title: The association of sleep and pain: an update and a path forward.
abstract: Ample evidence suggests that sleep and pain are related. However, many questions remain about the direction of causality in their association, as well as mechanisms that may account for their association. The prevailing view has generally been that they are reciprocally related. The present review critically examines the recent prospective and experimental literature (2005-present) in an attempt to update the field on emergent themes pertaining to the directionality and mechanisms of the association of sleep and pain. A key trend emerging from population-based longitudinal studies is that sleep impairments reliably predict new incidents and exacerbations of chronic pain. Microlongitudinal studies employing deep subjective and objective assessments of pain and sleep support the notion that sleep impairments are a stronger, more reliable predictor of pain than pain is of sleep impairments. Recent experimental studies suggest that sleep disturbance may impair key processes that contribute to the development and maintenance of chronic pain, including endogenous pain inhibition and joint pain. Several biopsychosocial targets for future mechanistic research on sleep and pain are discussed, including dopamine and opioid systems, positive and negative affect, and sociodemographic factors.
  
  
  CONCLUSIONS
  This critical review examines the recent prospective and experimental research (2005-present) on the association of sleep and pain in an attempt to identify trends suggestive of directionality and potential mechanisms. An update on this literature is needed to guide future clinical efforts to develop and augment treatments for chronic sleep disturbance and chronic pain.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: pfinan1@jhu.edu.
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Finan
authors.forename: Burel R
authors.initials: BR
authors.lastname: Goodin
authors.forename: Michael T
authors.initials: MT
authors.lastname: Smith
mesh_terms: D006801:Humans; D008137:Longitudinal Studies; D010146:Pain / Q000175:diagnosis* / Q000453:epidemiology*; D059408:Pain Management / Q000639:trends*; D011446:Prospective Studies; D012890:Sleep / Q000502:physiology; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy
keywords: Chronic pain; insomnia; longitudinal; sleep; sleep deprivation