If behavior changes and environment have not proven to be sufficient sleep aids, patients should discuss with their physician whether over-the-counter or prescription drugs should be used to treat their pain, improve their sleep, or both.
Practical pointIf a patient practices good sleep behaviors but regularly wakes up during the night because of pain, it could indicate an undetected medical condition that should be discussed with a physician.
Pain medication. These include analgesics (e.g. Tylenol), and non-steroidal anti-inflammatory agents (NSAIDs), such as aspirin, ibuprofen (e.g., Advil), naproxen (e.g., Aleve), and the new COX-2 inhibitors.
Stronger prescription pain relievers include muscle relaxants (generally used to treat muscle spasms) and antidepressants and anticonvulsants, which are sometimes used to treat nerve pain. Narcotic pain relievers are available but are generally used after surgery to treat intense pain.
Sleep medications. These can include over-the-counter drugs that have a sedating effect, like antihistamines, or combination pain reliever and sleep aids, such as Tylenol PM.
Hypnotics are stronger prescription medications that promote sleep, and fall into two classes: the benzodiazepines (e.g., Halcion or Restoril), and the non-benzodiazepines, benzodiazepine receptor agonists (e.g. Ambien or Lunesta). A new type of sleep medication, marketed as Rozerem, was introduced to consumers in 2006 and works by targeting the melatonin receptors in the brain that control the sleep-wake cycle.
Antidepressants (Antidepressant medications). Sometimes sleep disturbance in pain patients can be a result of untreated clinical depression. Other symptoms of clinical depression include appetite disturbance, decreased energy and motivation, lowered sex drive, crying spells, anxiety, lack of enjoyment, or problems with concentration and memory.
If you are experiencing these symptoms discuss the possibility of an antidepressants with your physician. Sleep disturbance should improve as the depression improves, beginning one to three weeks after starting antidepressants.
For more information on sleep medications, see Sleep Medications by Prescription and Treating Insomnia with Non-Prescription Sleep Aids.
While all these medications have been approved by the FDA, it should be noted that all have side effects which patients should consider, including the highly addictive nature of some pain medications and sleep aids. Also, combinations of pain and sleep medications may interact poorly, so caution should be exercised when using both types of drugs.
Managing Pain and Sleeping Well
Back pain regularly causes sleep problems, which can then delay healing or even make a back problem worse. Before deciding to use medications to treat their pain or sleep disorders, or in addition to medications, patients can adapt both their personal behaviors and physical environment to ensure each helps, not hurts, the chances of getting a good night’s sleep.