Abstract
Musculoskeletal pain is common and often occurs at multiple sites. Persons with chronic widespread pain (CWP) often report disturbed sleep. Until recently, the relationship between sleep disturbance and CWP has been unclear: does poor sleep increase the risk of developing CWP, do people with CWP develop poor sleep as a consequence of their pain, or is the relationship bi-directional? In this article, we have focused on the relationship between insomnia and CWP. We briefly present descriptive epidemiological data for insomnia and CWP. We then summarise the available evidence which supports the hypothesis that the relationship is bi-directional. Finally, we discuss the clinical management of CWP and insomnia in primary care, where the vast majority of cases of CWP are managed.
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Tafti M. Genetic aspects of normal and disturbed sleep. Sleep Med. 2009;10 Suppl 1:S17–21.
Macfarlane GJ, McBeth J, Jones GT. Epidemiology of pain. In: McMahon S, Koltzenburg M, Tracey I, Turk DC, editors. Wall and Melzack’s textbook of pain. 6th ed. Seattle: Elsevier Ltd; 2013.
Kamaleri Y, Natvig B, Ihlebaek CM, et al. Localized or widespread musculoskeletal pain: does it matter? Pain. 2008;138:41–6.
Croft P, Rigby AS, Boswell R, et al. The prevalence of chronic widespread pain in the general population. J Rheumatol. 1993;20:710–3.
Mundal I, Grawe RW, Bjorngaard JH, et al. Prevalence and long-term predictors of persistent chronic widespread pain in the general population in an 11-year prospective study: the HUNT study. BMC Musculoskelet Disord. 2014;15:213.
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. 2010;62(5):600–10.
Moldofsky H, Scarisbrick P, England R, et al. Musculosketal symptoms and non-REM sleep disturbance in patients with “fibrositis syndrome” and healthy subjects. Psychosom Med. 1975;37(4):341–51.
Hauri P, Hawkins DR. Alpha-delta sleep. Electroencephalogr Clin Neurophysiol. 1973;34(3):233–7.
Moldofsky H. Sleep influences on regional and diffuse pain syndromes associated with osteoarthritis. Semin Arthritis Rheum. 1989;18(4 Suppl 2):18–21.
Jaimchariyatam N, Rodriguez CL, Budur K. Prevalence and correlates of alpha-delta sleep in major depressive disorders. Innov Clin Neurosci. 2011;8(7):35–49.
Rains JC, Penzien DB. Sleep and chronic pain: challenges to the alpha-EEG sleep pattern as a pain specific sleep anomaly. J Psychosom Res. 2003;54(1):77–83.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.
Smith MT, Haythornthwaite JA. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev. 2004;8(2):119–32.
Vgontzas AN, Fernandez-Mendoza J. Insomnia with short sleep duration: nosological, diagnostic, and treatment implications. Sleep Med Clin. 2013;8(3):309–22.
Ohayon MM, Riemann D, Morin C, et al. Hierarchy of insomnia criteria based on daytime consequences. Sleep Med. 2012;13(1):52–7.
Morin CM, Belanger L, LeBlanc M, et al. The natural history of insomnia: a population-based 3-year longitudinal study. Arch Intern Med. 2009;169(5):447–53.
Ohayon MM, Reynolds CF. Epidemiological and clinical relevance of insomnia diagnosis algorithms according to the DSM-IV and the International Classification of Sleep Disorders (ICSD). Sleep Med. 2009;10(9):952–60.
Ancoli-Israel S. Sleep and its disorders in aging populations. Sleep Med. 2009;10 Suppl 1:S7–11.
Foley DJ, Monjan AA, Brown SL, et al. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep. 1995;18(6):425–32.
Reid KJ, Martinovich Z, Finkel S, et al. Sleep: a marker of physical and mental health in the elderly. Am J Geriatr Psychiatry. 2006;14(10):860–6.
Foley D, Ancoli-Israel S, Britz P, et al. Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey. J Psychosom Res. 2004;56(5):497–502.
Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33(2):160–72.
