Zeitschrift für Gerontologie und Geriatrie

, Volume 51, Issue 8, pp 871–874 | Cite as

Pain and sleep

A bidirectional relationship
  • Helmut FrohnhofenEmail author


Disturbed sleep and persistent pain are common in old people. Persistent pain has a well proven impact on sleep but the relationship between both phenomena is bidirectional since disturbed sleep affects pain perception by lowering the pain threshold. An optimal disease management takes both phenomena into account.


Intractable pain Sleep disorders Geriatrics Quality of life Analgesics 

Schmerz und Schlaf

Eine bidirektionale Beziehung


Gestörter Schlaf und anhaltende Schmerzen sind häufige Phänomene bei alten Menschen. Gut belegt ist der ungünstige Einfluss von persistierenden Schmerzen auf den Schlaf. Aber auch gestörter Schlaf beeinflusst die Schmerzwahrnehmung durch Absenkung der Schmerzschwelle. Ein optimales Management muss beide Phänomene berücksichtigen.


Anhaltender Schmerz Schlafstörungen Geriatrie Lebensqualität Analgetika 


Compliance with ethical guidelines

Conflict of interest

H. Frohnhofen declares that he has no competing interests.

This article does not contain any studies with human participants or animals performed by the author.


  1. 1.
    Ashworth PCH, Davidson KM, Espie CA (2010) Cognitive-behavioral factors associated with sleep quality in chronic pain patients. Behav Sleep Med 8:28–39CrossRefGoogle Scholar
  2. 2.
    Blågestad T, Pallesen S, Grønli J, Tang NKY, Nordhus IH (2016) How Perceived Pain Influence Sleep and Mood More Than The Reverse. A Novel, Exploratory Study with Patients Awaiting Total Hip Arthroplasty. Front Psychol 7:1689CrossRefGoogle Scholar
  3. 3.
    Blay SL, Andreoli SB, Gastal FL (2007) Chronic painful physical conditions, disturbed sleep and psychiatric morbidity. Results from an elderly survey. Ann Clin Psychiatry 19:169–174CrossRefGoogle Scholar
  4. 4.
    Bloom HG, Ahmed I, Alessi CA et al (2009) Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriatr Soc 57:761–789CrossRefGoogle Scholar
  5. 5.
    Brennan MJ, Lieberman JA (2009) Sleep disturbances in patients with chronic pain. Effectively managing opioid analgesia to improve outcomes. Curr Med Res Opin 25:1045–1055CrossRefGoogle Scholar
  6. 6.
    Davies KA, Macfarlane GJ, Nicholl BI et al (2008) Restorative sleep predicts the resolution of chronic widespread pain. Results from the EPIFUND study. Rheumatology (Oxf) 47:1809–1813CrossRefGoogle Scholar
  7. 7.
    Edwards MJ, Tang NK, Wright AM, Salkovskis PM, Timberlake CM (2011) Thinking about thinking about pain. A qualitative investigation of rumination in chronic pain. Pain Manag 1:311–323CrossRefGoogle Scholar
  8. 8.
    Edwards RR, Grace E, Peterson S, Klick B, Haythornthwaite JA, Smith MT (2009) Sleep continuity and architecture. Associations with pain-inhibitory processes in patients with temporomandibular joint disorder. Eur J Pain 13:1043–1047CrossRefGoogle Scholar
  9. 9.
    Fernández-de-las-Peñas C, Arendt-Nielsen L, Gerwin R (eds) (2010) Tension-type and cervicogenic headache. Pathophysiology, diagnosis, and management. Jones and Bartlett Publishers, Sudbury, MassGoogle Scholar
  10. 10.
    Foley D, Ancoli-Israel S, Britz P, Walsh J (2004) Sleep disturbances and chronic disease in older adults. Results of the 2003 National Sleep Foundation Sleep in America Survey. J Psychosom Res 56:497–502CrossRefGoogle Scholar
  11. 11.
