Multitargeting the sleep-pain interaction with pharmacological approaches: A narrative review with suggestions on new avenues of investigation

Wearable Devices: Current Status and Opportunities in Pain Assessment and Management

“…Specifically, wrist-worn accelerometers have been used to estimate sleep features [95-102] in addition to physical activity. Sleep has a bidirectional relationship with pain; disordered sleep may predispose patients to increased pain and pain (and its treatments) may disrupt sleep [103, 104]. While physical activity and the related construct of physical function are comparatively well studied, the dynamics between accelerometry-measured sleep and EMA of pain have undergone limited investigation.…”

Effects of pharmacotherapy on sleep-related outcomes in adults with chronic low back pain: a systematic review and meta-analysis of randomised controlled trials

“… 15 Many medications used for pain can have effects on sleep, which vary by medication types, sleep characteristics (e.g., sleep latency, total sleep time, sleep efficiency), and whether measures are subjectively or objectively collected. 16 , 17 , 18 For example, an antidepressant (duloxetine), when compared to placebo, decreased self-reported sleep continuity (total sleep time and sleep efficiency) in patients with chronic diabetic peripheral neuropathy, while anticonvulsant (pregabalin) increased sleep continuity in the sample. 17 These effects were not different to placebo when sleep was measured objectively via polysomnography.…”

“… 17 Medications used to manage sleep (e.g., sleep medications such as benzodiazepines, or antidepressants such as trazodone) are also often taken by patients with chronic pain, and effects on sleep and pain vary by types of medications and pain conditions. 16 , 17 , 18 , 19 For example, a review reported that, diazepam (sleep medication) decreased pain in rheumatoid arthritis, but a combination of tenoxicam and bromazepam (both benzodiazepines) was not superior to placebo. 16 Considering medications are often associated with adverse effects (e.g., nausea and vomiting from opioids, somnolence and fatigue from benzodiazepines) and increased risk of misuse or overdose, 20 it is important that clinicians understand implications medications have on health factors (e.g., sleep in patients with CLBP) which may influence treatment outcomes.…”

“… 16 , 17 , 18 , 19 For example, a review reported that, diazepam (sleep medication) decreased pain in rheumatoid arthritis, but a combination of tenoxicam and bromazepam (both benzodiazepines) was not superior to placebo. 16 Considering medications are often associated with adverse effects (e.g., nausea and vomiting from opioids, somnolence and fatigue from benzodiazepines) and increased risk of misuse or overdose, 20 it is important that clinicians understand implications medications have on health factors (e.g., sleep in patients with CLBP) which may influence treatment outcomes. Additionally, understanding multitargeting properties of a medication can reduce fragmentation of care (where a single symptom is treated with a single medication) and the risks associated with concurrent use of multiple medications.…”

“…Additionally, understanding multitargeting properties of a medication can reduce fragmentation of care (where a single symptom is treated with a single medication) and the risks associated with concurrent use of multiple medications. 16 , 21 Furthermore, prior findings based on heterogeneous or different chronic pain conditions may have limited generalisability to CLBP, given varying chronic pain conditions can respond differently to the same medication 16 and this can influence the sleep and pain relationship.…”