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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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Assessment of physical activity in patients with chronic low back or neck pain
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“Among patients with chronic low back pain (CLBP), the prevalence of insomnia ranges from 50% to 90%.(1,2) Insomnia affects quality of life, daily functioning, and recovery from pain in these patients.”
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“Factors believed to be linked to the aetiology of FMS such as dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis are also likely to affect sleep quality in FMS [37].”
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Chronic Pain, Insomnia and their Mutual Maintenance: A Call for Cognitive Bias Research
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“Insomnia can also affect pain perception, with pain rated more highly following a night of poor compared to good sleep (Smith & Haythornthwaite, 2004).”
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“Often characterized by reports of difficulty falling and/or staying asleep, disrupted or fragmented sleep patterns have also been associated with difficulties in sustaining attention, poor memory consolidation, and impaired executive functioning (26,27), and with increased pain sensitivity in healthy individuals (28)…”
BackgroundVinstrup, J., Jakobsen, M. D., Calatayud, J., Jay, K., & Andersen, L. L. (2018) · Frontiers in Neurology · doi:10.3389/fneur.2018.00968 · Cited by 37
“However, the directionality of the sleep/pain association is not entirely clear and has been a progressively growing area of research: Early longitudinal studies were reviewed by Smith and Haythornthwaite in 2004, where 5 of 6 and 4 of 6 studies reported evidence for a pain sleep and a sleep pain directionality, respe…”
BackgroundPerioperative Pharmacological Sleep‐Promotion and Pain Control: A Systematic Review
Bjurström, M. F., & Irwin, M. R. (2019) · Pain Practice · doi:10.1111/papr.12776 · Cited by 36
“Pain and sleep interact bidirectionally: pain may lead to disturbed sleep, and sleep disturbance can cause increased pain and hyperalgesia.(22,23,62,63) Poorly controlled postoperative pain is associated with lower objective sleep efficiency,(8) and pain is commonly”
BackgroundMubashir, T., Nagappa, M., Esfahanian, N., Botros, J., Arif, A. A., Suen, C. M., Wong, J., Ryan, C. M., & Chung, F. F. (2020) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.8392 · Cited by 37
“30 There is a great overlap between patients with chronic pain and those with SDB. Sleep is an important predictor of pain, and the management of sleep disorders such as sleep apnea may have bene fi ts beyond sleep in patientswithchronicpain.”
Spinal pain in pre-adolescence and the relation with screen time and physical activity behavior
Falch-Joergensen, A. C., Strandberg‐Larsen, K., Andersen, P. K., Hestbæk, L., & Andersen, A. N. (2021) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-021-04263-z · Cited by 35
Gellis, L. A., Gehrman, P., Mavandadi, S., & Oslin, D. W. (2010) · Military Medicine · doi:10.7205/milmed-d-09-00123 · Cited by 35
Pain profiles in a community dwelling population following spinal cord injury: a national survey
Burke, D., Fullen, B. M., & Lennon, O. C. (2017) · Journal of Spinal Cord Medicine · doi:10.1080/10790268.2017.1351051 · Cited by 33
Korff, M. V., Vitiello, M. V., McCurry, S. M., Balderson, B. H. K., Moore, A. L., Baker, L. D., Yarbro, P., Saunders, K. W., Keefe, F. J., & Rybarczyk, B. D. (2012) · Contemporary Clinical Trials · doi:10.1016/j.cct.2012.03.010 · Cited by 37
“There is preliminary evidence suggesting that behavioral sleep interventions have significant benefits for improving chronic pain outcomes [5-7], but this has yet to be evaluated in a large randomized trial.”
BackgroundVarious patterns of disrupted daily rest–activity rhythmicity associated with diabetes
Kadono, M., Nakanishi, N., Yamazaki, M., Hasegawa, G., Nakamura, N., & Fukui, M. (2016) · Journal of Sleep Research · doi:10.1111/jsr.12385 · Cited by 33
“Neuropathic pain can be associated with insomnia symptoms (Smith and Haythornthwaite, 2004).”
BackgroundTreatment of Chronic Pain by Long‐Acting Opioids and the Effects on Sleep
Mystakidou, K., Clark, A. J., FISCHER, J. H., Lam, A., Pappert, K., & Richarz, U. (2010) · Pain Practice · doi:10.1111/j.1533-2500.2010.00417.x · Cited by 32
“Finally, none of the studies took into account the presence of pre-existing primary sleep disorders that are known to influence sleep.(33) Pain severity does not predict sleep quality.”
