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How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature
Abstract
Sleep disturbance is perhaps one of the most prevalent complaints of patients with chronically painful conditions. Experimental studies of healthy subjects and cross-sectional research in clinical populations suggest the possibility that the relationship between sleep disturbance and pain might be reciprocal, such that pain disturbs sleep continuity/quality and poor sleep further exacerbates pain. This suggests that aggressive management of sleep disturbance may be an important treatment objective with possible benefits beyond the improvement in sleep. Little is known, however, about how to effectively treat sleep disturbance associated with pain or whether such treatment might have beneficial effects on reducing pain. A small, but growing literature has applied cognitive-behavioral therapies (CBT) for either pain management or insomnia to patients with chronic pain. In this article, we review the longitudinal literature on sleep disturbance associated with chronic pain and clinical trial literatures of cognitive-behavior therapy for pain management and insomnia secondary to chronic pain with the aim of evaluating whether the relationship between clinical pain and insomnia is reciprocal. While methodological problems are common, the literature suggests that the relationship is reciprocal and CBT treatments for pain or insomnia hold promise in reducing pain severity and improving sleep quality. Directions for future research include the use of validated measures of sleep, longitudinal studies, and larger randomized clinical trials incorporating appropriate attentional controls and longer periods of follow-up.
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“Dysfunction in the physiology of sleep is common in those suffering from chronic pain (Smith and Haythornthwaite, 2004).”
From Self-management strategies to consider to combat endometriosis symptoms during the COVID-19 pandemic (2020) · cites this paper as Smith and Haythornthwaite, 2004
In the citing paper
“Sleep disorders are among the most common concerns related to pain [73].”
From ACTsmart: Guided Smartphone-Delivered Acceptance and Commitment Therapy for Chronic Pain—A Pilot Trial. (2021) · cites this paper as [73]
In the citing paper
“between 50% and 88% of patients with chronic pain report problems with sleep (Smith & Haythornthwaite, 2004).”
From Hypnotic approaches for chronic pain management: Clinical implications of recent research findings. (2014) · cites this paper as Smith & Haythornthwaite, 2004
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“Over 40% of individuals with sleep problems report chronic pain, and more than 50% of individuals with chronic pain report difficulty sleeping (14).”
Bidirectionality between pain and insomnia symptoms: A prospective study
Jansson‐Fröjmark, M., & Boersma, K. (2011) · British Journal of Health Psychology · doi:10.1111/j.2044-8287.2011.02045.x · Cited by 57
Caumo, W., Hidalgo, M. P. L., de Souza, A., Torres, I. L. D. S., & Antunes, L. D. C. (2019) · Journal of Pain Research · doi:10.2147/jpr.s176857 · Cited by 58
“36 40 Even though the sleep disturbances can differ according to the pain syndrome, a previous study showed that 48.6% of people with chronic pain reported insomnia compared to 17.2% in those without chronic pain.”
InfluentialNature and Nurture of Human Pain
Belfer, I. (2013) · Scientifica · doi:10.1155/2013/415279 · Cited by 60
“Finally, studies in clinical populations, as well as experimental studies in healthy adults, suggest that pain experience and sleep are bidirectionally connected so that severe or persistent pain may disturb the sleep, while sleep disturbance enhances pain [81].”
BackgroundWaking EEG Cortical Markers of Chronic Pain and Sleepiness
Camfferman, D., Moseley, G. L., Gertz, K. J., Pettet, M. W., & Jensen, M. P. (2016) · Pain Medicine · doi:10.1093/pm/pnw294 · Cited by 57
Insomnia Really Hurts: Effect of a Bad Night's Sleep on Pain Increases With Insomnia Severity
Wei, Y., Blanken, T. F., & Someren, E. J. W. V. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00377 · Cited by 56
“It is generally accepted that the relationship between pain and insomnia is reciprocal (17, 18).”
