Sleep disturbances in patients with chronic pain: effectively managing opioid analgesia to improve outcomes

Background: Many patients with chronic pain experience pain-related sleep disturbances, such as difficulty falling and staying asleep and less restful sleep. Evidence suggests that pain and sleep exist in a bidirectional relationship in which pain causes sleep disturbance and sleep disturbance intensifies pain. This association can impair a patient's daily function and decrease quality of life. Evidence suggests that patients with chronic pain can use opioid analgesics or other pain medications to control their pain and, in turn, improve some measures of sleep. This may include subjective sleep measures such as increased sleep time, and, as evidenced in recent studies, objective sleep measures such as sleep efficiency. Scope: The role of effective analgesia in the improvement of pain-related sleep disturbance is discussed herein, specifically the risks and benefits of opioid therapy for the treatment of patients with chronic pain and disturbed sleep. MEDLINE and PubMed searches were conducted to locate relevant studies dated from January 1975 to April 2008. English-only randomized controlled trials and nonrandomized studies were considered. Findings: Numerous studies support the benefits of effective analgesia with opioid therapy on sleep. Conclusion: Pain control achieved with pharmacotherapy, specifically opioid therapy, may help to improve sleep in patients for which opioid therapy is appropriate.