Effect of Analgesics on Sleep in Patients with Chronic Pain
the MPR take:
Sleep can both be affected by chronic pain and modulate the perception of pain, making the relationship between sleep and chronic pain complex. A review in the British Journal of Pain evaluated pharmacological agents for the treatment of chronic pain and their impact on sleep-wake regulation. While widely prescribed, antidepressants can reduce REM sleep in healthy and depressed individuals, which may indirectly increase pain sensitivity in chronic pain patients. The sedative properties of antidepressants may benefit the patients at night, but many report residual daytime somnolence. Long-term use of opiods is associated with irregular waxing-waning breathing patterns that can disrupt respiration regulations during sleep. Newer anticonvulsants have been found to improve sleep disturbance and improve sleep outcomes in chronic pain patients. NSAIDs are the most commonly used analgesics for chronic pain and no evidence suggests an effect on sleep disorders. Cannabinoids plus opiates show promise in maintaining autonomic stability during sleep in animal studies and in reducing sleep apnea in humans, but additional research is needed, particularly in human trials.
Abstract: Pain and sleep share a bidirectional relationship, with each influencing the other. Several excellent reviews have explored this relationship. In this article, we revisit the evidence and explore existing research on this complex inter-relationship.