As part of a nationwide effort to address the widespread overuse and abuse of opioid pain relievers while simultaneously expanding knowledge on non-drug interventions, Washington State University has decided to lead a study to look at the relationship between chronic pain and sleep.
Marian Wilson, lead investigator and assistant professor in the College of Nursing at WSU, notes that physicians are being pressured to stop prescribing so many painkillers. New guidelines for prescribing medications, issued in 2016 by the Centers for Disease Control and Prevention recommend limiting the use of opioids in chronic pain patients.
Ms. Wilson began the research, noting that it is not fair to cut off pain relievers in chronic pain patients without having effective alternatives available.
While there is medical literature about sleep and pain, the topic has not been adequately studied. Previous research suggests there is a correlation, linking poor sleep to higher amounts of pain, but it is not clear which comes first. Is the pain worse because of sleep loss, or is sleep disrupted because of the pain?
The new grant given by the National Center for Complementary and Integrative Health (part of the National Institutes of Health) allows Dr. Wilson and colleagues from WSU Health Sciences in Spokane and the Department of Rehabilitation Medicine to study the topic over a two-year period.
The study will be part of a larger NIH-funded project focused on a veteran hypnosis-pain study. Dr. Wilson and team will collaborate with pain experts Mark Jensen and Rhonda Williams from University of Washington and the U.S. Veterans Administration Puget Sound Healthcare System. Additional sleep expertise will come from Dr. Hans Van Dongen, a professor at Elson S. Floyd College of Medicine and the director of the Sleep and Performance Research Center.
The parent study will focus on how effective self-hypnosis and mindful meditation interventions are in 240 veterans with chronic pain.
Ms. Wilson’s subproject about sleep and pain will review 135 veterans from the parent study. Each vet will do a sleep survey and wear monitoring devices for one week at three different times: before the intervention, immediately after, and then again three months after intervention.
Scientists will pair pain data with sleep data from the parent study to determine if improvements in pain are followed by or preceded by improvements in sleep, or if they happen simultaneously. This will serve as the first step toward developing treatments for sleep that will help with chronic pain.
Dr. Wilson has a passion for pain management. As a nurse scientist, while pursuing her Ph.D. in nursing, she reviewed a program that addressed the abuse of the emergency department by chronic pain patients seeking opioids. The program, instead of providing the prescriptions, referred patients back to their primary doctor, and it was considered successful in reducing the use of the emergency department in this patient population.
Wilson felt there was more that could be done to address the need for opioids in chronic pain patients, especially with regard to finding new ways to manage symptoms without drugs. She wrote her dissertation on the efficacy of self-management programs online for those with chronic pain, with the added benefit of reduced use of opioids.
Recently, Wilson performed a study that provided the online self-management program to chronic pain patients who receive methadone in place of an opioid drug. She performed extensive interviews with patients to get a better understanding of why they ended up addicted to the opioids and what they felt could be done to self-manage their pain and addiction symptoms.
Those study results have not been fully reviewed; however, Wilson still notes that something has to change with regards to the overuse of opioids in pain patients.
People are being sent home with a month’s supply of opioids after minor surgeries and tooth extractions, and it only takes two weeks of consistent opioid use to lead to dependence. This means that almost every household in America has opioids in the cabinet, and people are becoming addicts at rapid rates, leading to the need for methadone interventions. The idea of this new study is to start to find ways to prevent opioid overuse and dependence by concentrating on sleep.
Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development. Her hobbies include hiking in the Rockies, cooking, and reading.
© 2021 American Sleep Association.