Chronic pain and sleep disorders

O.V. Kotova, A.A. Belyaev, S.A. Melik-Arakelyan

1) Faculty of Continuous Medical Education, Medical Institute, Patrice Lumumba People’s Friendship University of Russia, Moscow, Russia; 2) International Society “Stress under Control”, Moscow, Russia; 3) Research Institute for Emergency Medicine named after N.V. Sklifosovsky, Moscow, Russia; 4) Pirogov Russian National Research Medical University (Pirogov University), Moscow, Russia

Pain is often accompanied by sleep disorders, which manifest themselves in insufficient duration or quality of sleep. The relationship between pain and sleep is bidirectional: pain can disrupt sleep, and poor sleep in turn reduces the pain threshold and increases spontaneous pain. Like chronic pain, sleep disorders are a serious public health problem that affects overall health. A recent meta-analysis found a high prevalence of sleep disturbances in people with chronic pain, including insomnia (72%), obstructive sleep apnea (32%), and restless legs syndrome (32%). There is evidence that short or disrupted sleep can cause hyperalgesia (i.e., increased sensitivity to painful stimuli) and the development or exacerbation of spontaneous pain attacks (eg, muscle pain, headache). Current understanding of the neurobiological mechanisms of pain involves the opioid, monoaminergic, orexinergic, immune, melatonin, endocannabinoid, hypothalamic-pituitary-adrenal, and adenosine signaling systems, some of which are reviewed in this article. The clinical implications of the bidirectional relationship between sleep and pain should be considered in pain management. A large-scale study demonstrated that short-term improvement in insomnia symptoms predicted both long-term improvement in sleep and reduction in pain, regardless of the treatment method – pharmacological or non-pharmacological, which supports the hypothesis that improved sleep can lead to more effective pain relief and should serve as a basis for the development of new drugs and, possibly, behavioral treatments that could help manage or relieve pain, potentially affecting the common mechanisms regulating sleep and pain.

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About the Authors

Olga V. Kotova, Cand. Sci. (Med.), Neurologist, Psychiatrist, Associate Professor at the Department of Psychiatry, Psychotherapy and Psychosomatic Pathology, Faculty of Continuous Medical Education, Medical Institute, Patrice Lumumba People’s Friendship University of Russia; Vice President of the International Society «Stress Under Control», Moscow, Russia; ol_kotova@mail.ru, ORCID: https://orcid.org/0000-0002-3908-0381 (corresponding author)
Anton A. Belyaev, Neurologist, Junior Researcher, Department of Emergency Vascular Surgery, Research Institute for Emergency Medicine named after N.V. Sklifosovsky, Moscow, Russia; ORCID: https://orcid.org/0000-0002-7186-870X
Sofya A. Melik-Arakelyan, Student, Institute of Maternity and Childhood, Pirogov Russian National Research Medical University (Pirogov University), Moscow, Russia; ORCID: https://orcid.org/0009-0008-0969-1756

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