Palabras clave
sueño
insomnio
sensibilización central
modulación endógena del dolor
Resumen
Introducción: El dolor lumbar crónico (DLC) constituye la principal causa mundial de años vividos con discapacidad. Las alteraciones del sueño son altamente prevalentes en estos pacientes y podrían influir en la cronificación, la discapacidad y la respuesta terapéutica. Sin embargo, el sueño continúa siendo una dimensión clínica infravalorada en la evaluación habitual del DLC.
Objetivo: Revisar la evidencia disponible sobre la relación entre sueño y DLC, sus mecanismos fisiopatológicos compartidos, su relevancia clínica y las implicaciones diagnósticas y terapéuticas para las unidades del dolor.
Métodos: Se realizó una revisión narrativa estructurada de la literatura mediante búsqueda en PubMed/MEDLINE, Scopus y Google Scholar. Se incluyeron revisiones sistemáticas, metanálisis, ensayos clínicos, estudios observacionales y guías clínicas que abordaran la relación entre sueño y DLC, los mecanismos fisiopatológicos implicados y las estrategias terapéuticas disponibles.
Resultados: La prevalencia de alteraciones del sueño en pacientes con DLC alcanza el 73 %, y la mala calidad del sueño se asocia con peor evolución clínica, mayor discapacidad y mayor probabilidad de sensibilización central. La relación entre sueño y dolor es bidireccional y está mediada por alteraciones de la modulación endógena del dolor, hiperactividad del eje hipotálamo-hipófiso-adrenal y fenómenos de neuroinflamación. La evaluación sistemática del sueño mediante anamnesis estructurada y cuestionarios validados permite identificar perfiles clínicos de mayor complejidad. Entre las intervenciones disponibles, la terapia cognitivo-conductual para el insomnio presenta la evidencia más sólida. Determinados tratamientos farmacológicos pueden mejorar variables relacionadas con el sueño, aunque su impacto analgésico directo en el DLC sigue siendo limitado.
Conclusiones: El sueño constituye una dimensión clínica con valor pronóstico y terapéutico en el DLC. Su evaluación sistemática permite identificar pacientes con mayor complejidad clínica y facilita un abordaje multimodal más individualizado. La incorporación rutinaria del sueño en la valoración del DLC podría contribuir a optimizar los resultados clínicos y funcionales.
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Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Derechos de autor 2026 Juan Fernando García Henares, Cristian Manuel Sánchez Barros, Erika Torres San Narciso, Carlos Antonio Morales Portillo, Manuel Alejandro Sánchez-García (Autor/a)