The Association of Sleep and Pain: An Update and a Path Forward

Abstract

Ample evidence suggests that sleep and pain are related. However, many questions remain about the direction of causality in their association, as well as mechanisms that may account for their association. The prevailing view has generally been that they are reciprocally related. The present review critically examines the recent prospective and experimental literature (2005-present) in an attempt to update the field on emergent themes pertaining to the directionality and mechanisms of the association of sleep and pain. A key trend emerging from population-based longitudinal studies is that sleep impairments reliably predict new incidents and exacerbations of chronic pain. Microlongitudinal studies employing deep subjective and objective assessments of pain and sleep support the notion that sleep impairments are a stronger, more reliable predictor of pain than pain is of sleep impairments. Recent experimental studies suggest that sleep disturbance may impair key processes that contribute to the development and maintenance of chronic pain, including endogenous pain inhibition and joint pain. Several biopsychosocial targets for future mechanistic research on sleep and pain are discussed, including dopamine and opioid systems, positive and negative affect, and sociodemographic factors.Perspective-This critical review examines the recent prospective and experimental research (2005-present) on the association of sleep and pain in an attempt to identify trends suggestive of directionality and potential mechanisms. An update on this literature is needed to guide future clinical efforts to develop and augment treatments for chronic sleep disturbance and chronic pain.

A Single Arm Pilot Trial of Brief Cognitive Behavioral Therapy for Insomnia in Adolescents with Physical and Psychiatric Comorbidities

“…For example, insomnia may precede the onset of major depressive episodes and sleep disruption may lead to physical health disorders such as chronic pain. 4,5 There is a large evidence base supporting the efficacy of cognitive behavioral therapy for insomnia (CBT-I) among adults with a diverse range of comorbid physical and psychiatric conditions. 6 In contrast, CBT-I is still in early stages of development within child and adolescent populations.…”

Sleep Problems are Associated With Chronic Pain Over and Above Mutual Associations With Depression and Catastrophizing

“…A substantial body of research now suggests the existence of a reciprocal relationship between pain and sleep, where pain can result in a reduction both in the quantity and quality of sleep; in turn, poor sleep can result in a subsequent increase in reported pain [3,7,8]. One key observation has been that sleep deprivation can decrease both the pain threshold and pain tolerance, even in healthy individuals [9,10].…”

Measuring Treatment Outcomes in Comorbid Insomnia and Fibromyalgia: Concordance of Subjective and Objective Assessments

“…1 The high prevalence of chronic insomnia among patients with chronic pain has been well-established, with reported rates of insomnia as high as 88% in this population. 2,3 Independently, sleep and pain are known to be associated with a host of negative consequences including decreased quality of life, mood disturbance, impaired quality of social interactions, dependence on medication, and cognitive dysfunction. However, these consequences are often exacerbated in chronic pain patients with comorbid insomnia.…”

“…However, these consequences are often exacerbated in chronic pain patients with comorbid insomnia. [2][3][4][5] In light of these findings, an understanding of effective measurement of sleep in the context of comorbid chronic pain and insomnia warrants consideration in order to effectively assess and treat impairments associated with both conditions.…”

“…However, these consequences are often exacerbated in chronic pain patients with comorbid insomnia. [2][3][4][5] In light of these findings, an understanding of effective measurement of sleep in the context of comorbid chronic pain and insomnia warrants consideration in order to effectively assess and treat impairments associated with both conditions.In research settings, insomnia is typically evaluated using several methods, including objective ( actigraphy) and subjective (sleep diaries) measurements of nighttime sleep. Despite their ubiquity in research, it is generally considered that objective methods of sleep measurement are less sensitive and specific than self-reports for identifying insomnia.…”