Day-to-day associations between pain intensity and sleep outcomes in an adult chronic musculoskeletal pain population: A systematic review

Background: In individuals with chronic musculoskeletal pain, a reciprocal relationship between sleep and pain across short and long-term evaluations exists. Sleep influences pain levels, while the level of pain also impairs sleep. However, given the day-to-day variability of both sleep and pain intensity, assessing this relationship within a daily time frame should be considered. Objectives: To systematically review the literature concerning the bidirectional day-to-day relationship between night-time sleep variables and day-time pain intensity in individuals with chronic musculoskeletal pain. Methods: A systematic search (final search on October 12, 2023) in four databases (PubMed, Web of Science, Embase, PsycInfo) identified eligible articles based on pre-defined criteria. Three independent reviewers executed data extraction and risk of bias assessment using the “Quality In Prognosis Studies” tool. The study findings were synthesized narratively. Results: Eleven articles (1014 study participants; 83 associations) were included. A bidirectional relationship between pain intensity and sleep was found. Nine articles indicated night-time sleep quality to be a more consistent predictor for next day pain intensity than vice versa. Conclusion: Nonetheless the bidirectional day-to-day sleep-pain relationship in individuals with chronic musculoskeletal pain, results suggest that self-reported sleep quality has a stronger predictive value on pain intensity then vice versa.