BackgroundAssociation between painful temporomandibular disorders and sleep quality: A systematic review
Dreweck, F. D. S., Soares, S., Duarte, J., Conti, P. C. R., Canto, G. D. L., & Porporatti, A. L. (2020) · Journal of Oral Rehabilitation · doi:10.1111/joor.12993 · Cited by 55
Trajectories of Insomnia in Adults After Traumatic Brain Injury
Wickwire, E. M., Albrecht, J. S., Capaldi, V. F., Jain, S., Gardner, R. C., Werner, J. K., Mukherjee, P., McKeon, A. B., Smith, M. T., Giacino, J. T., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.45310 · Cited by 63
Whale, K., Dennis, J. A., Wylde, V., Beswick, A. D., & Gooberman‐Hill, R. (2022) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-022-05318-5 · Cited by 57
“From the other direction, studies have demonstrated that reduced sleep is causally linked to greater pain [26, 30, 31], increasing both the neurotransmitters related to pain sensitivity and the inflammatory markers associated with pain [32, 33].”
BackgroundEffect of sleep loss on pain—New conceptual and mechanistic avenues
Kourbanova, K., Alexandre, C., & Latrémolière, A. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.1009902 · Cited by 59
Pavlova, M., Ference, J., Hancock, M., & Noel, M. E. (2017) · Pain Research and Management · doi:10.1155/2017/1586921 · Cited by 55
Mild-to-Moderate Traumatic Brain Injury: A Review with Focus on the Visual System
Rauchman, S. H., Albert, J., Pinkhasov, A., & Reiss, A. B. (2022) · Neurology International · doi:10.3390/neurolint14020038 · Cited by 56
Assari, S., Sonnega, A. J., Pepin, R. L., & Leggett, A. N. (2016) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-015-0202-z · Cited by 55
“Both cross-sectional [8, 9] and longitudinal [10, 11] studies have documented a link between poor sleep and CMC.”
BackgroundBeal, S. J., Kashikar‐Zuck, S., King, C. D., Black, W., Barnes, J. E., & Noll, J. G. (2019) · Pain · doi:10.1097/j.pain.0000000000001706 · Cited by 54
“In addition to these mechanisms, impairment in other psychological (eg, attentional control and self-regulation) and behavioral (eg, sleep disturbances) factors can co-occur with maltreatment and PTSS(11,24,39) and exacerbate pain.(48,49) More work is needed, including replication of these findings, to better understa…”
BackgroundLarsen, D. B., Laursen, M. B., Simonsen, O. H., Arendt‐Nielsen, L., & Petersen, K. K. (2021) · British Journal of Pain · doi:10.1177/20494637211005803 · Cited by 55
Dragioti, E., Bernfort, L., Larsson, B. K., Gerdle, B. U. C., & Levin, L. (2017) · European Journal of Pain · doi:10.1002/ejp.1130 · Cited by 53
“…et al., 2005; Jungquist et al., 2010; Miro et al., 2011; Von Korff et al., 2012; Bernardy et al., 2013; Tang et al., 2015b) and increase subjective well-being and quality of life (Taimela et al., 2000; Schmidt et al., 2011; Monticone et al., 2012, 2015; Bernardy et al., 2013; Tang et al., 2015b).”
BackgroundRelationship Between Sleep Disturbances and Chronic Pain: A Narrative Review
Jain, S. V., Panjeton, G. D., & Martins, Y. C. (2024) · Clinics and Practice · doi:10.3390/clinpract14060209 · Cited by 54
“…sleep restriction, show increased self-reported musculoskeletal pain, fatigue, and evoked pain responses obtained through somatosensory testing protocols (e.g., heat pain thresholds, pressure pain thresholds, or laser-evoked pain) when compared with healthy control subjects [2,35–37] (Table 2).”
Aili, K., Nyman, T., Svartengren, M., & Hillert, L. (2014) · European Journal of Pain · doi:10.1002/ejp.552 · Cited by 53
“Sleep problems is a factor associated with both pain (Smith and Haythornthwaite, 2004; Fishbain et al., 2010; Alsaadi et al., 2011) and sickness absence (Sivertsen et al., 2006, 2009; Akerstedt et al., 2007; Salo et al., 2010).”
