In Burn Cases, both Pain and Sleep Onset Insomnia predicted pain chronicity and their model suggested that the sleep problem was beyond what one would expect from the pain
Pain. 2008 Sep 15;138(3):497-506.
Sleep onset insomnia symptoms during hospitalization for major burn injury predict chronic pain.
Smith MT, Klick B, Kozachik S, Edwards RE, Holavanahalli R, Wiechman S, Blakeney P, Lezotte D, Fauerbach JA. abstract
Sleep Onset insomnia
lack of college education
would independently affect followup incidence of chronic pain
Comment – Lack of sleep begets pain and visa versa – what they call mutual maintenance. I believe lack of sleep needs to be treated agressively and opioids are the best bet there. Amitriptyline is an old classic for that as well. Part of the effect of Lyrica appears through sleep promotion. Zanaflex, a muscle relaxant, also is a help there. Looking for sleep apnea is a must and I believe all pain patients with sleep issues should be checked, particularly now that it appears opioids can aggravate it . It can be done privatedly in Regina by Vitalaire (noctural oxymetry ?$75) nad Prairie Oxygen (nasal, oxygen sensing, and chest ?$170)