The Effects of Recovery Sleep on Experimental Pain

Published:October 20, 2022DOI:


      • Total sleep deprivation leads to enhanced pain sensitivity.
      • One night of recovery sleep can partly reset hyperalgesic changes.
      • No effects of recovery sleep on endogenous pain modulation.


      Recent research suggests that recovery sleep (RS) has the potential to restore pain sensitivity and modulation after hyperalgesia due to preceding sleep deprivation. However, it has not yet been systematically examined whether the restoration of these pain parameters is driven by sleep characteristics of RS. Thus, the present study assessed changes in experimental pain during RS after total sleep deprivation (TSD) to test whether RS parameters predicted the restoration of the pain system. Thirty healthy participants completed one night of habitual sleep, one night of TSD and a subsequent recovery night. At-home sleep during baseline and recovery was assessed using portable polysomnography and a questionnaire. Before and after each night pressure pain thresholds (PPTs), temporal pain summation (TSP) and conditioned pain modulation (CPM) were assessed. PPTs decreased after TSD and increased following RS, indicating a restoration of pain sensitivity after hyperalgesia. RS characteristics did not predict this restoration, suggesting other mechanisms (eg, changes in serotonergic activity) underlying the observed pain changes. TSP indicated a lack of effect of experimental sleep manipulations on excitatory processes whereas CPM lacked sufficient reliability to investigate inhibitory processes. Thus, results indicate moderate effects of sleep manipulations on pain sensitivity, but not on pain modulation.
      Perspective: This article highlights the potential of recovery sleep to let pain thresholds return to normal following their decrease after a night of total sleep deprivation. In contrast, endogenous pain modulation (temporal pain summation, conditioned pain modulation) was not affected by sleep deprivation and recovery sleep.

