Sleep Disruption and Pain Sensitivity: A Bidirectional Relationship the Pain Clinic Rarely Addresses
DOI:
https://doi.org/10.5281/zenodo.22548973Keywords:
Sleep disturbance, Insomnia, Pain sensitivity, Chronic pain, Cognitive-behavioural therapy for insomnia, Sleep deprivationAbstract
Sleep disturbance and pain are linked by a well-documented bidirectional relationship: experimental
sleep deprivation and selective slow-wave sleep disruption lower pain threshold and impair endogenous
pain-inhibitory function, while pain itself fragments sleep continuity and reduces restorative slow-wave
sleep, creating a self-sustaining cycle. Despite a substantial and consistent evidence base, sleep is rarely
assessed systematically in routine pain-clinic practice, and insomnia treatment is rarely offered as a
component of pain management. This review synthesises the experimental, epidemiological, and
clinical-trial literature establishing the bidirectional sleep-pain relationship and the evidence supporting
cognitive-behavioural therapy for insomnia as an effective, currently under-used, adjunct to chronic pain
management.
References
Finan PH, Goodin BR, Smith MT. "The association of sleep and pain: an update and a path forward". J Pain 14(2013):1539-1552.
Smith MT, Haythornthwaite JA. "How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature". Sleep Med Rev 8(2004):119-132.
Lautenbacher S, Kundermann B, Krieg JC. "Sleep deprivation and pain perception". Sleep Med Rev 10(2006):357-369.
Haack M, Simpson N, Sethna N, Kaur S, Mullington J. "Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications". Neuropsychopharmacology 45(2020):205-216.
Edwards RR, Almeida DM, Klick B, Haythornthwaite JA, Smith MT. "Duration of sleep contributes to next-day pain report in the general population". Pain 137(2008):202-207.
Onen SH, Alloui A, Gross A, Eschallier A, Dubray C. "The effects of total sleep deprivation, selective sleep interruption and sleep recovery on pain tolerance thresholds in healthy subjects". J Sleep Res 10(2001):35-42.
Irwin MR, Olmstead R, Carroll JE. "Sleep disturbance, sleep duration, and inflammation: a systematic review and meta-analysis of cohort studies and experimental sleep deprivation". Biol Psychiatry 80(2016):40-52.
Afolalu EF, Ramlee F, Tang NKY. "Effects of sleep changes on pain-related health outcomes in the general population: a systematic review of longitudinal studies with exploratory meta-analysis". Sleep Med Rev 39(2018):82-97.
Tang NKY, Goodchild CE, Sanborn AN, Howard J, Salkovskis PM. "Deciphering the temporal link between pain and sleep in a heterogeneous chronic pain patient sample: a multilevel daily process study". Sleep 35(2012):675-687.
Sivertsen B, Lallukka T, Petrie KJ, Steingrimsdottir OA, Stubhaug A, Nielsen CS. "Sleep and pain sensitivity in adults". Pain 156(2015):1433-1439.
Finan PH, Smith MT. "The comorbidity of insomnia, chronic pain, and depression: dopamine as a putative mechanism". Sleep Med Rev 17(2013):173-183.
Roizenblatt S, Moldofsky H, Benedito-Silva AA, Tufik S. "Alpha sleep characteristics in fibromyalgia". Arthritis Rheum 44(2001):222-230.
Moldofsky H, Scarisbrick P. "Induction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation". Psychosom Med 38(1976):35-44.
Bjurstrom MF, Irwin MR. "Polysomnographic characteristics in nonmalignant chronic pain populations: a review of controlled studies". Sleep Med Rev 26(2016):74-86.
Smith MT, Edwards RR, McCann UD, Haythornthwaite JA. "The effects of sleep deprivation on pain inhibition and spontaneous pain in women". Sleep 30(2007):494-505.
Krause AJ, Prather AA, Wager TD, Lindquist MA, Walker MP. "The pain of sleep loss: a brain characterization in humans". J Neurosci 39(2019):2291-2300.
Vgontzas AN, Zoumakis E, Bixler EO, et al. "Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines". J Clin Endocrinol Metab 89(2004):2119-2126.
Bonvanie IJ, Oldehinkel AJ, Rosmalen JGM, Janssens KAM. "Sleep problems and pain: a longitudinal cohort study in emerging adults". Pain 157(2016):957-963.
Cheatle MD, Foster S, Pinkett A, Lesneski M, Qu D, Dhingra L. "Assessing and managing sleep disturbance in patients with chronic pain". Anesthesiol Clin 34(2016):379-393.
Tang NKY, Wright KJ, Salkovskis PM. "Prevalence and correlates of clinical insomnia co-occurring with chronic back pain". J Sleep Res 16(2007):85-95.
McCracken LM, Iverson GL. "Disrupted sleep patterns and daily functioning in patients with chronic pain". Pain Res Manag 7(2002):75-79.
Koffel E, Kroenke K, Bair MJ, Leverty D, Polusny MA, Krebs EE. "The bidirectional relationship between sleep complaints and pain: analysis of data from a randomized trial". Health Psychol 35(2016):41-49.
Wilson KG, Eriksson MY, DEon JL, Mikail SF, Emery PC. "Major depression and insomnia in chronic pain". Clin J Pain 18(2002):77-83.
Alsaadi SM, McAuley JH, Hush JM, Maher CG. "Prevalence of sleep disturbance in patients with low back pain". Eur Spine J 20(2011):737-743.
Menefee LA, Cohen MJ, Anderson WR, Doghramji K, Frank ED, Lee H. "Sleep disturbance and nonmalignant chronic pain: a comprehensive review of the literature". Pain Med 1(2000):156-172.
Finan PH, Buenaver LF, Runko VT, Smith MT. "Cognitive-behavioral therapy for comorbid insomnia and chronic pain". Sleep Med Clin 9(2014):261-274.
Tang NKY, Lereya ST, Boulton H, Miller MA, Wolke D, Cappuccio FP. "Nonpharmacological treatments of insomnia for long-term painful conditions: a systematic review and meta-analysis of patient-reported outcomes in randomized controlled trials". Sleep 38(2015):1751-1764.
Vitiello MV, McCurry SM, Shortreed SM, et al. "Cognitive-behavioral treatment for comorbid insomnia and osteoarthritis pain in primary care: the lifestyles randomized controlled trial". J Am Geriatr Soc 61(2013):947-956.
Amtmann D, Askew RL, Kim J, et al. "Pain affects depression through anxiety, fatigue, and sleep in multiple sclerosis". Rehabil Psychol 60(2015):81-90.
Generaal E, Vogelzangs N, Penninx BW, Dekker J. "Insomnia, sleep duration, depressive symptoms, and the onset of chronic multisite musculoskeletal pain". Sleep 40(2017):zsw030.
