One night of bad sleep can throw us off for days. It disrupts our energy levels, our ability to think clearly, and even our digestion. People that suffer from insomnia know that when caught in a spiral of poor sleep, stress and fatigue our ability to function the way we would like to is severely limited.

The relationship between pain and sleep is even more complex: pain can keep you up at night or make it very hard to fall as sleep, but at the same time poor sleep can raise the threshold for sensations making your experience of the pain worse than before.  A large scale Norwegian study  recently examined the connection between pain and sleep disturbance and found that patients reporting problems with both insomnia and chronic pain were more than twice as likely to have a lower tolerance to pain than other chronic pain patients. This study was the first general population study of its kind, calling for a more targeted effort towards sleep improvement in chronic pain patients.

So where do you start? There are a few habits that you can try out tonight to help you break the vicious cycle of pain and poor sleep; addressing both the chicken and the egg. Acknowledging the importance of good rest for your pain management and giving these tips a try are already proactive steps that will set you on a path to improvement.

Find your favorite routine

When you fear that you pain will disturb your sleep, it is common to have anxiety around going to bed. Developing a routine that you enjoy can be a nice distraction and something that you and your body can look forward to. Music, a warm bath, mindfulness techniques, breathing exercises,  and light reading all can relax you well before you are tucked in to bed.

Keep it cool

Even as the winter approaches, it is easier to fall asleep if your bedroom is cool. Check that your thermostat is at 65 degrees or lower before you get into bed.

Limit Screen-time

Looking directly into a bright light for most of the day ( computer, smartphone, tablet) disrupts our circadian rhythms making it more difficult to fall asleep at night. It is tough to break the habit of looking at our phones in bed, especially since it can serve as an alarm clock. Yet, avoiding screens for at least 45-60 minutes before closing your eyes can make a huge difference on the time it takes to fall asleep and the quality of the rest we are getting.  Is that last text message or email worth a whole night of restless sleep?

Get in a supported position

The Mayo Clinic has a series of photos of helpful positions for sleeping with back pain. These simple recommendations, easily achieved with just a well placed pillow, can protect your back from strain while you sleep.

Wind down naturally

If our system is stimulated it is very difficult for it to find a restful state. Avoid caffeine and alcohol in the later part of the day (after 2pm). This includes, coffee, tea, green tea and chocolate.

Check in with your physician or specialist

If you are not able to break the pain/insomnia cycle it is worth a visit to your doctor to make sure that the pain medications you are taking are not disrupting your sleep and to rule out any other underlying causes.


Exciting new research has recently emerged regarding the impact of mental imagery on reported pain levels, which could open new paths for research and treatment.

For patients living with chronic pain, it’s probably old news that pain can be different on different days, during different activities, or even when a patient is in different moods. This is because there are both physical and emotional components to pain, transforming a very intricate and precise firing of neurons into a varied and personal subjective experience. We know that these signals can be interrupted and diminished by drugs, physical therapies,  and new advances in technology

In a study conducted with 40 healthy volunteers, participants were stimulated on their arm with different temperatures and asked to rate their experience of pain on a scale of 1 to 100. For each temperature stimulus, a photo of a person’s face was shown to the participant on a screen. The research consisted of two parts: In the first part participants were shown the faces with the matching temperatures repeatedly, conditioning the group to associate the image with the level of pain reported. This part was essentially a classical test of the placebo effect, where the participants would expect and then report a level of pain that they associated with the image, even if the stimulus was changed. In the second part, the image was shown for 12 milliseconds and then masked, too fast to be perceived by the conscious mind. The researchers found similar results in the second experiment, indicating that the mechanisms in the brain responsible for the placebo effect can work without the person being consciously aware of the cues.

Mindfulness meditation is a process where calming the body, eliminating stress and recognizing pain signals as they occur allows patients to control how strong these impulses are interpreted by the brain. We mentioned use of mindfulness meditation techniques on the blog earlier this year.  This mental exercise technique uses guided visualization to bring awareness to all parts of the body. This is an active process, where the patient is imagining specific images that promote relaxation.

What sets this new research apart is that it questions whether or not the brain can respond to mental images without the person being conscious or aware of what they are seeing and ultimately determining if the unconscious mind can be trained to affect pain responses.

The conscious mind is sometimes described as the tip of an iceberg, with the larger unconscious mind lying beneath the surface of the water. What if treatments could target this submerged underworld?

If you are interested in reading more about the study the  full text  is available online.


Some recognizable examples of Nonsteroidal anti-inflammatory drugs (NSAIDs) include ibuprofen (Advil, Motrin), diclofenac, and  naproxen (Aleve).  They are frequently used as the first line of defence to reduce pain and inflammation.  Most NSAID medications are available without a prescription and are widely used to reduce fever and pain related to long- and short-term medical conditions such as headaches, arthritis, menstrual cramps, and flu symptoms. However, just because they are available without a prescription does not mean that they are 100% safe. New labeling requirements have raised awareness of potential risks for the estimated 30 million Americans taking nonsteroidal anti-inflammatory drugs each year.

The Food and Drug Administration has recently strengthened its warning on NSAIDs due to recent studies that shows even small amounts of NSAIDs present a risk of heart attack, heart failure, or stroke. The updated warning is a result of a growing body of research into these widely used over the counter (OTC) drugs. While it was always presented as a risk, the new strengthened warning clarifies that NSAIDs may increase the risk of heart attack or stroke in all patients, with or without heart disease or risk factors for heart disease as previously thought.  Those with risk factors of heart disease should be particularly cautious because they are already at a higher baseline for such complications. The FDA will require new labels to reflect this developing research.

Should you worry? Not if you are using these medications as directed. There seems to be a consensus from the medical community that more studies are needed before we empty out our medicine cabinets. Bruce Lambert, director of the Center for Communication and Health at Northwestern University, who specializes in drug safety communication shared his comments with the New York Times, “One of the underlying messages for this warning has to be there are no completely safe pain relievers, period.” Another article for NPR highlights the general rule of using caution with any medication.

Although the FDA’ s  new warnings need not cause alarm, the announcement is an important reminder to the millions of people that use NSAIDs on a daily basis that misuse or overuse of OTC drugs could result in severe health consequences. Patients that rely on these OTC painkillers long term should talk to their health care providers about reasonable alternatives.


The latest from the Apollo Blog outlines very interesting and encouraging interim research about chronic pain patients who are using opiates (pain killers) as their main way to manage their pain: a significant number of patients who are on addictive pain killers are reporting using less of those drugs while on the medical cannabis available through the Apollo program.

Also very interesting: a clinically significant number of their patients are offering lower numbers on pain scores, leading us to think that they are finding some relief for their pain when other types of treatments are failing.

According to a preliminary analysis of Apollo patient data, 27% lowered their use of opioid medications, which included Percocet, methadone and oxycodone. Across all patients, a significant average pain reduction score of 30% was reported.

Through the research, we are proud to present that 54% of patients showed a clinically significant reduction in pain score. Clinical significance is present when a pain score reduction of more than 30% is reached. Patients at or above this level saw an average reduction in pain score of 45%.

As a practice that is keen to see the world not just improve the way it manages pain, but better manage addictive medication, we see this as a major development for patients looking to manage pain without the challenges of high-dose narcotics.

Several Allevio physicians work closely with and are actively referring into the program.


More than managing headaches and chronic pain, Allevio is here to help you get your life back. Our services are completely geared to offering you the best relief available.

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