Pain and severe sleep disturbance in the general population: Primary data and meta-analysis from 240,820 people across 45 low- and middle-income countries
Four pages on PainSci cite Stubbs 2018: 1. The Complete Guide to Low Back Pain 2. 6 Main Causes of Morning Back Pain 3. Insomnia Until it Hurts 4. A potent link between pain and lousy sleep…regardless of your budget
PainSci commentary on Stubbs 2018: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
This study dove into data on both pain and severe sleep problems around the world, finding that they are “highly co-morbid.” That is, they go together: people who have sleep problems have pain, and people with pain have sleep problems. Duh? No one is going to be shocked by that, but this conclusion did not come from the usual suspects.
Science tends to focus on “subjects of convenience.” For instance, psychology studies are notorious for recruiting their subjects from the hungry university students they’re surrounded by: “Free pizza if you put up with a bit of zapping!”
But uni students are like a sub-species of human, and so what we “learn” about psychology from them is often not true of anyone else — a great example of why we take studies with a grain of salt.
Science also tends to focus on data of convenience, and so there was “a paucity of multinational population data” about pain and sleep deprivation. Stubbs et al. set out to fix that by using a lot of data from low- and middle-income countries, about almost a quarter million people — how’s that for a good sample size? And they found the same link that has been seen many times before in the more convenient and plentiful data from the richest countries, confirming that the link exists everywhere. And that what was not actually a given, however obvious it might seem.
There is a potent chemistry between sleep and health, and it is definitely not just a case of the “worried well” sweating the little stuff in our relatively comfortable lives. This data strongly suggests that the sleep-health link matters no matter who you are or where you’re from — it’s a basic feature of being human.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
OBJECTIVE: Pain and sleep disturbances are widespread, and are an important cause of a reduced quality of life. Despite this, there is a paucity of multinational population data assessing the association between pain and sleep problems, particularly among low- and middle-income countries (LMICs). Therefore, we investigated the relationship between pain and severe sleep disturbance across 45 LMICs.
METHOD: Community-based data on 240,820 people recruited via the World Health Survey were analyzed. Multivariable logistic regression analyses adjusted for multiple confounders were performed to quantify the association between pain and severe sleep problems in the last 30 days. A mediation analysis was conducted to explore potential mediators of the relationship between pain and severe sleep disturbance.
RESULTS: The prevalence of mild, moderate, severe, and extreme levels of pain was 26.0%, 16.2%, 9.1%, and 2.2% respectively, whilst 7.8% of adults had severe sleep problems. Compared to those with no pain, the odds ratio (OR, 95% CI) for severe sleep problems was 3.65 (3.24-4.11), 9.35 (8.19-10.67) and 16.84 (13.91-20.39) for those with moderate, severe and extreme pain levels respectively. A country wide meta-analysis adjusted for age and sex demonstrated a significant increased OR across all 45 countries. Anxiety, depression and stress sensitivity explained 12.9%, 3.6%, and 5.2%, respectively, of the relationship between pain and severe sleep disturbances.
CONCLUSION: Pain and sleep problems are highly co-morbid across LMICs. Future research is required to better understand this relationship. Moreover, future interventions are required to prevent and manage the pain and sleep disturbance comorbidity.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial. Kirwan 2024 Br J Sports Med.
- Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Hohenschurz-Schmidt 2024 Eur J Pain.
- Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes. Aasdahl 2021 BMC Musculoskelet Disord.
- Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. Moore 2023 J Pain.
- Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis: a systematic review and individual participant data meta-analysis. Holden 2023 The Lancet Rheumatology.