IS INDIRECT TREATMENT OF CENTRAL PAIN THROUGH DIRECT TREATMENT OF SLEEP HELPFUL?
All medical professionals prefer to use data which has passed the gates of study design, with due consideration to a truly representative sample of patients, elimination of confounding factors, conflicts of interest, appropriate statistics etc.
Unfortunately, the study which conforms perfectly to all of the desired boundaries has never been done and likely never will be done. The review boards and editorial contributors attempt to come as close as possible, but opportunities for error always creep in.
So, while recognizing the extreme limits of anecdotal evidence, there is probably no other type of data which can be presented at this time. The alternative to comment, which admittedly risks error, is that nothing, ever be written about Central Pain.
Central Pain has no vocabulary, no vernacular, no descriptive terms on which all mankind may agree as to meaning, since by definition, only those with Central Pain have felt some of these sensations. If one is dealing with alien or bizarre patterns of pain sensation, it is not possible to ask questions of patients which all agree have hit the nail on the head.
With that caveat, we have received reports that sleep deprival is an important factor in dealing with Central Pain. Speaking generally, many report that pain medicines simply do not result in satisfactory treatment. In the end, the CP sufferer finds himself or herself compelled to go on a one man plan to survive. Increasingly, the patients report that since they cannot manage the pain, they MUST find a way to manage their lives so as to minimize the pain consequences.
If we are to credit the reports, admittedly not ready yet for publication in a prospective study, it would appear that adequate sleep time is essential to combat the emotional onslaught that confronts the patient with severe Central Pain. Without sufficient rest, the mood drops significantly, pain is more potent, depression and even hopelessness are almost certain to follow.. The considerable mental effort necessary to deal with elaborated Central Pain cannot be sustained without sleep. In some cases, patients have indicated that treating sleep loss was the most important benefit from the pain clinic. The indirect address of pain through treating sleep loss sounds a bit extreme, but repeatedly we hear from patients that pain which is overwhelming in the middle of the night drops considerably the following day if only some sleep can be accomplished.
Sleep is compromised in various ways in Central Pain. In the severe cases, where light touch evokes the dysesthetic burning of CP, the touch of sheets prevents a sleep posture where one can fall asleep. If some somnolence is achieved , it is interrupted by burning from contact with the sheets and so a cycle begins through the long night which is more or less torturous. If a little sleep can be provided, when the sun comes up a little light at the end of the day’s tunnel appears, which buoys the spirit sufficiently to go on. Sleep is particularly important for someone whose mental and emotional accounts have been raided and nearly emptied by the brutality of burning dysesthesia, kinesthetic dysesthesia, lightning pains, pins and needles,, and other inventions of the deranged and dangerous pain system.
While sleep medications are diverse, and exercise when possible may help, even with the cruel and disabling muscle pains of CP, there are medications which assist sleep, even when no analgesic can be found to treat the pain. While side effects and dependency issues must be considered, it is not usually necessary to resort to exotic medicines to find something which works. The benzodiazepines have been used because they have the additional aspect of relieving some of the dysesthetic burning in some individuals.
There is always a cost to sedation, and sometimes it is a heavy one. Important decisions may pass you by. The choices and interactions which life entails can be mishandled or go unrecognized entirely. A patient on chronic sleep meds should be cautioned about assessment of and appropriate reactions to life’s challenges, family concerns, and personal planning. Still, despite any negative medication result, the operations of effective living are facilitated by sleep. And more importantly, the terrible pain which is sure to come calling on wakefulness can perhaps be held at bay if there is some emotional strength left, drawn from an account where sleep has made a deposit.
If you are lamenting the failure of your pain meds to relieve your Central Pain, it may be that the sleep you managed to get the night before is more important to you than analgesics. While pain meds are not always effective in CP, the sleep meds may be able to help. Managing your life with CP means avoiding stress and as Shakespeare reminded us. sleep “knits up nature’s raveled sleeve of care”. You may have bad dreams about burning or pain or whatever when you sleep, but regardless, you will have more energy if you have slept.. Sleep can be an alternative fuel for pain meds. If finances permit, find a good sleep surface, the right sheets, the right ambient temperature, the right quiet, and whatever else promotes falling and staying asleep. It won’t work completely if you are in terrible pain, but partial relief can make the difference between abject depression and something of a good attitude..
Commonly chosen meds include Klonopin or even plain old Valium. These are comparatively heavy meds, but we have not received reports of addiction with these drugs, although the possibility must be allowed for. In the meantime, talk with your health care provider about your sleep patterns. Small things can lead to big results and this is an area where medicines are available with supervision by a provider.
As always, information here is for educational purposes only and is not medical advice.. Never rely on a website or the internet where your health is concerned. Contact your personal physician for actual medical information.