Current Rheumatology Reports

, 13:535 | Cite as

Does Sleep Differ Among Patients with Common Musculoskeletal Pain Disorders?

  • Gilles J. LavigneEmail author
  • Angela Nashed
  • Christiane Manzini
  • Maria Clotilde Carra
Rheumatic Manifestations of Other Diseases (Roland Staud, Section Editor)


Most patients with chronic musculoskeletal pain report poor-quality sleep. The impact of chronic pain on sleep can be described as a vicious circle with mutual deleterious influences between pain and sleep-associated symptoms. It is difficult, however, to extract quantitative or consistent and specific sleep variables (eg, total sleep time, slow-wave sleep, sleep stage duration) that characterize the pain-related disruption of sleep. Comorbidity (eg, fatigue; depression; anxiety, sleep, movement, or breathing disorders) often confounds the reading and interpretation of sleep traces. Furthermore, many other methodologic issues complicate our ability to generalize findings (low external validity) to first-line medicine. Because sleep alterations in common musculoskeletal pain are neither specific nor pathognomonic, the aim is to provide a critical overview of the current understanding of pain and sleep interaction, discussing evidence-based and empiric knowledge that should be considered in further research and clinical applications.


Fibromyalgia Chronic widespread pain Rheumatoid arthritis Juvenile arthritis Osteoarthritis Temporomandibular disorder Sleep Musculoskeletal pain disorders Napping Slow-wave activity Sleep intensity Delta activity Alpha activity Insomnia Sleep disorders Breathing Sleep apnea Periodic limb movement during sleep 



The work of the principal author is supported by the Canada Research Chair program, CIHR, CFI, Canadian Government, and by the Quebec Pain Research Network of the FRSQ, Quebec Government. Dr. Carra holds a fellowship from the Ministère de l’Éducation, du Loisir et du Sport du Quebec.


