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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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Casilda-López, J., Ortíz‐Rubio, A., Torres‐Sánchez, I., López-Torres, I., Vallejo, M. Á. G., & Valenza, M. C. (2018) · Revista médica de Chile · doi:10.4067/s0034-98872018000900987 · Cited by 3
Sleep Quality in Osteoporotic Elderly: Relationship to Pain Sensitıvity and Depression
Aksoy, M. K., Karlıbel, İ. A., Dulger, S. U., & Altan, L. (2018) · International Journal of Depression and Anxiety · doi:10.23937/ijda-2017/1710009 · Cited by 3
A Philosophical Approach to the Rehabilitation of the Patient with Persistent Pain
Appel, P. R. (2020) · American Journal of Clinical Hypnosis · doi:10.1080/00029157.2019.1709152 · Cited by 3
“Sleep is a critical element in chronic pain management (Smith & Haythornthwaite, 2004; Smith, Perlis, Smith, Giles, & Carmody, 2000) as most self-regulation interventions require attention and concentration as fatigue arising from lack of such interferes with these abilities.”
BackgroundSkillgate, E., Hjortzberg, M. I., Strömwall, P., Hallqvist, J., Onell, C., Holm, L. W., & Bohman, T. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph181910051 · Cited by 3
Fibromyalgie : exemple d’interactions entre sommeil et douleur
Dauvilliers, Y. A., & Carlander, B. (2007) · Douleur et Analgésie · doi:10.1007/s11724-007-0067-y · Cited by 3
Familial Contributions to Self-Reported Sleep and Pain in Female Twins
Godfrey, K. M., Strachan, E. D., Mostoufi, S. M., Poeschla, B., Succop, A., & Afari, N. (2015) · Pain Medicine · doi:10.1111/pme.12894 · Cited by 3
Vugt, H. C. V. (2010) · Philips Research · doi:10.1007/978-90-481-3258-4_9 · Cited by 4
Williams, J. L. (2024) · PEARL (University of Plymouth) · doi:10.24382/kw4r-2791 · Cited by 2
Pain and Sleep–Treating Insomnia and Sleep Disturbances in Patients With Chronic Pain
Gevirtz, C. M. (2005) · Topics in Pain Management · doi:10.1097/00587875-200512000-00001 · Cited by 3
Wickwire, E. M., & Smith, M. T. (2010) · Medical psychiatry · doi:10.3109/9781420080803.014 · Cited by 3
Examining the Validity of a Model of Integrated Health Care Knowledge
Black, D. R., & Nugent, W. R. (2018) · Journal of the Society for Social Work and Research · doi:10.1086/699167 · Cited by 3
“…(Brown, 2015) on several of the items based on available research: obesity/insomnia (Hargens, Kaleth, Edwards, & Butner, 2013); pain/insomnia (Smith & Haythornthwaite, 2004); diabetes/obesity (Astrup & Finer, 2000); sexual dysfunction/HIV (Asboe et al., 2007); cancer/COPD (chronic…”
Hülse, R., Wenzel, A., Dudek, B., Losert-Bruggner, B., Hölzl, M., Hülse, M., & Häussler, D. (2019) · CRANIO® · doi:10.1080/08869634.2019.1630110 · Cited by 3
“There are several studies in the literature that suggest that pain and non-restorative sleep negatively influence one other [8,9].”
BackgroundDeguchi, R., Fujimoto, M., Sekiyama, H., & Sawamura, S. (2021) · Sleep and Biological Rhythms · doi:10.1007/s41105-021-00315-y · Cited by 3
Skarpsno, E. S., Gismervik, S. Ø., Fimland, M. S., & Aasdahl, L. (2021) · Nature and Science of Sleep · doi:10.2147/nss.s318052 · Cited by 3
Sharma, R., Dale, S. A., Wadhawan, S., Anderson, M. A., & Buchman, D. Z. (2022) · Neuroethics · doi:10.1007/s12152-022-09499-7 · Cited by 3
Kell, P. A., Huber, F. A., Street, E. N., Shadlow, J. O., & Rhudy, J. L. (2022) · Annals of Behavioral Medicine · doi:10.1093/abm/kaac034 · Cited by 3
The need for longitudinal research on chronic pain and sleep disturbance
Lee, K. A. (2015) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2015.10.006 · Cited by 3
Almeida, L. A., Bilterys, T., Looveren, E. V., Maîresse, O., Cagnie, B. J., Meeus, M., Moens, M., Goubert, D., Munneke, W., Danneels, L. A., et al. (2023) · Healthcare · doi:10.3390/healthcare11243152 · Cited by 2
Han, Y., Chen, X., Tang, G. H., Peng, Q., Liu, J., Liu, Y., Zhou, Q., & Long, L. (2024) · Modern Rheumatology · doi:10.1093/mr/roae071 · Cited by 2
Ghosh, S., Goyal, M., & Goyal, K. (2025) · Rehabilitación · doi:10.1016/j.rh.2025.100922 · Cited by 2
Hu, X., Zhan, Y., & Wang, J. (2025) · Psychology Research and Behavior Management · doi:10.2147/prbm.s553199 · Cited by 2
Brown, T., & Filbey, F. M. (2025) · Neurotherapeutics · doi:10.1016/j.neurot.2025.e00785 · Cited by 2
“Thus, the direct pain-alleviating qualities of THC [5,31,38] and indirect pain alleviation via increased SWS may benefit the regulation of pain.”
Reinen, J., Agurto, C., Cecchi, G., NAVITAS and ENVISION Studies Physician Author Group, Rauck, R. L., Loudermilk, E., Paez, J., Bojrab, L., Noles, J., Turley, T., et al. (2025) · npj Digital Medicine · doi:10.1038/s41746-025-02084-1 · Cited by 2
“7 – 9).”
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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