    Foley DJ, Vitiello MV, Bliwise DL, Ancoli-Israel S, Monjan AA, Walsh JK (2007) Frequent napping is associated with excessive daytime sleepiness, depression, pain, and nocturia in older adults. Findings from the National Sleep Foundation ‘2003 Sleep in America’ Poll. Am J Geriatr Psychiatry 15:344–350CrossRefGoogle Scholar
  12. 12.
    Fox PL, Raina P, Jadad AR (1999) Prevalence and treatment of pain in older adults in nursing homes and other long-term care institutions. A systematic review. Cmaj : Can Med Assoc J = J De L’association Medicale Can 160:329–333Google Scholar
  13. 13.
    Gloth FM (2011) Pharmacological management of persistent pain in older persons. Focus on opioids and nonopioids. J Pain 12:14–20CrossRefGoogle Scholar
  14. 14.
    Haack M, Mullington JM (2005) Sustained sleep restriction reduces emotional and physical well-being. Pain 119:56–64CrossRefGoogle Scholar
  15. 15.
    Hawker GA, Stewart L, French MR et al (2008) Understanding the pain experience in hip and knee osteoarthritis—an OARSI/OMERACT initiative. Osteoarthr Cartil 16:415–422CrossRefGoogle Scholar
  16. 16.
    Helme RD, Gibson SJ (2001) The epidemiology of pain in elderly people. Clin Geriatr Med 17:417–431CrossRefGoogle Scholar
  17. 17.
    Irwin MR, Olmstead R, Carrillo C et al (2012) Sleep loss exacerbates fatigue, depression, and pain in rheumatoid arthritis. Sleep 35:537–543CrossRefGoogle Scholar
  18. 18.
    Kundermann B, Krieg J‑C, Schreiber W, Lautenbacher S (2004) The effect of sleep deprivation on pain. Pain Res Manag 9:25–32CrossRefGoogle Scholar
  19. 19.
    Lautenbacher S, Kundermann B, Krieg J‑C (2006) Sleep deprivation and pain perception. Sleep Med Rev 10:357–369CrossRefGoogle Scholar
  20. 20.
    Lee YC, Chibnik LB, Lu B et al (2009) The relationship between disease activity, sleep, psychiatric distress and pain sensitivity in rheumatoid arthritis. A cross-sectional study. Arthritis Res Ther 11:R160CrossRefGoogle Scholar
  21. 21.
    Leong IY, Farrell MJ, Helme RD, Gibson SJ (2007) The relationship between medical comorbidity and self-rated pain, mood disturbance, and function in older people with chronic pain. J Gerontol A Biol Sci Med Sci 62:550–555CrossRefGoogle Scholar
  22. 22.
    Lichstein KL, Wilson NM, Johnson CT (2000) Psychological treatment of secondary insomnia. Psychol Aging 15:232–240CrossRefGoogle Scholar
  23. 23.
    Macintyre PE, Loadsman JA, Scott DA (2011) Opioids, ventilation and acute pain management. Anaesth Intensive Care 39:545–558CrossRefGoogle Scholar
  24. 24.
    Morin CM, Gibson D, Wade J (1998) Self-reported sleep and mood disturbance in chronic pain patients. Clin J Pain 14:311–314CrossRefGoogle Scholar
  25. 25.
    Mulier JP (2016) Perioperative opioids aggravate obstructive breathing in sleep apnea syndrome. Mechanisms and alternative anesthesia strategies. Curr Opin Anaesthesiol 29:129–133CrossRefGoogle Scholar
  26. 26.
    Onen S‑H, Onen F (2018) Chronic Medical Conditions and Sleep in the Older Adult. Sleep Med Clin 13:71–79CrossRefGoogle Scholar
  27. 27.
    Ong AD, Zautra AJ, Reid MC (2010) Psychological resilience predicts decreases in pain catastrophizing through positive emotions. Psychol Aging 25:516–523CrossRefGoogle Scholar
  28. 28.
    Ozminkowski RJ, Wang S, Walsh JK (2007) The direct and indirect costs of untreated insomnia in adults in the United States. Sleep 30:263–273CrossRefGoogle Scholar
  29. 29.
    Paul-Savoie E, Marchand S, Morin M et al (2012) Is the deficit in pain inhibition in fibromyalgia influenced by sleep impairments? Open Rheumatol J 6:296–302CrossRefGoogle Scholar