Dr. Lavigne served as a speaker at congress paid by UCB and has served as a consultant for Pfizer Canada and Philips Respironics. Drs. Nashed, Manzini, and Carra reported no potential conflicts of interest relevant to this article.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • Tracey I. Getting the pain you expect: mechanisms of placebo, nocebo and reappraisal effects in humans. Nat Med. 2010;16:1277–83. This is a landmark pain review with regard to placebo, neurophysiology, psychology, and imaging. PubMedCrossRefGoogle Scholar
  2. 2.
    Tracey I, Mantyh PW. The cerebral signature for pain perception and its modulation. Neuron. 2007;55:377–91.PubMedCrossRefGoogle Scholar
  3. 3.
    Lavigne G, Zucconi M, Castronovo C, et al. Sleep arousal response to experimental thermal stimulation during sleep in human subjects free of pain and sleep problems. Pain. 2000;84:283–90.PubMedCrossRefGoogle Scholar
  4. 4.
    Lavigne G, Brousseau M, Kato T, et al. Experimental pain perception remains equally active over all sleep stages. Pain. 2004;110:646–55.PubMedCrossRefGoogle Scholar
  5. 5.
    • Lavigne G, Smith MT, Denis R, Zucconi M. Pain and sleep. In: Kryger HM, Roth T, Dement WC, editors. Principles and practice of sleep medicine. St. Louis: Elsevier Saunders; 2011. P. 1442–51. This is a global review on sleep–pain interaction. CrossRefGoogle Scholar
  6. 6.
    Ohayon MM. Prevalence and correlates of nonrestorative sleep complaints. Arch Intern Med. 2005;165:35–41.PubMedCrossRefGoogle Scholar
  7. 7.
    Davies KA, Macfarlane GJ, Nicholl BI, et al. Restorative sleep predicts the resolution of chronic widespread pain: results from the Epifund study. Rheumatology. 2008;47:1809–13.PubMedCrossRefGoogle Scholar
  8. 8.
    Rohrbeck J, Jordan K, Croft P. The frequency and characteristics of chronic widespread pain in general practice: a case-control study. Br J Gen Pract. 2007;57:92–4.Google Scholar
  9. 9.
    Alattar M, Harrington JJ, Mitchell CM, Sloane P. Sleep problems in primary care: a North Carolina Family Practice Research Network (NC-FP-RN) study. J Am Board Fam Pract. 2007;20:365–74.CrossRefGoogle Scholar
  10. 10.
    Okura K, Lavigne GJ, Huynh N, et al. Comparison of sleep variables between chronic widespread musculoskeletal pain, insomnia, periodic leg movements syndrome and control subjects in a clinical sleep medicine practice. Sleep Med. 2008;9:352–61.PubMedCrossRefGoogle Scholar
  11. 11.
    •• Smith MT, Wickwire EM, Grace EG, et al. Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder. Sleep 2009;32:779–90. This paper discussed the comorbidities between temporomandibular joint disorder and sleep disorders (eg, insomnia, breathing disorders). PubMedGoogle Scholar
  12. 12.
    Moldofsky H, Inhaber NH, Guinta DR, Alvarez-Horine SB. Effects of sodium oxybate on sleep physiology and sleep/wake-related symptoms in patients with fibromyalgia syndrome: a double-blind, randomized, placebo-controlled study. J Rheumatol. 2010;37:2156–66.PubMedCrossRefGoogle Scholar
  13. 13.
    Shen J, Barbera J, Shapiro CM. Distinguishing sleepiness and fatigue: a focus on definition and measurement. Sleep Med Rev. 2006;10:63–76.PubMedCrossRefGoogle Scholar
  14. 14.
    Nijrolder I, van der Windt DA, Twisk JW, van der Horst HE. Fatigue in primary care: longitudinal associations with pain. Pain. 2010;150:351–7.PubMedCrossRefGoogle Scholar
  15. 15.
    AASM. International classification of sleep disorders. Westchester: American Academy of Sleep Medicine; 2005.Google Scholar
  16. 16.
    Mease PJ, Arnold LM, Crofford LJ, et al. Identifying the clinical domains of fibromyalgia: contributions from clinician and patient delphi exercises. Arthritis Rheum. 2008;59:952–60.PubMedCrossRefGoogle Scholar
  17. 17.
    Zautra AJ, Fasman R, Parish BP, Davis MC. Daily fatigue in women with osteoarthritis, rheumatoid arthritis, and fibromyalgia. Pain. 2007;128:128–35.PubMedCrossRefGoogle Scholar
  18. 18.
    Guilleminault C, Lopes MC, Hagen CC, da Rosa A. The cyclic alternating pattern demonstrates increased sleep instability and correlates with fatigue and sleepiness in adults with upper airway resistance syndrome. Sleep. 2007;30:641–7.PubMedGoogle Scholar
  19. 19.
    Neu D, Hoffmann G, Moutrier R, et al. Are patients with chronic fatigue syndrome just ‘tired’ or also ‘sleepy’? J Sleep Res. 2008;17:427–31.PubMedCrossRefGoogle Scholar
  20. 20.
