• Dr. Andrea Romera Rabasa, a specialist in the Pain Unit at Ribera Covadonga Hospital, emphasizes the importance of an interdisciplinary and biopsychosocial approach to patients, combining physical exercise, reh huhabilitation, psychological support, and personalized medical treatments.
• The Ribera Covadonga Hospital commemorates World Fibromyalgia and Chronic Fatigue Syndrome Day and reminds us that chronic pain already affects nearly nine million people in Spain, which is equivalent to 26% of the adult population.

Hospital Ribera Covadonga, a healthcare reference center of the group Ribera In Asturias, the commemoration of World Fibromyalgia and Chronic Fatigue Day is being commemorated, focusing on the need to recognize chronic pain as a complex disease that requires specialized care, an interdisciplinary approach and a comprehensive view of the patient.

“Chronic pain is not simply a symptom that accompanies another disease. Today we know that it is a clinical entity in its own right, and that it requires doctors specifically trained in it,” explains Dr. Andrea Romera Rabasa, anesthesiologist and pain treatment specialist at the Pain Unit of the Ribera Covadonga Hospital (Gijón).

Chronic pain was officially recognized as a distinct disease in 2019, when the International Association for the Study of Pain (IASP) and the World Health Organization (WHO) included it in the International Classification of Diseases. Currently, chronic pain is defined as “pain that persists beyond the usual healing time or lasts for more than three months.”

A silent disease that affects millions of people

Dr. Romera points out that chronic pain has become a true “silent epidemic.” According to international data, one in five adults worldwide suffers from moderate to severe chronic pain. In Spain, it affects approximately 26% of the adult population, that is, nearly nine million people.

“The real impact of chronic pain goes far beyond the physical. It affects rest, family life, the emotional sphere, work, and social relationships. Many patients end up isolating themselves because living with pain affects absolutely everything,” she points out.

The specialist insists that chronic pain must be understood from a biopsychosocial perspective, which considers physical, psychological, and social factors. “There is a bidirectional relationship between pain and emotions: fear, anxiety, or stress can amplify pain, and pain itself, in turn, generates more emotional suffering,” she explains.

A comprehensive and personalized treatment

Dr. Romera insists that there are no miracle cures for chronic pain, but there are treatments capable of significantly improving the patient’s quality of life and functionality. “In Pain Management Units, we don’t promise to make pain disappear overnight. Our goal is for pain to stop controlling the patient’s life,” she states. Treatment, she explains, should include adapted physical exercise, functional rehabilitation, proper nutrition, psychological support, and, when necessary, advanced interventional techniques and individualized pharmacological treatments.

Among the most innovative techniques are knee denervation in certain cases of osteoarthritis or infiltrations in patients with sciatica, alternatives that sometimes allow avoiding more aggressive surgeries.

Fibromyalgia: a real and still misunderstood disease

Coinciding with World Fibromyalgia Day, Dr. Andrea Romera dedicates part of the interview to this disease, which continues to be one of the most misunderstood pathologies related to chronic pain.

“Fibromyalgia has historically been a stigmatized disease because conventional diagnostic tests showed no abnormalities. This led many patients to feel questioned or misunderstood,” she explains. However, scientific advances in recent years have demonstrated that the pain in fibromyalgia is completely real and is related to central sensitization phenomena.

“We know that the central nervous system amplifies stimuli and processes normal signals as if they were painful. It’s as if the body’s alarm system were permanently activated,” he notes. Furthermore, recent research has also pointed to the role of the immune system in the development of the disease.

The specialist points out that fibromyalgia not only causes widespread pain, but also intense fatigue, sleep disorders, concentration problems, and what many patients describe as ‘brain fog.

How to Beat Insomnia When You Have Chronic Pain

Ah, elusive sleep. Insomnia. Many of us have been there. For people with chronic pain — whether from back pain, fibromyalgia or the pain of cancer treatment — sleep issues are especially common, and pain is one of the most common causes of insomnia. Up to 2/3 of patients with chronic pain conditions also experience sleep disorders.

