Last updated: Wed, Jul 31, 2024
Problems with sleeping and fatigue are very common among chronic pain patients. As many as one-half to almost 90% of chronic pain patients seen at clinics report sleep problems. The problem varies among patients, but generally pain patients have lower "sleep efficiency," meaning that the amount of time in restful sleep is much less than the time spent in bed. Pain patients spend more time awake and, when sleeping, get less of the most refreshing REM (rapid eye movement) sleep. In addition, pain patients who use opioids have a high prevalence of sleep apnea. It isn't clear whether or not this is caused by the opioids.1
The authors of the relevant chapter from the Handbook of Pain Assessment have opined that poor sleep is not a direct physiological effect of pain.
2 Sleep studies have shown, however, that the sleep of patients who have just been through a painful hospital procedure has a profile similar to that just described for chronic pain patients. In addition, normal sleepers who are subjected to noxious stimuli
at different stages of sleep tend to awaken and to show higher arousal of the brain's cortex.3
A structured review of 41 relevant studies that explored the linkage between sleep and pain showed very consistent support for the idea that pain causes poor sleep. Several studies have shown that a lack of sleep in normal subjects causes increased sensitivity to pain.4
The upshot is that good sleep is important to those who suffer pain, but may be hard to come by. As was pointed out in the last section, insomnia, particularly difficulty achieving sleep, increases the risk for suicide among pain patients.
Fatigue is also a problem with some pain patients, particularly those with fibromyalgia. Fibromyalgia patients have been reported to be twice as likely to suffer significant fatigue than patients with rheumatoid or osteoarthritis. One recent study has shown that pain and fatigue were directly associated over time.5