By Ed Coghlan.

It’s a well known fact that the lack of restorative sleep is a problem for chronic pain patients

Two studies presented at a recent European rheumatology conference provide some insight into the role of sleep in chronic pain. One study shows a predictive role of sleep difficulties for people with chronic pain, while the other provides insight into chronic pain and sleep among teens.

The National Sleep Foundation has been talking about the sleep problem for chronic and acute pain sufferers for several years. Pain joins two related concerns – stress and poor health – as key correlates of shorter sleep durations and worse sleep quality.

Pain is a key factor in the gap between the amount of sleep Americans say they need and the amount they’re getting – an average 42 minute sleep debt for those with chronic pain

“The relationship between pain and sleep is complex, as the consequences of sleep problems can affect perception to pain and, in turn, pain can interfere with sleep quality,” said Professor Robert Landewé, Chairperson of the Scientific Programme Committee, EULAR. “This is why these studies are important as they help elucidate the role of sleep in chronic pain and highlight it as a potentially important modifiable risk factor for alleviating the distress in these patients.”

There were four parameters relating to sleep that were part of the study. They include, difficulties initiating sleep, maintaining sleep, early morning waking and non-restorative sleep. Three was also one parameter related to fatigue. All were found to predict the onset of chronic widespread pain after five years in a model adjusted for age, gender, socio-economy and mental health. In addition, all parameters except ‘problems with early awakening’ predicted the onset of chronic widespread pain at 18 years.

“Our results demonstrate that sleep problems are an important predictor for chronic pain prognosis and highlight the importance of the assessment of sleep quality in the clinics,” said Katarina Aili, PhD, Spenshult Research and Development Center, Halmstad, Sweden.

Additional analysis showed that reporting all four sleeping problems at baseline versus no sleep problems was significantly associated with chronic widespread pain at both time points using a number of models adjusted for age, gender, socio-economy as well as mental health, number of pain regions or pain severity.

Individuals included in the study had not reported chronic widespread pain at baseline or during the previous three years, 1,249 entered the five-year and 791 entered the 18-year follow up analysis. Four parameters related to sleep (difficulties initiating sleep, maintaining sleep, early morning awakening and non-restorative sleep), and one parameter related to fatigue (SF-36 vitality scale) were investigated as predictors for chronic widespread pain.

Sleeping problems and anxiety associated to chronic multisite musculoskeletal pain in adolescents2

One in ten students in the study was suffering with chronic multisite musculoskeletal pain (CMP). Analysis showed that, compared to other students, having CMP was associated with reporting severe sleeping problems as well as probable cases of anxiety.

“Although the relationship between sleep and pain is complex, our results clearly indicate a strong association which needs to be explored further,” said Julia S. Malmborg, PhD student at The Rydberg Laboratory for Applied Sciences, Halmstad University, Sweden. “As both problems affect the physiological and psychological well-being of sufferers we hope that these results will be used by school health professionals to promote student health.”

The sleep gap narrows sharply among those who make sleep a priority.

Editor’s Note. If you have a “sleep story” to tell, please do in our commentary section.

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