      Key Words


      ANOVA (Analysis of Variance), BL (Baseline), CPM (Conditioned Pain Modulation), CS (Conditioning Stimulus), DNIC (Diffuse Noxious Inhibitory Controls), EEG (Electroencephalography), EMG (Electromyography), EOG (Electrooculography), ICC (Intra-Class Correlation), non-REM (Non Rapid Eye Movement Sleep), POST (Morning Laboratory Session), PPT (Pressure Pain Threshold), PRE (Evening Laboratory Session), PSG (Polysomnography), REM (Rapid-Eye-Movement Sleep), RS (Recovery Sleep), SE (Sleep Efficiency), SL (Sleep Onset Latency), SWS (Slow Wave Sleep), TAP (Test Battery for Attentional Performance), TS (Test Stimulus), TSD (Total Sleep Deprivation), TSP (Temporal Summation of Pain), TST (Total Sleep Time)
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        • Albani C
        • Blaser G
        • Geyer M
        • Schmutzer G
        • Brähler E
        • Bailer H
        • Grulke N
        Überprüfung der Gütekriterien der deutschen Kurzform des Fragebogens “Profile of Mood States” (POMS) in einer repräsentativen Bevölkerungsstichprobe.
        Psychother Psychosom Med Psychol. 2005; 55: 324-330
        • Amiri M
        • Alavinia M
        • Singh M
        • Kumbhare D
        Pressure pain threshold in patients with chronic pain: A systematic review and meta-analysis.
        Am J Phys Med Rehabil. 2021; 100: 656-674
        • Aviram J
        • Shochat T
        • Pud D
        Pain perception in healthy young men is modified by time-of-day and is modality dependent.
        Pain Med. 2015; 16: 1137-1144
        • Bar-Shalita T
        • Granovsky Y
        • Parush S
        • Weissman-Fogel I
        Sensory modulation disorder (SMD) and pain: A new perspective.
        Front Integr Neurosci. 2019; 13: 27
        • Eichhorn N
        • Treede R-D
        • Schuh-Hofer S
        The role of sex in sleep deprivation related changes of nociception and conditioned pain modulation.
        Neuroscience. 2018; 387: 191-200
        • Farooqui SM
        • Brock JW
        • Zhou J
        Changes in monoamines and their metabolite concentrations in REM sleep-deprived rat forebrain nuclei.
        Pharmacol Biochem Behav. 1996; 54: 385-391
        • Girdler SS
        • Maixner W
        • Naftel HA
        • Stewart PW
        • Moretz RL
        • Light KC
        Cigarette smoking, stress-induced analgesia and pain perception in men and women.
        Pain. 2005; 114: 372-385
        • Goubert D
        • Danneels L
        • Graven-Nielsen T
        • Descheemaeker F
        • Coppieters I
        • Meeus M
        Differences in pain processing between patients with chronic low back pain, recurrent low back pain and fibromyalgia.
        Pain Physician. 2017; 20: 307-318
        • Graven-Nielsen T
        • Arendt-Nielsen L
        Peripheral and central sensitization in musculoskeletal pain disorders: An experimental approach.
        Curr Rheumatol Rep. 2002; 4: 313-321
        • Grouper H
        • Eisenberg E
        • Pud D
        The relationship between sensitivity to pain and conditioned pain modulation in healthy people.
        Neurosci Lett. 2019; 708134333
        • Grulke N
        • Bailer H
        • Schmutzer G
        • Brähler E
        • Blaser G
        • Geyer M
        • Albani C
        Normierung der deutschen Kurzform des Fragebogens „Profile of Mood States“ (POMS) anhand einer repräsentativen Bevölkerungsstichprobe—Kurzbericht.
        Psychother Psychosom Med Psychol. 2006; 56: 403-405
        • Hoffmann RM
        • Müller T
        • Hajak G
        • Cassel W
        Abend-Morgenprotokolle in Schlafforschung und Schlafmedizin—Ein Standardinstrument für den deutschsprachigen Raum.
        Somnologie. 1997; 1: 103-109
        • Horn-Hofmann C
        • Kunz M
        • Madden M
        • Schnabel EL
        • Lautenbacher S
        Interactive effects of conditioned pain modulation and temporal summation of pain-the role of stimulus modality.
        Pain. 2018; 159: 2641-2648
        • Jaehne A
        • Loessl B
        • Bárkai Z
        • Riemann D
        • Hornyak M
        Effects of nicotine on sleep during consumption, withdrawal and replacement therapy.
        Sleep Med Rev. 2009; 13: 363-377
        • Kamiyama H
        • Iida T
        • Nishimori H
        • Kubo H
        • Uchiyama M
        • Laat A de
        • Lavigne G
        • Komiyama O
        Effect of sleep restriction on somatosensory sensitivity in the oro-facial area: An experimental controlled study.
        J Oral Rehabil. 2019; 46: 303-309
        • Karmann AJ
        • Lauer C
        • Ziegler E
        • Killian L
        • Horn-Hofmann C
        • Lautenbacher S
        Associations of nocturnal sleep with experimental pain and pain catastrophizing in healthy volunteers.
        Biol Psychol. 2018; 135: 1-7
        • Kennedy DL
        • Kemp HI
        • Ridout D
        • Yarnitsky D
        • Rice ASC
        Reliability of conditioned pain modulation: A systematic review.
        Pain. 2016; 157: 2410-2419
        • Kristiansen ES
        • Nielsen LS
        • Christensen SS
        • Botvid SHC
        • Nørgaard Poulsen J
        • Gazerani P
        Sleep deprivation sensitizes human craniofacial muscles.
        Somatosens Mot Res. 2017; 34: 116-122
        • Kundermann B
        • Krieg JC
        • Schreiber W
        • Lautenbacher S
        The effects of sleep deprivation on pain.
        Pain Res Manage. 2004; 9: 25-32
        • Lautenbacher S
        Experimental approaches in the study of pain in the elderly.
        Pain Med. 2012; 13: S44-S50
        • Lautenbacher S
        • Kundermann B
        • Krieg J-C
        Sleep deprivation and pain perception.
        Sleep Med Rev. 2006; 10: 357-369
        • Lautenbacher S
        • Roscher S
        • Strian F
        Inhibitory effects do not depend on the subjective experience of pain during heterotopic noxious conditioning stimulation (HNCS): A contribution to the psychophysics of pain inhibition.
        Eur J Pain. 2002; 6: 365-374
        • Martin SL
        • Power A
        • Boyle Y
        • Anderson IM
        • Silverdale MA
