOLINS

When patients use a treatment that our Kiwi neuroscience company has designed for the relief of chronic pain, there is one knock-on benefit that most of our patients notice first.

It’s something most of us want more of but can’t always get, the biological origins of which are still being understood. Something that if we were all doing well, would transcend eight productive hours and promote wellbeing through its many benefits.

It is, of course, a good night’s sleep. In fact, 94% of participants of our clinical trial in the UK reported an improvement in sleep, followed by a reduction in anxiety (90%) and the remarkably positive effect of reduced feelings of depression (100%).

Chronic pain sufferers often report higher levels of pain after lack of sleep, broken sleep, or poor sleep quality¹. People with sleep dysfunction also appear to be at a higher risk of developing chronic pain conditions like fibromyalgia and migraines, and diseases of the brain such as dementia.

The link between sleep and pain is unquestionable but emerging evidence suggests that the effect of sleep on pain may be even stronger than the effect of pain on sleep.

The relationship between sleep, anxiety, depression and chronic pain is a self-perpetuating cycle that is difficult to break. The limbic system is the part of the brain involved in our behavioural and emotional responses and that controls our fight or flight response.

When someone is in a constant state of pain, they are in a fight or flight response mode. This causes the release of adrenalin, which can cause anxiety. The hypothalamus determines our quality of sleep and if flooded with adrenaline, our sleep is likely to be disrupted. Lack of sleep then leaves you vulnerable to experiencing low mood and greater levels of pain which can lead to the further release of adrenaline… thus continuing the destructive cycle.

So, what is sleep and why is it so important to the treatment of pain? 

For a long time, it was thought the brain was inactive during sleep, but neuroscience has discovered that human sleep is far more complex. Sleep is divided into two separate and distinct states: rapid eye movement (REM) and non-REM sleep. Both are equally important in maintaining physical and mental homeostasis – the self-regulating process by which we maintain stability while adjusting to conditions that are best for our survival.

If these sleep states are interrupted, chronic pain sufferers can experience extreme and disabling fatigue.

Non-REM sleep is important for both brain and body restoration. It is the key phase of sleep that is associated with physical healing, dealing with stress and recovery from illness. People who experience chronic pain can find it hard to fall into non-REM sleep and are in turn robbed of the crucially important healing state that their body so badly needs.

REM sleep is considered “active sleep” because brain activity and EEG patterns are similar to brain activity when we are awake. REM sleep is important to the consolidation of information, the development of memories, and is especially important for psychological wellbeing².

It is in REM sleep that we believe new neural pathways are created and reinforced after training with the Axon system. When our patients use EEG neurofeedback, they are creating and strengthening new neural pathways. The old neural pathways take a while to recalibrate, and it takes time for those changes to become embedded. REM sleep is fundamental to this process. It allows patients’ brains to start making big changes that can promote the brain to heal itself through neuroplasticity.

Several factors can disrupt our sleep states including caffeine, alcohol, body temperature, blue light from electronic devices, and medication. For chronic pain sufferers who are often taking regular medication for pain, depression and anxiety, such as opioids, NSAIDS and anti-depressants, the effects can be profound.

It is our hope, that as our medical technology, known as Axon, continues to promote better sleep, reduce anxiety, and enhance mood, we will see patients reduce their reliance on medication for all of these ailments and establish healthy sleep patterns. The self-perpetuating cycle will become a positive one, where better sleep promotes healing, reduces anxiety, enhances moods, reduces pain which supports sleep and healing… you get the idea.

We are still exploring how often patients will need to use Axon for the treatment of chronic pain, however early indications suggest that the brain can respond to a “booster” session using the Axon to remind the brain of its new pathways to respond to chronic pain, in the same way that you get a booster to protect you from the COVID-19 virus.

And the best way to consolidate that memory? A good night’s sleep.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449130/

[2] https://www.sleepfoundation.org/mental-health#:~:text=Sufficient%20sleep%2C%20especially%20REM%20sleep,consolidation%20of%20positive%20emotional%20content.

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