Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization

Abstract

Chronic pain conditions are highly comorbid with insufficient sleep. While the mechanistic relationships between the 2 are not understood, chronic insufficient sleep may be 1 pathway through which central pain-modulatory circuits deteriorate, thereby contributing to chronic pain vulnerability over time. To test this hypothesis, an in-laboratory model of 3 weeks of restricted sleep with limited recovery (5 nights of 4-hour sleep per night followed by 2 nights of 8-hour sleep per night) was compared with 3 weeks of 8-hour sleep per night (control protocol). Seventeen healthy adults participated, with 14 completing both 3-week protocols. Measures of spontaneous pain, heat-pain thresholds, cold-pain tolerance (measuring habituation to cold over several weeks), and temporal summation of pain (examining the slope of pain ratings during cold water immersion) were assessed at multiple points during each protocol. Compared with the control protocol, participants in the sleep-restriction protocol experienced mild increases in spontaneous pain (P < 0.05). Heat-pain thresholds decreased after the first week of sleep restriction (P < 0.05) but normalized with longer exposure to sleep restriction. By contrast, chronic exposure to restricted sleep was associated with decreased habituation to, and increased temporal summation in response to cold pain (both P < 0.05), although only in the past 2 weeks of the sleep-restriction protocol. These changes may reflect abnormalities in central pain-modulatory processes. Limited recovery sleep did not completely resolve these alterations in pain-modulatory processes, indicating that more extensive recovery sleep is required. Results suggest that exposure to chronic insufficient sleep may increase vulnerability to chronic pain by altering processes of pain habituation and sensitization.

Sleep problems and fatigue as predictors for the onset of chronic widespread pain over a 5- and 18-year perspective

“…The mechanistic relationship between sleep problems and chronic pain is not yet clear. One suggested mechanism is that insufficient sleep alters the processes of pain habituation and sensitization, and increase vulnerability to chronic pain [ 18 ]. The purpose of using a wash-out period was to distinguish between regional pain (presumably without central sensitization) and CWP (where disturbed pain systems are common).…”

“…Previous studies indicate that sleep predict pain prognosis, [ 15 – 17 ]. The underlying mechanisms for why disturbed sleep would predict pain prognosis is not yet fully established, however there are studies indicating that sleep disturbances influence pain sensitization and pain inhibitory systems [ 18 ].…”

<p>Less Pain, Better Sleep? The Effect of a Multidisciplinary Back Pain App on Sleep Quality in Individuals Suffering from Back Pain – a Secondary Analysis of App User Data</p>

“…[4][5][6][7][8] Basic research provides evidence that low sleep quality affects nociception with decreased pain thresholds, increased subjective pain ratings and also cortical processing. [9][10][11][12][13][14][15][16] It is assumed that especially the functionality of the pain inhibiting circuits is negatively affected by poor sleep quality. Curbed activity of the endogenous pain inhibition leads to an imbalance of excitatory and inhibitory activation which in turn does not only increase pain sensitivity in healthy individuals but also worsens pain symptoms in patients with acute and chronic pain.…”

Poor Sleep Is a Risk Factor for Low-Back Pain among Healthcare Workers: Prospective Cohort Study

“…In mechanical, interventional and epidemiological studies alike, considerable effort has been devoted to progressively shed light on the relationship between sleep and pain [8,[11][12][13][14][15][16][17]. For example, a recent meta-analysis with pooled estimates from 37 studies using polysomonography in populations with persistent pain, reported a 72% prevalence of insomnia [18].…”