Assessing and Managing Insomnia in Patients With Chronic Pain

Author: Martin D. Cheatle

Patients suffering from chronic pain commonly experience comorbid problems that can further impair quality of life. These include psychological and medical comorbidities and fatigue and sleep disorders. Greater than 50% of patients with pain disorders experience sleep disturbance, with estimates as high as 70% to 80%. Experimental studies of healthy subjects and crosssectional research in clinical populations have demonstrated that there is a strong relationship between sleep disturbance and pain, and that this relationship is reciprocal--pain disturbing sleep continuity/quality and poor sleep exacerbating pain. Chronic pain and sleep disorders independently have been demonstrated to contribute to psychiatric and medical morbidities, disability, and a significantly reduced quality of life. In spite of the persuasive literature on the deleterious effect of sleep on pain and pain on sleep, clinicians may not adequately assess and effectively treat sleep disorders in the pain population. This symposium will review the prevailing theories of this interrelationship, outline efficient and sensitive methods to assess sleep disorders, and discuss both pharmacologic and nonpharmacologic interventions to improve sleep quality in patients with chronic pain.

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