BackgroundBromberg, M. H., Connelly, M. A., Anthony, K. K., Gil, K. M., & Schanberg, L. E. (2015) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000298 · Cited by 36
Nordmann, S., Lions, C., Vilotitch, A., Michel, L., Mora, M., Spire, B., Maradan, G., Morel, A., Roux, P., & Carrieri, M. (2016) · Psychopharmacology · doi:10.1007/s00213-016-4202-4 · Cited by 34
Jansson‐Fröjmark, M., Evander, J., & Alfonsson, S. (2018) · Journal of Behavioral Medicine · doi:10.1007/s10865-018-9949-0 · Cited by 32
Clinical correlates of sleep problems in systemic sclerosis: the prominent role of pain
Milette, K., Razykov, I., Pope, J. E., Hudson, M., Motivala, S. J., Baron, M. G., & Thombs, B. D. (2010) · Lara D. Veeken · doi:10.1093/rheumatology/keq411 · Cited by 32
Buhr, G. T., & White, H. K. (2006) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2005.11.002 · Cited by 32
Pan, F., Tian, J., Cicuttini, F., & Jones, G. (2020) · Pain and Therapy · doi:10.1007/s40122-020-00208-x · Cited by 31
Mun, C. J., Davis, M. C., Campbell, C. M., Finan, P. H., & Tennen, H. A. (2019) · Journal of Pain · doi:10.1016/j.jpain.2019.09.001 · Cited by 34
Hanyuda, A., Sawada, N., Uchino, M., Kawashima, M., Yuki, K., Tsubota, K., Tanno, K., Sakata, K., Yamagishi, K., Iso, H., et al. (2021) · The Ocular Surface · doi:10.1016/j.jtos.2021.04.001 · Cited by 32
Aili, K., Nyman, T., Hillert, L., & Svartengren, M. (2015) · Scandinavian Journal of Public Health · doi:10.1177/1403494814567755 · Cited by 31
“It has been suggested that the intensity of LBP is only weakly associated with sleep disturbances [11], and that the association between sleep disturbances and musculoskeletal pain is reciprocal [12].”
BackgroundHogan, M.-E., Taddio, A., Katz, J., Shah, V., & Krahn, M. (2017) · Pain · doi:10.1097/j.pain.0000000000000776 · Cited by 30
Qualidade do sono em pacientes idosos com patologias vasculares periféricas
Corrêa, K., & Ceolim, M. F. (2008) · Revista da Escola de Enfermagem da USP · doi:10.1590/s0080-62342008000100002 · Cited by 30
Miller, M. B., Roumanis, M. J., Kakinami, L., & Dover, G. C. (2020) · Journal of Pain Research · doi:10.2147/jpr.s230039 · Cited by 32
“Our chronic pain population experienced wake and sleep-onset times with high variability, which is consistent with previous research indicating the chronic pain population often experiences disrupted sleep and inconsistent sleep patterns.(4) In our study, average wake time was 7:31am, so segmenting morning data using…”
ResultCrosstalk between Sleep Disturbance and Opioid Use Disorder: A Narrative Review.
Fathi, H. R., Yoonessi, A., Khatibi, A., Rezaeitalab, F., & Ardanı, A. R. (2020) · PubMed Central · doi:10.22122/ahj.v12i2.249 · Cited by 30
Bjurström, M. F., Irwin, M. R., Chen, D. C., Smith, M. T., & Montgomery, A. K. (2021) · Journal of Pain · doi:10.1016/j.jpain.2021.04.008 · Cited by 30
Frange, C., Franco, A. M., Brasil, E. L., Hirata, R. P., Lino, J. A., Mortari, D. M., Ykeda, D. S., Leocádio-Miguel, M. A., D’Aurea, C. V. R., Silva, L. O. E., et al. (2022) · Sleep Science · doi:10.5935/1984-0063.20220083 · Cited by 34
The assessment of sleep in pediatric chronic pain sufferers
de la Vega, R., & Miró, J. (2012) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2012.04.002 · Cited by 29
Antinociceptive and hypnotic activities of pregabalin in a neuropathic pain-like model in mice
Wang, T., Yin, D., Guo, W. M., Liu, Y., Li, Y., Qu, W., Han, W., Hong, Z., & Huang, Z. (2015) · Pharmacology Biochemistry and Behavior · doi:10.1016/j.pbb.2015.05.007 · Cited by 29
“0 latency, reduced slow-wave sleep, and shifts in sleep stage (Morin et al., 1998; Smith and Haythornthwaite, 2004).”
BackgroundPoor Sleep Is a Risk Factor for Low-Back Pain among Healthcare Workers: Prospective Cohort Study
Vinstrup, J., Jakobsen, M. D., & Andersen, L. L. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17030996 · Cited by 29
Comparison of sleep problems between term and preterm born preschool children
Durankuş, F., Çiftdemir, N. A., Özbek, Ü. V., Duran, R., & Acunaş, B. (2020) · Sleep Medicine · doi:10.1016/j.sleep.2020.09.013 · Cited by 30
Lee, C.-F., Lin, K., Lin, M., Lin, C., Chang, S., & Kao, C. (2014) · Sleep Medicine · doi:10.1016/j.sleep.2014.06.009 · Cited by 29
Damasceno, F., Skinner, G. O., Gomes, A., Araújo, P. C. O., & Almeida, O. (2009) · Pharmacology Biochemistry and Behavior · doi:10.1016/j.pbb.2009.07.005 · Cited by 29
The role of tramadol ER in the treatment of chronic pain
Rosenberg, M. T. (2009) · International Journal of Clinical Practice · doi:10.1111/j.1742-1241.2009.02161.x · Cited by 29
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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