Sleep issues and musculoskeletal pain: A two-way street with numerous influences

This article discusses research that shows sleep issues can lead to pain, and pain can lead to sleep issues. It also explores other factors influencing both sleep and pain, such as mood and affect, as well as potential dual treatment options, including medication and psychotherapy.  

Sleep difficulties and musculoskeletal pain often go hand in hand. Research published in Frontiers in Psychiatry in June 2023 reports that more than 65% of patients with chronic pain report trouble sleeping and 40% of people with insomnia have chronic pain.  

While some researchers are working to identify cause and effect, whether sleep issues more commonly lead to pain or if pain typically precedes sleep issues, others are attempting to identify factors that may be contributing to both. Here’s what they’ve found. 

Sleep issues increase predisposition to pain

A 2018 review in CHEST says while the conventional view is a bidirectional relationship between sleep disturbances and pain, longitudinal studies are now exploring whether the former often precedes the latter. Many suggest individuals experiencing trouble sleeping have a higher predisposition for chronic pain or a worsening of their pain-based condition. 

Insomnia has been identified as a contributor to pain development or worsening. Insufficient sleep, sleep apnea, narcolepsy and grinding of the teeth during sleep (sleep bruxism) may also lead to this effect, though more research is needed to determine each’s propensity to increase the risk of developing a painful condition. 

Another 2018 review, this one in Sleep Medicine Reviews, assessed whether changing sleep issues could impact pain outcomes. It reported a two-fold increase in the development of a pain condition when sleep quality declines. When sleep quantity is reduced, this risk increases three-fold. 

Pain reduces sleep quality in multiple ways

Being in physical pain can make it more difficult to fall asleep. It also impacts a person’s ability to stay asleep. Research published in 2022 found pain sensitivity follows a 24-hour rhythm, with this sensitivity being highest in the middle of the night. This can contribute to increased wakening frequencies. 

Sometimes it is pain-relieving medications behind reduced sleep quality. A 2020 review in Neuropsychopharmacology notes that opioids have sleep-disruptive effects, with NSAIDs also having mild impacts. If patients are prescribed a tricyclic antidepressant or corticosteroid to help deal with pain, this can negatively affect their sleep as well. 

The role of mood and affect on sleep issues

Other research suggests a person’s mood or psychological affect may impact their susceptibility to both pain and sleep issues. A 2019 systematic review in the Clinical Journal of Pain highlights several studies finding a connection between pain, sleep problems and psychological issues related to anxiety, depression, negative mood or affect, attention to pain and pain helplessness. 

Consequences of co-occurring pain and sleep issues

It’s no surprise pain and low sleep quality can each impact mental and physical health. But when they exist in tandem, some effects are magnified.  

A 2020 review found patients experiencing both chronic pain and sleep issues often have more severe pain and for longer duration. They also tend to have greater disability and increased mental health risks associated with depression, anxiety, catastrophizing and suicidal ideation. 

Combatting pain and sleep difficulties together

What can patients do when facing pain and sleep disturbances? The 2020 review mentioned above reports the medication pregabalin is effective for improving sleep and pain symptoms, with cognitive behavioral therapy (CBT) also offering long-term sleep improvement when chronic pain exists. 

A study involving youth with chronic migraine headaches and co-occurring insomnia reported reduced headache days and insomnia symptoms after six CBT sessions held over six to 12 weeks, followed by another session one month later. These improvements were still present three months after treatment ended, with subjects also experiencing reduced pain-related activity limitations. 

Final thoughts

In the end, pain and sleep issues are a two-way street with several other factors at play. Finding ways to resolve both can help patients enjoy an improved quality of life.