Back pain can disrupt sleep and not enough sleep can increase the sensation of pain. Dr. Florian Brunner, Chief of Physical Medicine & Rheumatology at Balgrist University Hospital, says how you can break the vicious circle.
Dr. Brunner, what type of back pain do your patients suffer from most frequently?
Clarifying the cause of back pain is generally a challenge. This is because eight out of ten patients do not have any structural explanation for their pain. In other words, tissue damage which could aid diagnosis, is as a rule not identifiable. It is then about asking targeted questions and performing a detailed physical examination, in order to determine the cause of the pain.
What therapies do you prescribe for your patients?
It largely depends on the individual patient and case. First and foremost, there is always a need to keep the patient active so that they can cope with everyday life. The most important thing is helping others to help themselves. In other words, we offer active exercise therapy which teaches patients to integrate various exercises into their daily routine. This could be strength training or swimming – anything which stimulates the cardiovascular system, muscle building and the metabolism. Moreover, depending on the case, physiotherapy, chiropractic or osteopathy could be indicated.
When do you prescribe medication?
Depending on the type and degree of pain, we prescribe traditional painkillers, remedies for nerve pain or pain-modulating medication which belong to the group of antidepressants. At the same time, concomitant therapies may be indicated such as hypnosis, meditation or pain psychology.
How can back pain affect sleep?
In principle, the question here is: what came first? Is it the sleeping disorder which increases pain or does the back pain prevent us from sleeping? In principle, it is a vicious circle: chronic sleep deprivation can increase the sensation of pain, and the pain in turn negatively impacts sleep.
How do I solve the sleeping problem?
We try to break the vicious circle, first and foremost with non-drug therapies such as autogenic training and relaxation exercises. We sometimes also prescribe herbal remedies. Antidepressants or sleeping pills are really only prescribed in exceptional cases.