title: Pain in Sleepwalking: A Clinical Enigma.
abstract: OBJECTIVE
  Sleepwalking is a disorder characterized by arousal specifically from slow wave sleep with dissociated brain activity that may be related to lower nociceptive state. Our objectives were to assess the frequency of chronic pain, headache, and migraine in sleepwalkers compared to controls, examine the impact and determinants of pain in sleepwalkers, and report analgesia frequency during injurious parasomnia episodes.
  
  
  METHODS
  Cross-sectional case-control study.
  
  
  METHODS
  Data were collected at the Sleep Disorders Center, Montpellier, France.
  
  
  METHODS
  One hundred patients with sleepwalking were assessed for disease characteristics, sleep (polysomnography, sleepiness, and insomnia), pain (chronic pain, multidimensional pain inventory, headache, and migraine), depressive symptoms, and quality of life compared to 100 adult controls. Pain perception was retrospectively assessed during injurious parasomnia episodes.
  
  
  RESULTS
  Raw association data showed that lifetime headache, migraine, and chronic pain at time of study were significantly associated with sleepwalking (also called somnambulism). Compared to controls, sleepwalkers reported more frequent daytime sleepiness, and depressive and insomnia symptoms. After adjustments, sleepwalking was associated with increased risk for headache and migraine only. Compared to pain-free sleepwalkers, sleepwalkers with chronic pain were more likely to be older and to have greater daytime sleepiness, insomnia, and depressive symptoms, with no difference in polysomnography assessment. Of the 47 sleepwalkers with at least one previous violent parasomnia episode, 78.7% perceived no pain during episodes, allowing them to remain asleep despite injury.
  
  
  CONCLUSIONS
  Our results highlight the clinical enigma of pain in sleepwalking patients with complaints of frequent chronic pain, migraine, and headache during wakefulness but who report retrospectively experience of analgesia during severe parasomnia episodes, suggesting a relationship between dissociated brain activity and nociceptive dysregulation.
authors.affiliation: National Reference Network for Narcolepsy, Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France.|Inserm U1061, Montpellier, France, Université Montpellier 1, Montpellier, France.
authors.forename: Régis
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Inserm U1061, Montpellier, France, Université Montpellier 1, Montpellier, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Jaussent
authors.affiliation: National Reference Network for Narcolepsy, Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France.|Inserm U1061, Montpellier, France, Université Montpellier 1, Montpellier, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Dauvilliers
mesh_terms: D000293:Adolescent; D000328:Adult; D001143:Arousal; D016022:Case-Control Studies; D059350:Chronic Pain / Q000150:complications / Q000175:diagnosis; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000175:diagnosis; D005260:Female; D005602:France; D006261:Headache / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications / Q000175:diagnosis; D010146:Pain / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D058748:Pain Perception; D020447:Parasomnias / Q000150:complications; D017286:Polysomnography; D011788:Quality of Life; D012189:Retrospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000175:diagnosis; D012894:Sleep Stages; D013009:Somnambulism / Q000150:complications* / Q000503:physiopathology* / Q000523:psychology; D014851:Wakefulness; D055815:Young Adult
keywords: analgesia; headache; pain; parasomnia; sleepwalking