  30. 30.
    Power JD, Perruccio AV, Badley EM (2005) Pain as a mediator of sleep problems in arthritis and other chronic conditions. Arthritis Rheum 53:911–919CrossRefGoogle Scholar
  31. 31.
    Ramar K (2009) Reversal of sleep-disordered breathing with opioid withdrawal. Pain Pract 9:394–398CrossRefGoogle Scholar
  32. 32.
    Roehrs T, Hyde M, Blaisdell B, Greenwald M, Roth T (2006) Sleep loss and REM sleep loss are hyperalgesic. Sleep 29:145–151CrossRefGoogle Scholar
  33. 33.
    Roehrs T, Roth T (2005) Sleep and pain. Interaction of two vital functions. Semin Neurol 25:106–116CrossRefGoogle Scholar
  34. 34.
    Roehrs TA, Harris E, Randall S, Roth T (2012) Pain sensitivity and recovery from mild chronic sleep loss. Sleep 35:1667–1672Google Scholar
  35. 35.
    Rudy TE, Weiner DK, Lieber SJ, Slaboda J, Boston JR (2007) The impact of chronic low back pain on older adults. A comparative study of patients and controls. Pain 131:293–301CrossRefGoogle Scholar
  36. 36.
    Simpson NS, Scott-Sutherland J, Gautam S, Sethna N, Haack M (2018) Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization. Pain 159:33–40CrossRefGoogle Scholar
  37. 37.
    Smith MT, Edwards RR, McCann UD, Haythornthwaite JA (2007) The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep 30:494–505CrossRefGoogle Scholar
  38. 38.
    Spielman AJ, Saskin P, Thorpy MJ (1987) Treatment of chronic insomnia by restriction of time in bed. Sleep 10:45–56Google Scholar
  39. 39.
    Tang NKY, Goodchild CE, Salkovskis PM (2012) Hybrid cognitive-behaviour therapy for individuals with insomnia and chronic pain. A pilot randomised controlled trial. Behav Res Ther 50:814–821CrossRefGoogle Scholar
  40. 40.
    Tang NKY, Goodchild CE, Sanborn AN, Howard J, Salkovskis PM (2012) Deciphering the temporal link between pain and sleep in a heterogeneous chronic pain patient sample. A multilevel daily process study. Sleep 35:675–87AGoogle Scholar
  41. 41.
    Theadom A, Cropley M (2010) “This constant being woken up is the worst thing”—experiences of sleep in fibromyalgia syndrome. Disabil Rehabil 32:1939–1947CrossRefGoogle Scholar
  42. 42.
    Tiede W, Magerl W, Baumgärtner U, Durrer B, Ehlert U, Treede R‑D (2010) Sleep restriction attenuates amplitudes and attentional modulation of pain-related evoked potentials, but augments pain ratings in healthy volunteers. Pain 148:36–42CrossRefGoogle Scholar
  43. 43.
    Turk DC, Dworkin RH, Revicki D et al (2008) Identifying important outcome domains for chronic pain clinical trials. An IMMPACT survey of people with pain. Pain 137:276–285CrossRefGoogle Scholar
  44. 44.
    van Dongen HPA, Maislin G, Mullington JM, Dinges DF (2003) The cumulative cost of additional wakefulness. Dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep 26:117–126CrossRefGoogle Scholar
  45. 45.
    Zautra AJ, Johnson LM, Davis MC (2005) Positive affect as a source of resilience for women in chronic pain. J Consult Clin Psychol 73:212–220CrossRefGoogle Scholar
  46. 46.
    Zhang J, Lam S‑P, Li SX et al (2012) Insomnia, sleep quality, pain, and somatic symptoms. Sex differences and shared genetic components. Pain 153:666–673CrossRefGoogle Scholar
  47. 47.
    Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Faculty of Health, Department of MedicineUniversity Witten-HerdeckeWittenGermany

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