Keywords
sleep
insomnia
central sensitization
endogenous pain modulation
Abstract
Background: Chronic low back pain (CLBP) is the leading cause of years lived with disability worldwide. Sleep disturbances are highly prevalent among patients with CLBP and may contribute to pain persistence, disability, and poorer treatment outcomes. Despite this, sleep remains an underrecognized component of routine clinical assessment.
Objective: To review the available evidence on the relationship between sleep and CLBP, their shared pathophysiological mechanisms, clinical relevance, and implications for assessment and management in pain units.
Methods: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and Google Scholar. Systematic reviews, meta-analyses, clinical trials, observational studies, and clinical practice guidelines addressing the relationship between sleep and CLBP, underlying mechanisms, and therapeutic strategies were included.
Results: Sleep disturbances affect up to 73 % of patients with CLBP. Poor sleep quality is associated with worse clinical outcomes, greater disability, and a higher likelihood of central sensitization. The relationship between sleep and pain is bidirectional and involves alterations in endogenous pain modulation, hypothalamic–pituitary–adrenal axis dysregulation, and neuroinflammatory processes. Systematic assessment of sleep using structured clinical interviews and validated questionnaires may help identify patients with more complex clinical profiles. Among available interventions, cognitive behavioral therapy for insomnia (CBT-I) has the strongest supporting evidence. Several pharmacological treatments may improve sleep-related outcomes; however, their direct analgesic effects in CLBP appear limited.
Conclusions: Sleep represents a clinically relevant dimension with important prognostic and therapeutic implications in CLBP. Routine assessment of sleep may help identify patients with greater clinical complexity and support a more individualized multimodal treatment approach. Integrating sleep evaluation into the routine management of CLBP may contribute to improved clinical and functional outcomes.
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