Original ArticleThe effect of sleep deprivation on pain perception in healthy subjects: a meta-analysis
Introduction
Chronic pain and sleep disorders are common in the general population. The prevalence of chronic pain ranges from 10% to 40% [1], which is comparable with the prevalence of sleep disorders (10–36% [2], [3], [4], [5], [6], [7], [8], [9]).
Increasingly more studies indicate a reciprocal relationship between sleep and pain [2], [3], [4], [5], [6], [10]. This hypothesis is based on epidemiological, pharmaceutical, clinical, and experimental studies. For example, 50–88% of patients with chronic pain also suffer from sleep disorders [11], [12], [13]. Alternatively, > 40% of patients with insomnia also report chronic pain [6]. Several pharmaceutical studies, including studies on eszopiclone [14], triazolam [15], or pregabalin [16], showed a simultaneous improvement of both sleep and pain. In addition, clinical trials highlight a bidirectional relationship between sleep and pain. Patients with a range of sleep disorders, such as obstructive sleep apnea syndrome (OSAS) [17] and restless legs syndrome (RLS) [18], seem to be hyperalgesic. The pain sensitivity improves with effective treatment of the respective sleep disorder. This improvement has been demonstrated in both pharmacological interventions, such as levodopa (L-DOPA) therapy for RLS [18], as well as non-pharmacological interventions, such as continuous positive airway pressure (CPAP) treatment for OSAS [17]. The latter study is of particular interest, as the improvement disappears immediately upon the discontinuation of CPAP therapy [17].
The first experimental study that showed an effect of sleep deprivation on pain perception was published in 1975 [19]. Since then, several studies have confirmed these results [7], [20], [21]. A review from 2006 showed a clear effect of sleep deprivation on pain perception in animals, whereas human data were inconclusive [22]. The same study group extended the systematic review in 2014 and found evidence of the hyperalgesic effect of sleep deprivation, both in animals and humans [23]. By focusing solely on controlled trials, a review indicated conclusive evidence of an increase of bodily complaints, or a decrease of pain thresholds, following sleep deprivation [24].
Varying explanations exist for the reciprocity between sleep and pain. For example, sleep and pain could share similar neurotransmitter systems, such as the dopaminergic system [25] and the serotonin system [26], or influence the endogenous opioid system [27]. In addition, substance P, which is involved in pain processes, interferes with sleep by reducing sleep efficiency or increasing awakenings [28]. However, the pathway of this interaction is not sufficiently clarified by the present research.
In summary, there is a large body of evidence for the interaction between sleep and pain. However, the size of this effect is unclear and the clinical relevance uncertain. Therefore, this meta-analysis was conducted to quantify the effect of sleep deprivation on pain perception.
Section snippets
Search strategy
Five electronic scientific databases, namely PubMed, Cochrane, Psyndex, Psycinfo, and Scopus, were used. The search was conducted on December 5, 2014, with no limitations on the publication date. All terms that were appropriate in former reviews were used [22], [23], [24], [29].
Sleep AND pain AND (“sleep restriction” OR “sleep deprivation” OR “sleep loss” OR “sleep interruption” OR “hyperalgesia” OR “total sleep deprivation” OR “partial sleep deprivation” OR “sleep fragmentation”)
One author
Study selection
Fig. 1 shows the study selection process. A total of 456 records were found in the searching procedure after removing duplicates. By screening the titles and abstracts, 34 potential eligible studies were identified. After full-text analyses, 21 studies were excluded for the following reasons: no primary research [40], [41], [42], no experimental design [43], no sleep deprivation [44], [45], [46], [47], [48], [49], no primary pain outcome [50], [51], only non-healthy participants [52], and no
Discussion
This meta-analysis confirms the effect of sleep deprivation on pain perception. A medium effect (SMD = 0.62) was found for the between-group analysis and a large effect (SMD = 1.49) was found for the within-group analysis. Sleep deprivation increases self-reported pain and affects evoked pain responses obtained through somatosensory testing protocols (eg, heat pain thresholds, pressure pain thresholds, or laser-evoked pain).
Patients with chronic pain exhibit several changes in sleep, such as
Conflict of interest
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2015.07.022.
Acknowledgment
The authors thank Friederike Hurtig (F.H.) for screening abstracts and titles during the search procedure, Anna Glechner for her support in answering methodological questions, and Robert Jank for his support revising the manuscript.
References (107)
- et al.
Quality of sleep and its daily relationship to pain intensity in hospitalized adult burn patients
Pain
(2001) Relationship between chronic painful physical condition and insomnia
J Psychiatr Res
(2005)- et al.
