Does chronic pain lead to sleep disturbance? Or… is it the other way around?

Young woman with long hair and a red manicure is sleeping in bed with sleep mask and peeking from underneath the sleeping mask

Does chronic pain lead to sleep disturbance? Or… is it the other way around? 

Yes. And yes. It’s bidirectional. 

As Physiotherapists and health care professionals, we work daily with chronic pain cases. In these situations, it’s completely needed to evaluate the sleep quality of our patients. The scientific evidence about the relationship of these two items is big enough to be ignored. It’s mandatory to access this information in the personal history of each patient. (1,4,5) To determine the role of pain in sleep, a comprehensive assessment of poor sleep associated with insomnia and sleep disorders (e.g., breathing pauses such as apnea) must be considered essential.  

It is very usual for people with chronic pain conditions to share some sleep habits, such as awakening during the night and having difficulty initiating or maintaining sleep. By improving sleep in a patient, we are more likely to enhance the quality of life, daytime functioning, and pain control. (3) 

Chronic pain and medication can also walk hand in hand. The use of opioid medication can lead to sleep disorders, such as insomnia and sleep-disorder breathing (sleep apnea). There must be a good balance in the prescription of opioids and the impact they might have on patients sleep. (6) 

As Physiotherapists, there are two key points that we must emphasize: 

– To know patients pharmacology prescriptions. There is a huge number of secondary effects that we should expect when we deal with these patients, especially because of their medication (opioids, benzodiazepines, antidepressants, antipsychotics, and anticonvulsants). (4,5) 

– To access the patients’ sleep habits. This is the point that we have full power: to understand patients sleep disturbance and to be able to educate them with cognitive behavioural therapy. Psychoeducation, Sleep restriction, Sleep Hygiene, Relaxation training and Stimulus control are some of the topics to educate on. (2,4) 

So, if you are doing a Physiotherapy program please do not wonder if your Physiotherapist asks you some questions about your sleep habit. On contrary, think about why they’re not doing it! Keep your mind wide open… but your eyes closed during the night!  

Author: João Pereira Physiotherapist at CMM – Brentford.
14/12/2021

1. Moldofsky, H.; Scarisbrick, P. (1976). Induction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation. Psychosom Med 
2. 
Tang, NK;, Wright, KJ; Salkovskis, PM. (2007). Prevalence and correlates of clinical insomnia co-occurring with chronic back pain. Sleep Res.
3. Brennan, Michael J.; Lieberman, Joseph A. (2009). Sleep disturbances in patients with chronic pain: effectively managing opioid analgesia to improve outcomes.
4. Cheatle et al (2016). Assessing and Managing Sleep Disturbance in Patients with Chronic Pain.
5. Robertson, J. A.; Purple, R. J.; Cole, P.; Zaiwalla, Z.; Wulff, K.; Pattinson, K. T. S. (2016). Sleep disturbance in patients taking opioid medication for chronic back pain.
6. Marshansky, S.; Mayer, P; Rizzo D.; Baltzan, M.; Denis, R.; Lavigne, G. (2017) Progress in Neuropsychopharmacology & Biological Psychiatry. 

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