CRPS Associated with Sleep Disturbances

Chronic pain including CRPS/RSD has become the most common reason for outpatient medical visits. Treatment of chronic pain syndromes (CRPS) and the habitual use/need of opioids have dramatically increased in the past 2 decades. Between 1990 and 1996, the long-term use of oxycodone increased by 23%, hydromorphone use increased by 19%, morphine use increased by 59%, and the use of fentanyl increased 1168%.  This dramatic rise in habitual narcotic use has continued, and the long-term use of opioids more than doubled from 2000-2008.

A bidirectional relationship exists between pain (CRPS patients) and sleep disturbances.  Pain from CRPS fragments sleep continuity, impairs sleep quality, and disrupts normal sleep architecture. Reciprocally, poor quality or insufficient quality of sleep may decrease the pain threshold, impair recovery from injuries, or further exacerbate the pain response.  Thus, as you can see the disturbance in sleep for a CRPS patient or any Chronic Pain patient produces a harmful pattern that only perpetuates the pain cycle.

Painful stimuli produce microarousals, which disrupt sleep continuity and alter normal sleep. Chronic pain or CRPS is associated with increased high frequency EEG activity and a decrease in slow frequency EEG activity. Furthermore, CRPS is associated with the appearance of alpha waves superimposed on slower EEG frequencies, or "alpha-delta" sleep.  In short, pain produces a state of shallow sleep while disrupting restorative slow-wave sleep.

Information from Industry

An estimated 28 million Americans have sleep complaints due to chronic pain syndromes, including CRPS. Among patients with chronic pain, more than 50% experience sleep disturbances, some reports say as many as 70%-88% of patients with CRPS report sleep trouble.  Sleep disturbance shows an independent and linear correlation with pain severity, even after controlling for health measures and sleep habits.

Sleep complaints portend worse outcomes among those with chronic pain or CRPS.  Compared with patients who have no sleep complaints, patients with chronic pain - CRPS and insomnia report poorer quality-of-life indices and have increased healthcare utilization.

In patients with CRPS/RSD, complaints of poor sleep quality and fatigue are just as prominent as complaints of pain.  Similar to other conditions, sleep quality and the pain response share a reciprocal cause-and-effect relationship. Among patients with CRPS/RSD, a poor night's sleep predicts more pain the next day, and more pain predicts greater sleep impairment that night.  Patients with CRPS/RSD frequently experience nonrestorative sleep and alpha-wave intrusions are commonly observed during polysomnography. The prevalence of insomnia, restless legs syndrome (RLS), and hypersomnia are higher among patients with CRPS/RSD than within the general population.  Similarly, OSA is significantly more common, with observed rates of 46%-80% reported among patients with CRPS.

Conclusions

CRPS and disrupted sleep are commonly associated, and they share a clear cause-and-effect relationship. Pain fragments sleep, and poor sleep worsens the pain response. The prevalence of sleep disorders and the number of patients experiencing chronic pain continue to increase. Finally, pain and sleep disorders are among the most common reason for medical care. It is important to understand these conditions and appreciate the intimate relationship they share.

It seems clear that long-term narcotic use causes, precipitates, or exacerbates sleep-disordered breathing; as the use of these agents continues to grow, so will the number of individuals with opioid-induced apnea. Prompt recognition and appropriate treatment will probably improve outcomes and quality of life. It may also reduce overall healthcare utilization and aid in controlling pain.

Unfortunately, until there is a true treatment to put CRPS into remission, there will be a need for opioids or some type of medications to assist CRPS patients deal with the unrelenting pain they dealing with on a continual basis.  If your sleep is continuing to get worse please speak with your physician to ensure that you’re not dealing with “Opioid Sleep Apnea”.

Please feel free to contact me for additional information on CRPS / RSD at rsd.crpsforum@gmail.com, or feel free to leave a message here on the blog!