Sleep disturbance in pain clinic patients
Pain
(1985) - et al.
Hyperalgesia and functional sensory loss in restless legs syndrome
Pain
(2013) - et al.
The effects of total and REM sleep deprivation on laser-evoked potential threshold and pain perception
Pain
(2011) - et al.
Activation of the prostaglandin system in response to sleep loss in healthy humans: potential mediator of increased spontaneous pain
Pain
(2009) - et al.
Sleep deprivation and pain perception
Sleep Med Rev
(2006) - et al.
Brainstem modulation of pain during sleep and waking
Sleep Med Rev
(2003) - et al.
Deprivation of REM sleep in the rat and the opioid peptides beta-endorphin and dynorphin
Neurosci Lett
(1986) - et al.
Sleep disturbance induced by substance P in mice
Behav Brain Res
(2006)
The association of sleep and pain: an update and a path forward
J Pain
Sleep continuity and architecture: associations with pain-inhibitory processes in patients with temporomandibular joint disorder
Eur J Pain
Sleep deprivation in chronic somatoform pain-effects on mood and pain regulation
Psychiatry Res
Sustained sleep restriction reduces emotional and physical well-being
Pain
Sleep deprivation is hyperalgesic in patients with gastroesophageal reflux disease
Gastroenterology
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
Sleep restriction attenuates amplitudes and attentional modulation of pain-related evoked potentials, but augments pain ratings in healthy volunteers
Pain
Self-reported pain sensitivity: lack of correlation with pain threshold and tolerance
Eur J Pain
Duration of sleep contributes to next-day pain report in the general population
Pain
Temporal daily associations between pain and sleep in adolescents with chronic pain versus healthy adolescents
Pain
Short-term improvement in insomnia symptoms predicts long-term improvements in sleep, pain, and fatigue in older adults with comorbid osteoarthritis and insomnia
Pain
Disrupted sleep the night before breast surgery is associated with increased postoperative pain
J Pain Symptom Manage
The comorbidity of insomnia, chronic pain, and depression: dopamine as a putative mechanism
Sleep Med Rev
Sleep deprivation in adolescents: correlations with health complaints and health-related quality of life
Sleep Med
Sleep deprivation leads to mood deficits in healthy adolescents
Sleep Med
Efficacy of melatonin in the treatment of endometriosis: a phase II, randomized, double-blind, placebo-controlled trial
Pain
[Chronic pain: epidemiology and health care utilization]
Nervenarzt
The effects of total sleep deprivation, selective sleep interruption and sleep recovery on pain tolerance thresholds in healthy subjects
J Sleep Res
Sleep in depressed and nondepressed participants with chronic low back pain: electroencephalographic and behaviour findings
Sleep
Self-reported sleep and mood disturbance in chronic pain patients
Clin J Pain
Sleep loss and REM sleep loss are hyperalgesic
Sleep
Sleep and pain: interaction of two vital functions
Semin Neurol
The effects of sleep deprivation on pain inhibition and spontaneous pain in women
Sleep
Sleep difficulties, pain and other correlates
J Intern Med
Somatic diseases and sleep complaints. An epidemiological study of 3,201 Swedish men
Acta Med Scand
Sleep quality and presleep arousal in chronic pain
J Behav Med
The effect of eszopiclone in patients with insomnia and coexisting rheumatoid arthritis: a pilot study
Prim Care Companion J Clin Psychiatry
Effects of triazolam on sleep, daytime sleepiness, and morning stiffness in patients with rheumatoid arthritis
J Rheumatol
An international, randomized, double-blind, placebo-controlled, phase III trial of pregabalin monotherapy in treatment of patients with fibromyalgia
J Rheumatol
Continuous positive airway pressure in severe obstructive sleep apnea reduces pain sensitivity
Sleep
Musculoskeletal symptoms and non-REM sleep disturbance in patients with ‘fibrositis syndrome’ and healthy subjects
Psychosom Med
[Sleep deprivation and pain: a review of the newest literature]
Schmerz
[Sleep and pain: a bi-directional relation?]
Psychiatr Prax
Sleep deprivation decreases binding of [11C]raclopride to dopamine D2/D3 receptors in the human brain
J Neurosci
The measurement of observer agreement for categorical data
Biometrics
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
BMJ
Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs
Psychol Methods
Effect sizes for growth-modeling analysis for controlled clinical trials in the same metric as for classical analysis
Psychol Methods
Synthesizing standardized mean-change measures
Br J Math Stat Psychol
Meta-analytic procedures for social research
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