Sleep in chronic pain: problems and treatments

Chronic pain of any etiology often represents a difficult problem for the clinician and patient. Pain will usually be impossible to eliminate, and adequate pain reduction usually requires multiple therapeutic trials and careful polypharmacy. Identifying and treating comorbid sleep disturbances can improve the treatment of patients with chronic pain. Both pain medicine and sleep medicine are areas in which physician training has been inadequate. The literature on sleep disturbances in selected pain conditions, pathophysiology of sleep disturbance in the pain context, a case study, and basic clinical strategies for managing sleep problems in this population will be summarized. The overall treatment approach is based on optimizing pain control, identifying and treating psychiatric comorbidity, carefully investigating sleep patterns, and use of sleep-specific pharmacotherapeutic and psychotherapeutic interventions for improving sleep.