BackgroundWhat Is the Effect of Strength Training on Pain and Sleep in Patients With Fibromyalgia?
Andrade, A., Vilarino, G. T., & Bevilacqua, G. G. (2017) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000000782 · Cited by 54
“These two symptoms are related; pain is a factor that hinders sleep quality, and sleep deprivation is a factor that increases sensitivity to pain.(7) However, it is noted that the causal relation of sleep disorders to pain is more common than the causal relation of pain to sleep disorders.”
BackgroundSymptom Interactions as Mechanisms Underlying Symptom Pairs and Clusters
Parker, K. P., Kimble, L. P., Dunbar, S. B., & Clark, P. C. (2005) · Journal of Nursing Scholarship · doi:10.1111/j.1547-5069.2005.00037.x · Cited by 53
Exploring Clinical Associations Using ‘-Omics’ Based Enrichment Analyses
Hanauer, D. A., Rhodes, D. R., & Chinnaiyan, A. M. (2009) · PLoS ONE · doi:10.1371/journal.pone.0005203 · Cited by 52
“Insomnia may be a result of both the suffering one endures from chronic back pain as well as from possible treatments for back pain [22,23] but it would be important for a clinician to consider the possibility of a sleep disorder in someone with back pain.”
BackgroundCharacteristics of Sleep in Older Persons With Chronic Pain
Lunde, L.-H., Pallesen, S., Krangnes, L., & Nordhus, I. H. (2010) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e3181b61923 · Cited by 52
“Instead, reliance on sleep measures derived from global disease impact scales and the use of single sleep items seem to be the rule rather than the exception.(10,12) Few studies of patients with chronic pain have used objective sleep measures such as polysomnography and actigraphy.”
BackgroundMethodInfluentialVinik, A. I., Emir, B., Parsons, B., & Cheung, R. Y. (2013) · Pain Medicine · doi:10.1111/pme.12310 · Cited by 51
Ødegård, S. S., Omland, P. M., Nilsen, K. B., Stjern, M., Gravdahl, G. B., & Sand, T. (2014) · Clinical Neurophysiology · doi:10.1016/j.clinph.2014.12.011 · Cited by 52
Gosling, J. A., Batterham, P. J., Glozier, N., & Christensen, H. M. (2014) · Sleep Medicine · doi:10.1016/j.sleep.2014.04.007 · Cited by 52
“Furthermore, chronic insomnia may have different causes to intermittent insomnia, including chronic pain [37] and hormonal changes [38].”
BackgroundFitzgerald, T., & Vietri, J. (2015) · Sleep Disorders · doi:10.1155/2015/607148 · Cited by 46
Hoben, M., Chamberlain, S. A., Knopp‐Sihota, J., Poss, J. W., Thompson, G. N., & Estabrooks, C. A. (2015) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2015.11.002 · Cited by 53
Wu, Y.-E., Li, Y., Luo, Y., Wang, T., Wang, H., Chen, S., Qu, W., & Huang, Z. (2015) · Acta Pharmacologica Sinica · doi:10.1038/aps.2015.86 · Cited by 51
Metadata
- Authors
- Smith, M. T., & Haythornthwaite, J. A.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Smith, Michael T
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2004-04
- Volume
- 8
- Issue
- 2
- Pages
- 119-132
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W2167864730
- Cited by
- 914
- References
- 95
- Citations by year
- 2026: 38 · 2025: 44 · 2024: 33 · 2023: 52 · 2022: 54 · 2021: 61 · 2020: 59 · 2019: 58 · 2018: 55 · 2017: 58 · 2016: 64 · 2015: 64 · 2014: 52 · 2013: 33 · 2012: 41
- FWCI
- 2.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Keywords
- sleep disorders, chronic pain, insomnia, cognitive behavioral therapy for insomnia, pain management, sleep quality, longitudinal study
- MeSH terms
- Chronic Disease, Clinical Trials as Topic, Humans, Pain, Sleep Wake Disorders, Cognitive Behavioral Therapy, Pain Management
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