Carnes D, Parsons S, Ashby D, et al. Chronic musculoskeletal pain rarely presents in a single body site: results from a UK population study. Rheumatology. 2007;46(7):1168–70.
Wolfe F, Ross K, Anderson J, et al. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995;38(1):19–28.
Choudhury Y, Bremner SA, Ali A, et al. Prevalence and impact of chronic widespread pain in the Bangladeshi and White populations of Tower Hamlets, East London. Clin Rheumatol. 2013;32(9):1375–82.
McBeth J, Lacey RJ, Wilkie R. Predictors of new-onset widespread pain in older adults: results from a population-based prospective cohort study in the UK. Arthritis Rheumatol. 2014;66(3):757–67. Sleep disturbance was the strongest predictor of incident widespread pain in older people. The mechanism of association needs to be identified.
Branco JC, Bannwarth B, Failde I, et al. Prevalence of fibromyalgia: a survey in five European countries. Semin Arthritis Rheum. 2010;39(6):448–53.
Thomas E, Peat G, Harris L, et al. The prevalence of pain and pain interference in a general population of older adults: cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP). Pain. 2004;110(1–2):361–8.
Macfarlane GJ, Pye SR, Finn JD, et al. Investigating the determinants of international differences in the prevalence of chronic widespread pain: evidence from the European Male Ageing Study. Ann Rheum Dis. 2009;68(5):690–5.
Vincent A, Lahr BD, Wolfe F, et al. Prevalence of fibromyalgia: a population-based study in Olmsted County, Minnesota, utilizing the Rochester Epidemiology Project. Arthritis Care Res. 2013;65(5):786–92.
Bigatti SM, Hernandez AM, Cronan TA, et al. Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression. Arthritis Rheum. 2008;59(7):961–7.
Tang NK, Wright KJ, Salkovskis PM. Prevalence and correlates of clinical insomnia co-occurring with chronic back pain. J Sleep Res. 2007;16(1):85–95.
Taylor DJ, Mallory LJ, Lichstein KL, et al. Comorbidity of chronic insomnia with medical problems. Sleep. 2007;30(2):213–8.
Moldofsky H, Scarisbrick P. Induction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation. Psychosom Med. 1976;38(1):35–44.
Schuh-Hofer S, Wodarski R, Pfau DB, et al. One night of total sleep deprivation promotes a state of generalized hyperalgesia: a surrogate pain model to study the relationship of insomnia and pain. Pain. 2013;154(9):1613–21.
Anderson RJ, McCrae CS, Staud R, et al. Predictors of clinical pain in fibromyalgia: examining the role of sleep. J Pain. 2012;13(4):350–8.
Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539–52.
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(12):1809–13.
Gupta A, Silman AJ, Ray D, et al. The role of psychosocial factors in predicitng the onset of chronci widesrpead pain: results from a prospective population--based study. Rheumatology. 2007;46(4):666–71.
Mork PJ, Nilsen TI. Sleep problems and risk of fibromyalgia: longitudinal data on an adult female population in Norway. Arthritis Rheum. 2012;64(1):281–4. This large longitudinal study reported a dose-response relationship between sleep problems and the risk of developing fibromyalgia. Importantly, this effect was stronger in older when compared to younger women.
Ødegård SS, Sand T, Engstrom M, et al. The impact of headache and chronic musculoskeletal complaints on the risk of insomnia: longitudinal data from the Nord-Trondelag health study. J Headache Pain. 2013;14:24.
Tang NK, McBeth J, Jordan KP, et al. Impact of musculoskeletal pain on insomnia onset: a prospective cohort study. Rheumatology. 2014. doi:10.1093/rheumatology/keu283.
Jenkins CD, Stanton BA, Niemcryk SJ, Rose RM. A scale for the estimation of sleep problems in clinical research. J Clin Epidemiol. 1988;41:313–21.
National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries. Insomnia. http://cks.nice.org.uk/insomnia#!scenariorecommendation:2. Accessed 29 Sept 2014.
Schutte-Rodin S, Broch L, Buysse D, et al. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5):487–504.
Brennan MJ, Lieberman JA. Sleep disturbances in patients with chronic pain: effectively managing opioid analgesia to improve outcomes. Curr Med Res Opin. 2009;25(5):1045–55.