        • Jones AKP
        5-HT modulation of pain perception in humans.
        Psychopharmacology (Berl). 2017; 234: 2929-2939
        • Matre D
        • Andersen MR
        • Knardahl S
        • Nilsen KB
        Conditioned pain modulation is not decreased after partial sleep restriction.
        Eur J Pain. 2016; 20: 408-416
        • McNair DM
        • Lorr M
        • Droppleman LF
        Profile of mood states: Manual.
        EdITS. 1992;
        • Moldofsky H
        • Scarisbrick P
        • England R
        • Smythe H
        Musculosketal symptoms and non-REM sleep disturbance in patients with “fibrositis syndrome” and healthy subjects.
        Psychosom Med. 1975; 37: 341-351
        • Mongrain V
        • Dumont M
        Increased homeostatic response to behavioral sleep fragmentation in morning types compared to evening types.
        Sleep. 2007; 30: 773-780
        • Mun CJ
        • Suk HW
        • Davis MC
        • Karoly P
        • Finan P
        • Tennen H
        • Jensen MP
        Investigating intraindividual pain variability: Methods, applications, issues, and directions.
        Pain. 2019; 160: 2415
        • Nie H
        • Arendt-Nielsen L
        • Andersen H
        • Graven-Nielsen T
        Temporal summation of pain evoked by mechanical stimulation in deep and superficial tissue.
        J Pain. 2005; 6: 348-355
        • Older SA
        • Battafarano DF
        • Danning CL
        • Ward JA
        • Grady EP
        • Derman S
        • Russell IJ
        The effects of delta wave sleep interruption on pain thresholds and fibromyalgia-like symptoms in healthy subjects; correlations with insulin-like growth factor I.
        J Rheumatol. 1998; 25: 1180-1186
        • Onen SH
        • Alloui A
        • Gross A
        • Eschallier A
        • Dubray C
        The effects of total sleep deprivation, selective sleep interruption and sleep recovery on pain tolerance thresholds in healthy subjects.
        J Sleep Res. 2001; 10: 35-42
        • Rechtschaffen A
        • Kales A
        A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects.
        Government Printing Office, Washington D.C., U.S. Public Health Service, U.S1968
        • Roehrs TA
        • Harris E
        • Randall S
        • Roth T
        Pain sensitivity and recovery from mild chronic sleep loss.
        SLEEP. 2012; 35: 1667-1672
        • Simpson NS
        • Scott-Sutherland J
        • Gautam S
        • Sethna N
        • Haack M
        Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization.
        Pain. 2018; 159: 33-40
        • Smith MT
        • Edwards RR
        • McCann UD
        • Haythornthwaite JA
        The effects of sleep deprivation on pain inhibition and spontaneous pain in women.
        SLEEP. 2007; 30: 494-505
        • Staffe AT
        • Bech MW
        • Clemmensen SLK
        • Nielsen HT
        • Larsen DB
        • Petersen KK
        Total sleep deprivation increases pain sensitivity, impairs conditioned pain modulation and facilitates temporal summation of pain in healthy participants.
        PLoS ONE. 2019; 14e0225849
        • Staud R
        Abnormal endogenous pain modulation is a shared characteristic of many chronic pain conditions.
        Expert Rev Neurother. 2012; 12: 577-585
        • Stroemel-Scheder C
        • Karmann AJ
        • Ziegler E
        • Heesen M
        • Knippenberg-Bigge K
        • Lang PM
        • Lautenbacher S
        Sleep, experimental pain and clinical pain in patients with chronic musculoskeletal pain and healthy controls.
        J Pain Res. 2019; 12: 3381-3393
        • Stroemel-Scheder C
        • Kundermann B
        • Lautenbacher S
        The effects of recovery sleep on pain perception: A systematic review.
        Neurosci Biobehav Rev. 2020; 113: 408-425
        • Stroemel-Scheder C
        • Lautenbacher S
        Assessment of effects of total sleep deprivation and subsequent recovery sleep: A methodological strategy feasible without sleep laboratory.
        BMC Psychol. 2021; 9: 141
        • Taillard J
        • Philip P
        • Coste O
        • Sagaspe P
        • Bioulac B
        The circadian and homeostatic modulation of sleep pressure during wakefulness differs between morning and evening chronotypes.
        J Sleep Res. 2003; 12: 275-282
        • Toru M
        • Mitsushio H
        • Mataga N
        • Takashima M
        • Arito H
        Increased brain serotonin metabolism during rebound sleep in sleep-deprived rats.
        Pharmacol Biochem Behav. 1984; 20: 757-761
        • Vaegter HB
        • Handberg G
        • Graven-Nielsen T
        Hypoalgesia after exercise and the cold pressor test is reduced in chronic musculoskeletal pain patients with high pain sensitivity.
        Clin J Pain. 2016; 32: 58-69
        • Vyazovskiy VV
        Sleep, recovery, and metaregulation: Explaining the benefits of sleep.
        Nat Sci Sleep. 2015; 7: 171-184
        • Wang L
        • Hamaker E
        • Bergeman CS
        Investigating inter-individual differences in short-term intra-individual variability.
        Psychol Methods. 2012; 17: 567-581
        • Werner MU
        • Mjöbo HN
        • Nielsen PR
        • Rudin A
        Prediction of postoperative pain: A systematic review of predictive experimental pain studies.
        Anesthesiology. 2010; 112: 1494-1502
        • Yarnitsky D
        • Granot M
        • Granovsky Y
        Pain modulation profile and pain therapy: Between pro- and antinociception.
        Pain. 2014; 155: 663-665
        • Zimmermann P
        • Fimm B
        A test battery for attentional performance.
        Applied Neuropsychology of Attention. Theory, Diagnosis and Rehabilitation. Psychology Press, London2002: 110-151
        • Zingler VC
        • Denecke K
        • Jahn K
        • Meyer L
        • Krafczyk S
        • Krams M
        • Elfont R
        • Brandt T
        • Strupp M
        • Glasauer S
        The effect of nicotine on perceptual, ocular motor, postural, and vegetative functions at rest and in motion.
        J Neurol. 2007; 254: 1689-1697