The Impact of Disturbed Sleep on Pain

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Ask the Experts about Insomnia

From Medscape Primary Care

The Impact of Disturbed Sleep on Pain

Question

What is the impact of disturbed sleep on pain?

Response from Roth, PhD

Professor, Department of Psychiatry, Wayne State University College of

Medicine, Detroit; Director, Sleep Disorders Center, Henry Ford Hospital,

Detroit.

A variety of sleep disturbances, including difficulty falling asleep and

frequent nocturnal awakenings, are commonly reported by patients

experiencing pain. Even among pain patients not reporting frequent

awakening, reports of nonrefreshing sleep are common. Sleep laboratory-based

studies in patients with acute pain (eg, postoperative patients), as well as

in patients with chronic pain (eg, neuropathic pain and rheumatologic

conditions), show frequent arousals, difficulty falling back to sleep after

nocturnal awakenings, and a reduced time spent in REM sleep.[1]

Clearly, pain causes sleep disturbances. However, it is becoming

increasingly clear that these sleep disturbances result in an increased

sensitivity to pain, thereby setting up a cycle of pain leading to disturbed

sleep which, in turn, leads to more pain.[2] Both the loss of REM sleep,

even for 1 night, and partial sleep deprivation can lead to increased pain

sensitivity.[3-5] A loss of sleep as small as 4 hours over 1 night results

in a significant decrease in pain threshold.[6] Although 4 hours of sleep

loss for a night may seem extreme, it is important to remember that the

consequences of sleep loss accumulate across nights. Thus, 1-2 hours of

sleep loss across 2-4 nights would have the same effect. Furthermore, it may

not simply be disturbed sleep that exacerbates pain. The administration of

opiates to alleviate pain may turn out to be counterproductive, as these

medications are REM suppressants, and loss of REM sleep increases pain

sensitivity, as noted earlier. Thus, t!

he preservation of sleep time and sleep architecture are important parts of

pain management. Interventions such as maximizing the sleep environment in

postoperative and other hospital patients as well as the use of behavioral

and pharmacologic treatment to manage insomnia in chronic pain patients are

important aids in the management of pain. Finally, insomnia clinical trials

in comorbid pain conditions should measure treatment efficacy, not only in

terms of sleep, but also in terms of pain control and the need for

analgesics.

References

Menefee LA, Cohen M, WR, Doghramji K, ED, Lee H. Sleep

disturbance and nonmalignant pain: a comprehensive review of the literature.

Pain Med. 2000;1:156-172. Abstract

Affleck G, Urrows S, Tennen H, Higgins P, Abeles M. Sequential daily

relations of sleep, pain intensity, and attention to pain among women with

fibromyalgia. Pain. 1996;68:363-368. Abstract

Moldofsky H, Scarisbrick P. Induction of neurasthenic musculoskeletal pain

syndrome by selective sleep stage deprivation. Psychosom Med. 1976;38:35-44.

Abstract

Moldofsky H, Scarisbrick P, England R, Smythe H. Musculoskeletal symptoms

and non-REM sleep disturbance in patients with " fibrositis syndrome " and

healthy subjects. Psychosom Med. 1975;37:341-351. Abstract

Lentz MJ, Landis CA, Rothermel J, Shaver JL. Effects of selective slow wave

sleep disruption on musculoskeletal pain and fatigue in middle aged women. J

Rheumatol. 1999;26:1586-1592. Abstract

Roehrs TA, Blaisdell B, Greenwald MK, Roth T. Pain threshold and sleep loss.

Sleep. 2003;26(suppl):A196.

Funding Information

Supported through an educational grant from Sanofi-Synthelabo Inc., a member

of the sanofi-aventis Group.

Disclosure: Roth, PhD, has disclosed that he has received grants from

Aventis, Cephalon, GlaxoKline, Neurocrine, Pfizer, Sanofi, Sepracor,

Somaxon, Syrex, and Takeda. Dr. Roth has also disclosed that he has served

as a consultant for AstraZeneca, Aventis, Cephalon, Cypress, Eli Lilly,

GlaxoKline, Hypnion, King, Lundbeck, McNeil, Merck, Neurocrine,

Organon, Orginer, Pfizer, Roche, Sanofi, Sepracor, Somaxon, Syrex, Takeda,

Transoral, Vivometrics, and Wyeth, and as a speaker for Sanofi.

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