Busch AJ, Webber SC, Brachaniec M, et al. Exercise therapy for fibromyalgia. Curr Pain Headache Rep. 2011;15(5):358–67.
McCurry SM, Shortreed SM, Von Korff M, et al. Who benefits from CBT for insomnia in primary care? Important patient selection and trial design lessons from longitudinal results of the Lifestyles trial. Sleep. 2014;37(2):299–308.
Dunn KM, Saunders KW, Rutter CM, et al. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med. 2010;152(2):85–92.
Saunders KW, Dunn KM, Merrill JO, et al. Relationship of opioid use and dosage levels to fractures in older chronic pain patients. J Gen Intern Med. 2010;25(4):310–5.
Johnson M, Collett B, Castro-Lopes JM. The challenges of pain management in primary care: a pan-European survey. J Pain Res. 2013;6:393–401.
Bennett RM, Kamin M, Karim R, et al. Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain: a double-blind, randomized, placebo-controlled study. Am J Med. 2003;114(7):537–45.
Smith H, Bracken D, Smith J. Pharmacotherapy for fibromyalgia. Front Pharmacol. 2011. doi:10.3389/fphar.2011.00017.
Everitt H, McDermott L, Leydon G, et al. GPs’ management strategies for patients with insomnia: a survey and qualitative interview study. Br J Gen Pract. 2014;64(619):e112–9.
Hauser W, Bernardy K, Uceyler N, et al. Treatment of fibromyalgia syndrome with gabapentin and pregabalin—a meta-analysis of randomized controlled trials. Pain. 2009;145(1–2):69–81.
Hauser W, Petzke F, Sommer C. Comparative efficacy and harms of duloxetine, milnacipran, and pregabalin in fibromyalgia syndrome. J Pain. 2010;11(6):505–21.
Gureje O, Von Korff M, Simon GE, et al. Persistent pain and well-being: a World Health Organization Study in primary care. JAMA. 1998;280(2):147–51.
Weschules DJ, Maxwell T, Reifsnyder J, et al. Are newer, more expensive pharmacotherapy options associated with superior symptom control compared to less costly agents used in a collaborative practice setting? Am J Hosp Palliat Care. 2006;23(2):135–49.
Schweitzer PK, Curry DT, Eisenstein RD, et al. Pharmacological treatment of insomnia. In: Attarian HP, Schuman C, editors. Clinical handbook of insomnia. 2nd ed. New York: Humana Press; 2010. p. 297–316.
Wine JN, Sanda C, Caballero J. Effects of quetiapine on sleep in nonpsychiatric and psychiatric conditions. Ann Pharmacother. 2009;43(4):707–13.
Budur K, Rodriguez C, Foldvary-Schaefer N. Advances in treating insomnia. Cleve Clin J Med. 2007;74(4):251–66.
Sengupta P. Health impacts of yoga and pranayama: a state-of-the-art review. Int J Prev Med. 2012;3(7):444–58.
Hester J, Tang NK. Insomnia co-occurring with chronic pain: clinical features, interaction, assessments and possible interventions. Rev Pain. 2008;2:2. doi:10.1177/204946370800200102.
Department of Health. Long term conditions compendium of information. 3rd ed. 2012. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216528/dh_134486.pdf. Accessed 29 Sept 2014.
Jyrkka J, Enlund H, Korhonen MJ, et al. Patterns of drug use and factors associated with polypharmacy and excessive polypharmacy in elderly persons: results of the Kuopio 75+ study: a cross-sectional analysis. Drugs Aging. 2009;26(6):493–503.
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John McBeth, Ross Wilkie, John Bedson, Carolyn Chew-Graham, and Rosie J. Lacey declare that they have no conflict of interest.
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McBeth, J., Wilkie, R., Bedson, J. et al. Sleep Disturbance and Chronic Widespread Pain. Curr Rheumatol Rep 17, 1 (2015). https://doi.org/10.1007/s11926-014-0469-9
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DOI: https://doi.org/10.1007/s11926-014-0469-9