The Importance of Sleep for People With Chronic Pain: Current Insights and Evidence

Abstract

We are currently in the midst of a sleep crisis. Our current work and lifestyle environments are normalizing poor sleep with substantial negative impact on our health. Research on sleep has linked sleep deprivation to poorer mental health, obesity, cancer, diabetes, heart disease, and a myriad of other health conditions. Sleep deprivation is an even greater issues for people with musculoskeletal conditions and chronic pain. Between 67% and 88% of individuals with chronic pain experience sleep disruption and insomnia, and at least 50% of people with insomnia report chronic pain. The link between sleep and pain is well documented. Experimental, cohort, and longitudinal studies have all demonstrated that restricted sleep is linked to greater pain. Poor sleep therefore not only affects general health but has a direct impact on inflammation, pain response, and experience. Improving sleep in people living with musculoskeletal conditions and with chronic pain has the potential to deliver great benefit to many. This article describes the evidence base that can underpin such work, including research about the link between pain and sleep as well as theories and approaches to intervention that may help.

Potential Role of Obstructive Sleep Apnea on Pain Sensitization and Jaw Function in Temporomandibular Disorder Patients

“…Several previous reports have proposed the relationship between sleep fragmentation and pain sensitization. 11 20 21 Aforementioned results also supported this phenomenon that respiratory arousals had significant correlations with the number of active TrPs in the masticatory muscles. Sleep deprivation can cause myalgia, tenderness, and chronic fatigue and one study suggested that sleep deprivation impairs descending pain-inhibition pathways that are crucial for controlling and coping with pain.…”

“… 16 18 19 The relationship between sleep fragmentation and pain sensitization have been proposed, also. 11 20 21 Pain management in OSA patient is complex owing to complicated pain mechanisms and pathophysiology of OSA, therefore the clear management guidelines or treatment protocol have not been proposed yet.…”

Sleep Disturbance in Musculoskeletal Conditions: Impact of a Digital Care Program

“…[67][68][69] These results emphasize the opportunity of taking advantage of the adaptability of digital multimodal programs, to better address the specific needs of high-risk patients. Patients also reported improvement in both anxiety and depression, which are domains highly comorbid with both chronic MSK pain and sleep disorders, 11,12,70,71 and whose association tends to result in lower improvement and worse outcomes. 11,72 This is in agreement with the reported in the present study, as patients with spine pain and more severe mental health issues were more likely to end up in a more severe sleep category at the program completion.…”

“…Sleep disturbances are highly prevalent and comorbid with a number of different medical conditions. 1,5,11,12 Despite more wide investigation on the association between sleep and MSK pain in chronic widespread pain and chronic low back pain, evidence indicates that this association also exists for a broader range of conditions, [55][56][57] including those affecting the upper limb. 55,58,59 In fact, sleep disturbance is one of the main complaints among patients with shoulder disorders.…”

“…[8][9][10] Moreover, poor sleep is associated with the development of chronic pain, especially musculoskeletal (MSK) conditions. [11][12][13] On the other hand, MSK conditions result in significant disability and suffering, with a very high worldwide prevalence of 1.71 billion. 14,15 Sleep disorders are highly comorbid with MSK conditions with a reported prevalence of 72.1% for chronic back pain, 65.4% for rheumatoid arthritis, 70.3%…”