Founder of Health Rising and Phoenix Rising
Sleep is turning out to be a bigger factor in pain that most people realized. Most people in chronic pain get poor sleep - that's understandable - but what's more surprising is that half the people who suffer from insomnia also suffer from chronic pain. It turns out that poor sleep is actually more predictive of having chronic pain than chronic pain is predictive of having poor sleep.
The takeaway is that if you want to reduce the pain you're in one good way to do that is to get better sleep. [fright]
Positive emotions confer resilience against chronic pain. When subjected to an acute stressor people who were able to maintain their positive outlookexperienced less pain than those who could not.
The downside is that if you're not getting enough sleep it's appears that it's doubly hard to generate positive emotions. Continual sleep disruption, in particular, appears to inhibit one's ability to generate positive emotions; i.e. positive effect.“Among patients with chronic pain, those who are able to generate positive emotions tend to adapt better to their pain conditions and have better outcomes, such as lower pain levels, better physical function, and more prosocial behavior,”
Where does this "positive effect" come from? The dopaminergic reward system - a system that has been implicated in both chronic fatigue syndrome and fibromyalgia. Dopamine regulates arousal, sleep and reward. It turns out that fatigue is highly associated with reduced dopamine activity in ME/CFS. Throw together poor arousal and minimal reward plus sleep deprivation and you've got a real problem. Add in the pain sensitization that may result from poor sleep and you've got a multidimensional problem."Several studies have shown that sleep loss leads to impaired positive affect, without appreciably changing negative affect, indicating that sleep loss might sap patients of good feelings and render people more vulnerable to pain.
One researcher suggested that augmenting therapies like acceptance and commitment therapy (ACT), and mindfulness-based stress reduction (MBSR) (and yes, CBT) with a focus on helping people generate and maintain positive emotions could be helpful. There's little doubt about that but there is another problem...
It appears that inflammation could start the whole sleep, pain, low reward (low dopamine) process. Miller found that increased levels of phenylalanine and reduced levels of tyrosine (the precursor to dopamine) were associated with increased fatigue (but not depression) in hepatitis C patients treated with IFN-a. That finding suggested that immune activation could be knocking down dopamine production in those patients and possibly in ME/CFS patients. Why ME/CFS patients? Because the same inflammation induced dopamine problems appear to be occurring in ME/CFS.
The low reward/increased pain scenario, then, probably has to include inflammation triggered dopamine reductions. That suggest that one key may be reducing inflammation. Supplements such as folic acid, L-methylfolate, and S-adenosyl-methionine (SAMe) that upregulate dopamine production could also be helpful. Other possibilities include new drugs being developed to block upregulated kynurenine pathways which whack dopamine production while raising hell with the microglia.
Meanwhile, creating a positive outlook which replaces frustration with what's been lost and fear at what might lie ahead with gratitude and acceptance can itself help to reduce inflammation at least somewhat. Above all try and get the best sleep you can.
The good news is that all these issues - increased pain, poor sleep, the difficulty in maintaining positive outlooks and the reduced dopamine/reward problems - may all be interlinked and the linkages are being uncovered.
Read more: Dopamine, the Basal Ganglia and Chronic Fatigue Syndrome #II – Treatments