Contact: Daniel S. Lewin, PhD
(412) 624-2940
dlewin@idt.net

Sleep Plays Role in Managing Childhood Chronic Pain

Sleep is an important and often-overlooked factor in the care and comfort of children with painful chronic illnesses, new research shows.

Daniel S. Lewin, PhD, and Ronald E. Dahl, MD, scientists at the Western Psychiatric Institute and Clinic, Pittsburgh, reviewed several aspects of sleep regulation relevant to pediatric pain management.

"Pain from illnesses such as juvenile arthritis and sickle cell disease can disrupt children's sleep, leaving them tired, in a poorer mood, and less motivated to do things that might help in their physical and psychological recovery," said Lewin. "In turn, sleep loss may leave children more sensitive to pain sensations, which can further erode sleep—setting up a vicious cycle between sleeplessness and increasing pain."

"There is mounting evidence that adequate sleep is essential for optimal physical health," said Lewin. Neurohormones thought to be critical to normal physical development and repair of damaged tissue are released during sleep, for example. At sleep onset there is a reduction in the release of stress hormones, like cortisol, and during sleep there is a dampening of the effects of stress, such as chronic pain, on the immune system. The research appears in the current issue of the Journal of Developmental and Behavioral Pediatrics.

Sleep disturbances can also have profound effects on children's mental well being. Increased sleepiness and fatigue may sap children's motivation to exercise or partake in other activities that help distract them from the pain they feel. They also may become more irritable, more easily frustrated, and less able to concentrate.

"Studies in adults suggest that sleep deprivation may even increase people's perception of pain, rendering them far more sensitive than if they had received adequate rest," said Lewin.

Fortunately, many of the behavioral treatments used to combat pain can also be applied to improving children's sleep. Relaxation techniques, for example, can lessen feelings of pain and reduce anxiety that may interfere with sleep. Distraction techniques, like counting backwards by threes, are useful both in getting children through pain flare-ups and in helping them to initiate sleep. Techniques that help children to counter negative, irrational thoughts, such as "I'll always be in pain," or "I'll never get to sleep," are similarly effective.

The researchers speculate that long-term sleep deprivation may be one important factor in the development of chronic pain conditions in some children.

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The Journal of Developmental and Behavioral Pediatrics is published bimonthly by the Society for Developmental and Behavioral Pediatrics. For information about the journal, contact Mary Sharkey at (212) 595-7717.