Managing Pain and Discomfort After Spinal Injuries: Tips for Better Sleep

Injury to the first and second cervical vertebrae?

Hello Doctor, at the end of 2015, my mother fell while cleaning the windows at home.
She was careful but stepped into empty space and landed on her back.
Fortunately, there were no fractures, but she did sustain compression injuries to the first and second vertebrae.
During her visit to the doctor, she was advised to wear a brace daily for a month and return for a follow-up.
Currently, her recovery seems acceptable, but she still needs to wear the brace and avoid lifting heavy objects.
She has also been undergoing rehabilitation at an orthopedic clinic.

Although she has no issues during the day, she experiences problems at night.
She reports that when she lies down and relaxes, her lower body feels disconnected from her upper body, and the discomfort and soreness that are absent during the day all come back at night.
This makes it very difficult for her to sleep, and she often wakes up in pain in the middle of the night.
Even with sleeping pills, she still wakes up in pain.

Could you please advise on which areas of her rehabilitation should be focused on for improvement? Are there other methods to alleviate her soreness so she can sleep better? Should she make any adjustments to her sleeping position? I hope you can assist with your response.
Thank you!

Ms. Mao, 30~39 year old female. Ask Date: 2016/02/21

Dr. Shi Guozheng reply Orthopedics

Are you referring to the compression fractures of the first and second lumbar vertebrae? Typically, if the height of the vertebral body has not decreased significantly (greater than 50%), conservative treatment can be applied, which includes medication and a back brace for about four weeks.
Pain will gradually alleviate, and recovery can occur within two to three months.
However, the back brace should be worn for approximately three months.
Sleeping on the side may be more comfortable, and a physician can prescribe some sleep aids to assist with sleep.

Reply Date: 2016/02/21

More Info

Managing pain and discomfort after spinal injuries, especially during the night, can be quite challenging. It’s important to address both the physical and psychological aspects of pain management to improve sleep quality. Here are several strategies that may help your mother cope with her discomfort and enhance her sleep experience.

1. Physical Therapy and Rehabilitation
Continued rehabilitation is crucial for recovery from spinal injuries. Since your mother has been advised to wear a brace and undergo physical therapy, it’s essential to ensure that she is following through with her rehabilitation exercises. These exercises should focus on strengthening the core and back muscles, which can help support the spine and reduce pain.
- Strengthening Exercises: Gentle exercises that strengthen the abdominal and back muscles can provide better support for the spine. A physical therapist can tailor a program that suits her specific needs.

- Stretching: Incorporating stretching exercises can help alleviate tension in the muscles surrounding the spine. This can be particularly beneficial before bedtime to promote relaxation.

2. Sleep Positioning
The way your mother sleeps can significantly impact her pain levels. Here are some recommendations for sleep positions that may help:
- Side Sleeping: Sleeping on her side with a pillow between her knees can help align the spine and reduce pressure on the lower back. This position can also alleviate discomfort in the hips and legs.

- Back Sleeping: If she prefers to sleep on her back, placing a pillow under her knees can help maintain the natural curve of the spine and reduce strain on the lower back.

3. Use of Supportive Pillows
Investing in a good quality mattress and pillows can make a significant difference. A medium-firm mattress is often recommended for individuals with back pain. Additionally, using supportive pillows that maintain proper neck and spine alignment can help reduce discomfort.

4. Pain Management Techniques
Since your mother experiences pain that disrupts her sleep, it may be beneficial to explore various pain management techniques:
- Heat Therapy: Applying a heating pad to the affected areas before bedtime can help relax muscles and alleviate pain.
- Cold Therapy: Conversely, if there is inflammation, cold packs can reduce swelling and numb sharp pain.

- Medication: While she is already taking sleep aids, it may be worth discussing with her doctor the possibility of adjusting her pain management regimen. Non-steroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants may be appropriate, depending on her specific condition.

5. Mindfulness and Relaxation Techniques
Stress and anxiety can exacerbate pain perception. Techniques such as mindfulness meditation, deep breathing exercises, or gentle yoga can help calm the mind and body, making it easier to fall asleep and stay asleep.

6. Consultation with Specialists
If her pain persists despite these interventions, it may be beneficial for her to consult with a pain management specialist or a neurologist. They can provide further evaluation and may suggest additional treatments such as acupuncture, chiropractic care, or even injections for pain relief.

7. Lifestyle Modifications
Encouraging your mother to maintain a healthy lifestyle can also contribute to her overall well-being. This includes:
- Regular Physical Activity: Engaging in low-impact activities such as walking or swimming can improve circulation and reduce stiffness.

- Healthy Diet: A balanced diet rich in anti-inflammatory foods can support recovery and overall health.

Conclusion
Improving sleep quality after a spinal injury involves a multifaceted approach that includes physical rehabilitation, proper sleep positioning, pain management strategies, and lifestyle modifications. It’s essential for your mother to communicate openly with her healthcare providers about her symptoms and any changes in her condition. With the right support and interventions, she can find relief from her discomfort and improve her sleep quality.

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