Sleep and pain may share a bi-direction relationship amongst patients with chronic musculocutaneous pain

1. Increased current diurnal pain affected quality of sleep and total sleep time the following night amongst patients with chronic musculocutaneous pain.

2. Seasonality and fluctuations in mental distress did not impact the relationship between pain and sleep on a day-to-day basis amongst patients with chronic musculocutaneous pain.

Evidence Rating Level: 2 (Good)

Numerous studies have provided evidence for a bi-directional relationship between pain and sleep. However, there is a paucity in research with respect to day-to-day associations between pain and sleep, and how additional factors such as seasonality may affect this relationship. This prospective cohort study sought to examine the bi-directional relationship between pain and sleep on a day-to-day basis amongst patients with chronic primary musculocutaneous pain (CMP). How seasonality (summer vs. winter) or daily fluctuations in mental distress affected this relationship was also studied. 56 patients aged 18-65 years with CMP were enrolled from the Rehabilitation Department or Pain Clinic at the University Hospital of North Norway. Patients with major medical conditions, neurological conditions, or had a diagnosis of sleep disorders other than insomnia were excluded. Primary outcomes assessed for sleep indices (subjective measures of sleep quality obtained via questionnaires, objective measures of sleep via actigraphy) and pain measures [via the Brief Pain Inventory (BPI)].

The study’s main finding demonstrated that current pain was a significant predictor of poor next-night sleep quality. It was also suggested that current pain marginally impacted next-night sleep duration. Inversely, sleep quality was found to have some effect on reported pain the subsequent day. Furthermore, mental distress and seasonality did not impact the day-to-day relationship between sleep and pain. Limitations included small sample size which underpowered the study, and that medication use was not recorded or adjusted for in analysis. Nonetheless, this study was significant in re-iterating the importance of evaluating sleep in chronic pain patients, and how influential sleep and pain are amongst each other.

Click to read the study in Journal of Sleep Research 

Image: PD

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