    Takahashi M. The role of prescribed napping in sleep medicine. Sleep Med Rev. 2003;7:227–35.PubMedCrossRefGoogle Scholar
  21. 21.
    Werth E, Diijk DJ, Achermann P, Borbely AA. Dynamics of the sleep EEG after an early evening nap: experimental data and simulations. Am J Physiol. 1996;271:R501–10.PubMedGoogle Scholar
  22. 22.
    •• Edwards RR, Almeida DM, Klick B, et al. Duration of sleep contributes to next-day pain report in the general population. Pain 2008;137:202–7. This study yielded strong findings that showed that individuals with shorter and longer sleep times report more pain. PubMedCrossRefGoogle Scholar
  23. 23.
    • Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 2010;62:600–10. This was a revision of fibromyalgia diagnostic criteria: tender point examination is no longer needed to evaluate patients. CrossRefGoogle Scholar
  24. 24.
    Bigatti SM, Hernandez AM, Cronan TA, Rand KL. Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression. Arthritis Rheum. 2008;59:961–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Landis CA, Lentz MJ, Rothermel J, et al. Decreased sleep spindles and spindle activity in midlife woman with fibromyalgia and pain. Sleep. 2004;27:741–50.PubMedGoogle Scholar
  26. 26.
    •• Burns JW, Crofford LJ, Chervin RD. Sleep stage dynamics in fibromyalgia patients and controls. Sleep Med. 2008;9:689–96. This paper and that by Chervin et al. [27] showed that fibromyalgia patients have different sleep macrostructure compared with controls. PubMedCrossRefGoogle Scholar
  27. 27.
    Chervin RD, Teodorescu M, Kushwaha R, et al. Objective measures of disordered sleep in fibromyalgia. J Rheumatol. 2009;36:2009–16.PubMedCrossRefGoogle Scholar
  28. 28.
    Rizzi M, Sarzi-Puttini P, Atzeni P, et al. Cyclic alternating pattern: a new marker of sleep alteration in patients with fibromyalgia? J Rheumatol. 2004;31:1193–9.PubMedGoogle Scholar
  29. 29.
    Drewes AM, Gade K, Nielsen KD, et al. Clustering of sleep electroencephalographic patterns in patients with the fibromyalgia syndrome. Br J Rheumatol. 1995;34:1151–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Roizenblatt S, Moldofsky H, Benedito-Silva AA, Tufik S. Alpha sleep characteristics in fibromyalgia. Arthritis Rheum. 2001;44:222–30.PubMedCrossRefGoogle Scholar
  31. 31.
    •• Lavigne GJ, Okura K, Abe S, et al. Gender specificity of the slow wave sleep lost in chronic widespread musculoskeletal pain. Sleep Med. 2011;12:179–85. Females with fibromyalgia have lower power of slow-wave sleep compared with controls and male patients. PubMedCrossRefGoogle Scholar
  32. 32.
    MacFarlane JG, Shahal B, Mously C, Moldofsky H. Periodic K-alpha sleep EEG activity and periodic limb movements during sleep: comparisons of clinical features and sleep parameters. Sleep. 1996;19:200–4.PubMedGoogle Scholar
  33. 33.
    Martinez-Lavin M, Hermosillo AG, Rosas M, Soto ME. Circadian studies of autonomic nervous balance in patients with fibromyalgia: a heart rate variability analysis. Arthritis Rheum. 1998;41:1966–71.PubMedCrossRefGoogle Scholar
  34. 34.
    •• Louie GH, Tektonidou MG, Caban-Martinez AJ, Ward MM. Sleep disturbances in adults with arthritis: prevalence, mediators, and subgroups at greatest risk. Data from the 2007 National Health Interview Survey. Arthritis Care Res (Hoboken) 2011;63:247–60. Patients with RA had a higher risk of reporting insomnia complaints compared with controls. CrossRefGoogle Scholar
  35. 35.
    Mahowald MW, Mahowald SR, Bundlie SR, Ytterberg SR. Sleep fragmentation in rheumatoid arthritis. Arthritis Rheum. 1989;32:974–83.PubMedCrossRefGoogle Scholar
  36. 36.
    Drewes AM, Svendsen L, Taagholt SJ, et al. Sleep in rheumatoid arthritis: a comparison with healthy subjects and studies of sleep-wake interactions. Br J Rheumatol. 1998;37:71–81.PubMedCrossRefGoogle Scholar
  37. 37.
    •• Ward TM, Brandt P, Archbold K, et al. Polysomnography and self-reported sleep, pain, fatigue, and anxiety in children with active and inactive juvenile rheumatoid arthritis. J Pediatr Psychol. 2008;33:232–41. Important differences on sleep architecture in juvenile RA patients were pointed out in this article and in the article by Lopes et al. [38]. PubMedCrossRefGoogle Scholar
  38. 38.
    Lopes MC, Guilleminault C, Rosa A, et al. Delta sleep instability in children with chronic arthritis. Braz J Med Biol Res. 2008;41:938–43.PubMedCrossRefGoogle Scholar
  39. 39.