Pain worsens sleep patterns and sleep disturbances worsen pain. It’s a vicious cycle,” says pain specialist Robert Bolash, MD. These problems can range from difficulty falling asleep to difficulty staying asleep. And without good sleep, this can lead to heightened pain and worsening sleep.

Treating insomnia can help your chronic pain subside. But before treating insomnia, it’s important to rule out other issues that could be causing your sleep struggles, says sleep specialist Michelle Drerup, PsyD.

“Sometimes, after receiving a new

diagnosis, it’s common for people to struggle with other disorders that can affect sleep, like depression or post-traumatic stress disorder,” she says.

If you struggle with insomnia, it can also be caused by a sleep-related medical condition, like sleep apnea. When your sleep quality is poor, your pain levels are exacerbated. “At times, we see patients with pain diagnoses who really have a medical condition such as sleep apnea. When their sleep apnea is treated, their pain diminishes as well,” Dr. Bolash explains.

Those are the simple cases. But more often, treating pain and insomnia requires a team approach with help from different medical specialists. “We know that certain pain medications can improve sleep, and we prescribe these for those who have both a sleep disorder and a specific pain disorder,” says Dr. Bolash. “However, we must use caution with opioid pain medications, which can disrupt sleep and prevent patients from entering deep sleep after as little as one dose,” Dr. Bolash says. Opioids can also cause sleep-related breathing disturbances.

He adds that once easily reversible causes — from drinking too much caffeine to using opioids — are stopped, behavioral therapy is often the next treatment of choice.

First: Understanding the insomnia

To understand how chronic pain might make it difficult to fall asleep, it is helpful to think about your bedtime routine. Most people will eliminate distractions in order to relax and fall asleep, including things such as turning off lights, making it quiet and getting comfortable.

First: Understanding the insomnia

To understand how chronic pain might make it difficult to fall asleep, it is helpful to think about your bedtime routine. Most people will eliminate distractions in order to relax and fall asleep, including things such as turning off lights, making it quiet and getting comfortable.

“But this quiet environment can actually cause problems if you have chronic pain,” says Dr. Drerup, “because then the only thing you have to focus on is your pain.” Unfortunately, without other

distractions, pain seems to become “louder” and in many cases, the perception of pain — not necessarily the actual pain — increases when attempting to fall asleep.

Second: Understanding the therapy

Cognitive behavioral therapy for insomnia (CBT-I) includes a number of strategies designed to improve your sleep quality and help you change

thoughts and behaviors that interfere with sleep. This type of therapy is often preferred over medications because it has no side effects and is a more effective long-term solution.

One of the main goals of CBT-I is to help you control or eliminate negative thoughts and worries that keep you awake. CBT-I helps you to become more aware of thoughts related to sleep. “Once controlled, those thoughts tend to decrease and it is easier for you to fall asleep,” says Dr. Drerup.

Another strategy to help with insomnia is relaxation training, which reduces or eliminates muscle tension and distracts you from racing thoughts. Techniques include specific muscle group relaxation, guided imagery and meditation.

“Regardless of the type of relaxation strategy used, the treatment involves professional guidance and teaching these skills over a number of sessions,” Dr. Drerup says. She conducts both individual and group sessions on CBT for insomnia.

Usually, patients will take part in three to eight sessions to learn these techniques and discover what works for them,” she says.

The good news is that CBT for insomnia has been proven effective with 70 to 80% of patients who seek this treatment, says Dr. Drerup.

Third: Understanding good sleep hygiene

For these strategies to work, you also need to follow good sleep hygiene. Here, Dr. Drerup offers highlights of the standard guidelines:

• Use the bed and bedroom for sleep and sex only. Avoid sleep-incompatible behaviors in the bed, including reading, watching TV or worrying.
• Go to bed only when sleepy.
• If unable to sleep within 15-20 minutes of getting in bed, get up and go into another room. Return to bed only when sleepy again. (Repeat if necessary.)
• Maintain a regular wake time regardless of the amount of sleep that night.
• Avoid naps during the day.
• Watch caffeine and alcohol before bedtime.
• Exercise, but don’t do it within a couple hours of bedtime.