From: Eur J Pain. 2009 Nov;13(10):1043-7. Epub 2009 Jan 24
Recent research suggests bi-directional interactions between the experience of pain and the process of sleep; pain interferes with the ability to obtain sleep, and disrupted sleep contributes to enhanced pain perception. Our group recently reported, in a controlled experimental study, that sleep fragmentation among healthy adults resulted in subsequent decrements in endogenous pain inhibition. The present report follows up that observation by extending this line of research to a sample of patients experiencing persistent pain. Patients with chronic temporomandibular joint disorder pain were studied using polysomnography and psychophysical evaluation of pain responses. The authors assessed whether individual differences in sleep continuity and/or architecture were related to diffuse noxious inhibitory controls, a measure of central nervous system pain inhibition. Among 53 temporomandibular joint disorder patients, higher sleep efficiency and longer total sleep time were positively associated with better functioning of diffuse noxious inhibitory controls. These results suggest the possibility that disrupted sleep may serve as a risk factor for inadequate pain-inhibitory processing and hint that aggressive efforts to treat sleep disturbance early in the course of a pain condition might be beneficial in reducing the severity or impact of clinical pain.
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From: J Orofac Pain. 2002;16(3):221-8.
To explore the relationships between sleep quality, perceived pain, and psychologic distress among patients with temporomandibular disorders. A total of 137 consecutive patients who sought care at the University of Kentucky Orofacial Pain Center for the management of temporomandibular disorders participated in this study and completed a battery of standardized, self-report questionnaires at their first clinic visit. The Pittsburgh Sleep Quality Index (PSQI) and the Multidimensional Pain Inventory (MPI) were used to measure patients’ sleep quality and multiple dimensions of pain and suffering, respectively. The Revised Symptom Checklist-90 (SCL-90R) was used to evaluate psychologic symptoms. A median cutoff (PSQI total score: 10) divided the patients into 2 groups, i.e., 67 poor sleepers and 70 good sleepers. There were no statistically significant differences in gender and age distributions between the 2 groups. Poor sleepers reported significantly higher scores than good sleepers on each of the 14 scales of the SCL-90R and on 7 of the 13 scales of the MPI. Stepwise multiple regression analyses demonstrated that poorer sleep quality was predicted by higher pain severity, greater psychologic distress, and less perceived life control. This study supports the frequent comorbidity of reported sleep disturbance, perceived pain severity, and psychologic distress in patients with temporomandibular disorders.
From: Sleep Med Rev. 2004 Apr;8(2):119-32
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 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 cognitive-behavioral therapies 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.
Related Article: Duration of sleep contributes to next-day pain report in the general population
