Abstract
Ample evidence suggests that sleep and pain are related. However, many questions remain
about the direction of causality in their association, as well as mechanisms that
may account for their association. The prevailing view has generally been that they
are reciprocally related. The present review critically examines the recent prospective
and experimental literature (2005–present) in an attempt to update the field on emergent
themes pertaining to the directionality and mechanisms of the association of sleep
and pain. A key trend emerging from population-based longitudinal studies is that
sleep impairments reliably predict new incidents and exacerbations of chronic pain.
Microlongitudinal studies employing deep subjective and objective assessments of pain
and sleep support the notion that sleep impairments are a stronger, more reliable
predictor of pain than pain is of sleep impairments. Recent experimental studies suggest
that sleep disturbance may impair key processes that contribute to the development
and maintenance of chronic pain, including endogenous pain inhibition and joint pain.
Several biopsychosocial targets for future mechanistic research on sleep and pain
are discussed, including dopamine and opioid systems, positive and negative affect,
and sociodemographic factors.
Perspective
This critical review examines the recent prospective and experimental research (2005–present)
on the association of sleep and pain in an attempt to identify trends suggestive of
directionality and potential mechanisms. An update on this literature is needed to
guide future clinical efforts to develop and augment treatments for chronic sleep
disturbance and chronic pain.
Key words
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Article info
Footnotes
Funding for work on the current study was provided by NIH R01 AR05487 (MTS), NIH R01AR059410 (MTS), and NIH T32 NS070201 (PHF).
The authors declare no conflicts of interest.
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© 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.
