Does Effective Management of Sleep Disorders Improve Pain Symptoms?

Abstract

Co-morbid insomnia is a much more frequent problem than primary insomnia. In co-morbid insomnia, management of the underlying disease can improve sleep difficulty. Conversely, treating the sleep disorder may also improve the co-morbid condition. For example, patients with painful chronic illnesses are more likely to experience sleep disturbance than patients with non-painful illnesses. Moreover, there is evidence that insomnia further exacerbates pain in these illnesses. This suggests that a reciprocal relationship exists between pain and sleep, and that intervention targeted primarily at insomnia may improve pain. Treatment options for sleep disorders in the context of pain that have been assessed include cognitive behavioural therapy for insomnia and various pharmacological therapies. In randomized clinical trials, cognitive behavioural therapy significantly improved insomnia secondary to chronic pain compared with control therapy, but pain was only improved in patients in whom it was associated with pain disorders other than fibromyalgia. Of the pharmacological agents studied (zopiclone, zolpidem and triazolam), only triazolam improved both sleep and pain to a greater extent than placebo. Overall, clinical data supporting a cause-effect relationship between insomnia and pain are preliminary and are limited to several small trials. Further investigation is required to clarify the extent of the link between insomnia and pain and whether successfully managing insomnia secondary to pain improves pain symptoms. Areas of particular interest include investigation of the effect of sleep agents on analgesia and the effect of analgesics on sleep.

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Acknowledgements

The discussions that took place during a workshop at the 6th annual meeting of The International Sleep Disorders Forum: The Art of Good Sleep, held in 2008, contributed to the preparation of this article. The author would like to thank the following individuals who attended the workshop and contributed to the discussions that have informed the content of this article: Alison Bentley (South Africa), Michael Bonnet (USA), Jeffery Fahs (USA), Do-Un Jeong (Korea), Alan Lankford (USA), Holger Link (USA), Charles Morin (Canada), Michael Sateia (USA) and Michael Vitiello (USA). The author would like to thank Susan Keam and Matt Weitz from Wolters Kluwer Pharma Solutions for providing medical writing support in the preparation of this article. This assistance was supported by sanofi-aventis. The International Sleep Disorders Forum: The Art of Good Sleep 2008 was funded by sanofi-aventis.

Declaration of conflicts of interest: Timothy Roehrs is a consultant to sanofi-aventis and has received honoraria. No authorship assistance was received besides the names disclosed above.

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Correspondence to Timothy A. Roehrs PhD.

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Roehrs, T.A. Does Effective Management of Sleep Disorders Improve Pain Symptoms?. Drugs 69, 5–11 (2009). https://doi.org/10.2165/11531260-000000000-00000

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Keywords

  • Cognitive Behavioural Therapy
  • Fibromyalgia
  • Sleep Disorder
  • Pregabalin
  • Zolpidem