Sleep restriction attenuates amplitudes and attentional modulation of pain-related evoked potentials, but augments pain ratings in healthy volunteers

Abstract

The experiment investigated the impact of sleep restriction on pain perception and related evoked potential correlates (laser-evoked potentials, LEPs). Ten healthy subjects with good sleep quality were investigated in the morning twice, once after habitual sleep and once after partial sleep restriction. Additionally, we studied the impact of attentional focussing on pain and LEPs by directing attention to (intensity discrimination) or away from the stimulus (mental arithmetic). Laser stimuli directed to the hand dorsum were rated as 30% more painful after sleep restriction (49+/-7 mm) than after a night of habitual sleep (38+/-7 mm). A significant interaction between attentional focus and sleep condition suggested that attentional focusing was less distinctive under sleep restriction. Intensity discrimination was preserved. In contrast, the amplitude of the early parasylvian N1 of LEPs was significantly smaller after a night of partial sleep restriction (-36%, p<0.05). Likewise, the amplitude of the vertex N2-P2 was significantly reduced (-34%, p<0.01); also attentional modulation of the N2-P2 was reduced. Thus, objective (LEPs) and subjective (pain ratings) parameters of nociceptive processing were differentially modulated by partial sleep restriction. We propose, that sleep reduction leads to an impairment of activation in the ascending pathway (leading to reduced LEPs). In contradistinction, pain perception was boosted, which we attribute to lack of pain control distinct from classical descending inhibition, and thus not affecting the projection pathway. Sleep-restricted subjects exhibit reduced attentional modulation of pain stimuli and may thus have difficulties to readily attend to or disengage from pain.

Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion

“…Sleep durations below 5 hours were associated with increased pain in all of these study types. 18,19,[105][106][107][108][109][110] Increased pain symptoms were associated with sleep duration of less than 6 hours in four studies (three self-report and one objective monitoring). 18,19,105,106 Sleep durations of 7-8 or 8-9 hours were consistently associated with reduced pain symptoms.…”

Night-shift work is associated with increased pain perception

“…Prospective studies indicate that sleep problems are associated with an increased risk for longlasting musculoskeletal pain (9)(10)(11)(12)(13)(14)(15) and experimental studies suggest that even a relatively modest restriction or disturbance of sleep increases pain sensitivity. This is manifested as larger responses to experimentally induced pain (16)(17)(18)(19)(20)(21), as increased spontaneous pain (22)(23)(24), or as altered pain modulation (23,(25)(26)(27)(28)(29). A recent meta-analysis confirm that sleep restriction increases sensitivity for several types of pain (30).…”

A Descriptive Study of Pressure Pain Threshold at 2 Standardized Sites in People With Acute or Subacute Neck Pain

“…We used a simple 1-item numeric rating of sleep quality the previous night, based on previous findings that sleep disturbance influences pain intensity/ sensitivity. 4,16,28 We did not see a relationship between this item and pain intensity. It is possible that our measure was either not sufficiently sensitive for detecting sleep disturbance variations or that focusing on the previous night might not have been the optimal framing.…”

“…1,5,9 Age may also influence sensitivity to pressure pain independently from the disease process, as suggested by evidence that PPT increases with advancing age. 11 So may sleep quality influence pain sensitivity, as shown by both Chhangani and colleagues 4 and Tiede and colleagues, 28 using heat-related pain tests. Algometry can be easily performed in a clinical setting.…”