![]() ![]() The steadily emergent view supported by those reviews has been that pain and sleep are reciprocally related, and that acute experimentally-induced sleep loss increases pain sensitivity. ![]() Prior reviews on the subject have examined evidence from prospective 103 and experimental 54 studies to determine if sleep and pain are reciprocally related or better characterized through unidirectional models. In the backdrop of this accruing evidence in support of a sleep/pain association, two fundamental questions continue to linger: 1) Are pain and sleep reciprocally or unidirectionally related? and 2) What mechanisms account for the associations between sleep and pain? The vast expanse of research on the association of sleep and pain necessitates that we narrow the scope of the present review. Further, both chronic pain and sleep disturbances share an array of physical and mental health comorbidities, such as obesity 45, type 2 diabetes 18, 50, and depression 34, 127. Across most medical interventions, the development of pain as a side effect coincides with the development of sleep disturbance, and vice-versa 20. Sleep complaints are present in 67-88% of chronic pain disorders 70, 103 and at least 50% of individuals with insomnia-the most commonly diagnosed disorder of sleep impairment-suffer from chronic pain 117. Humans require both pain and sleep for survival however, chronic impairments in the systems regulating pain and sleep can have a broad negative impact on health and well-being. Sleep is a behaviorally regulated drive that broadly serves to maintain homeostasis and optimize function across multiple physiologic systems. Pain is a physical and emotional signal of bodily harm that strongly motivates behavior. Several biopsychosocial targets for future mechanistic research on sleep and pain are discussed, including dopamine and opioid systems, positive and negative affect, and sociodemographic factors. Recent experimental studies suggest that sleep disturbance may impair key processes that contribute to the development and maintenance of chronic pain, including endogenous pain inhibition and joint pain. Microlongitudinal studies employing deep subjective and objective assessments of pain and sleep support the notion that sleep impairments are a stronger, more reliable predictor of pain than pain is of sleep impairments. A key trend emerging from population-based longitudinal studies is that sleep impairments reliably predict new incidents and exacerbations of chronic pain. The present review critically examines the recent prospective and experimental literature (2005-present) in an attempt to update the field on emergent themes pertaining to the directionality and mechanisms of the association of sleep and pain. The prevailing view has generally been that they are reciprocally related. However, many questions remain about the direction of causality in their association, as well as mechanisms that may account for their association. ![]() Ample evidence suggests that sleep and pain are related. ![]()
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