    Goulet JP, Lavigne GJ, Lund JP. Jaw pain prevalence among French-speaking Canadians in Quebec and related symptoms of temporomandibular disorders. J Dent Res. 1995;74:1738–44.PubMedCrossRefGoogle Scholar
  40. 40.
    Solberg Nes L, Carlson CR, Crofford LJ, et al. Self-regulatory deficits in fibromyalgia and temporomandibular disorders. Pain. 2010;151:37–44.PubMedCrossRefGoogle Scholar
  41. 41.
    Dao TT, Lund JP, Lavigne GJ. Comparison of pain and quality of life in bruxers and patients with myofascial pain of the masticatory muscles. J Orofac Pain. 1994;8:350–6.PubMedGoogle Scholar
  42. 42.
    de Leeuw R, Studts JL, Carlson CR. Fatigue and fatigue-related symptoms in an orofacial pain population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99:168–74.PubMedCrossRefGoogle Scholar
  43. 43.
    Velly AM, Gornitsky M, Philippe P. Contributing factors to chronic myofascial pain: a case-control study. Pain. 2003;104:491–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Rompre PH, Daigle-Landry D, Guitard F, et al. Identification of a sleep bruxism subgroup with a higher risk of pain. J Dent Res. 2007;86:837–42.PubMedCrossRefGoogle Scholar
  45. 45.
    Riley Iii JL, Benson MB, Gremillion HA, et al. Sleep disturbances in orofacial pain patients: pain-related or emotional distress? J Craniomandib Pract. 2001;19:106–13.Google Scholar
  46. 46.
    Yatani H, Studts J, Cordova M, et al. Comparison of sleep quality and clinical and psychologic characteristics in patients with temporomandibular disorders. J Orofac Pain. 2002;16:221–8.PubMedGoogle Scholar
  47. 47.
    •• Woolf CJ. Overcoming obstacles to developing new analgesics. Nat Med. 2010;16:1241–7. This review is essential for understanding obstacles in analgesic efficacy and innovative drug developments. PubMedCrossRefGoogle Scholar
  48. 48.
    •• Laverdure-Dupont D, Rainville P, Montplaisir J, Lavigne G. Changes in rapid eye movement sleep associated with placebo-induced expectations and analgesia. J Neurosci. 2009;29:11745–52. Novel findings support the idea that expectation from placebo analgesia is influenced by sleep. PubMedCrossRefGoogle Scholar
  49. 49.
    Laverdure-Dupont D, Rainville P, Montplaisir J, Lavigne G. Relief expectation and sleep. Rev Neurosci. 2010;21:381–95.PubMedCrossRefGoogle Scholar
  50. 50.
    Laverdure-Dupont D, Rainville P, Montplaisir J., Lavigne G. Can placebo analgesia occur during sleep? Presented at 13th World Congress on Pain (IASP). Montreal, Canada; 2010: August 29–September 22, 2010.Google Scholar
  51. 51.
    Tang NK, Wright KJ, Salkovskis PM. Prevalence and correlates of clinical insomnia co-occurring with chronic back pain. J Sleep Res. 2007;16:85–95.PubMedCrossRefGoogle Scholar
  52. 52.
    Shaw IR, Lavigne G, Mayer P, Choiniere M. Acute intravenous administration of morphine perturbs sleep architecture in healthy pain-free young adults: a preliminary study. Sleep. 2005;28:677–82.PubMedGoogle Scholar
  53. 53.
    Roehrs T, Hyde M, Blaisdell B, et al. Sleep loss and rem sleep loss are hyperalgesic. Sleep. 2006;29:145–51.PubMedGoogle Scholar
  54. 54.
    Russell IJ, Mease PJ, Smith TR, et al. Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major depressive disorder: results from a 6-month, randomized, double-blind, placebo-controlled, fixed-dose trial. Pain. 2008;136:432–44.PubMedCrossRefGoogle Scholar
  55. 55.
    Arnold LM, Russell IJ, Diri EW, et al. A 14-week, randomized, double-blinded, placebo-controlled monotherapy trial of pregabalin in patients with fibromyalgia. J Pain. 2008;9:792–805.PubMedCrossRefGoogle Scholar
  56. 56.
    Russell IJ, Perkins AT, Michalek JE. Sodium oxybate relieves pain and improves function in fibromyalgia syndrome: a randomized, double-blind, placebo-controlled, multicenter clinical trial. Arthritis Rheum. 2009;60:299–309.PubMedCrossRefGoogle Scholar
  57. 57.
    Onen F, Onen H. Obstructive sleep apnea and cognitive impairment in the elderly. Psychol Neuropsychiatr Vieil. 2010;8:163–9.PubMedGoogle Scholar
  58. 58.
    Franco L, Rompre P, de Grandmont P, Abe S, Lavigne G. A mandibular advancement appliance reduces pain and rhythmic masticatory muscle activity in patients with morning headache. J Orofac Pain 2011;25(3):240-249.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Gilles J. Lavigne
    • 1
    Email author
  • Angela Nashed
    • 1
  • Christiane Manzini
    • 1
  • Maria Clotilde Carra
    • 1
  1. 1.Faculté de médecine dentaireUniversité de MontréalMontréalCanada

Personalised recommendations