Insomnia in a patient with musculoskeletal pain: A vicious cycle of reciprocal influence
https://doi.org/10.21518/ms2025-471
Abstract
More than 56% of the world’s population suffers from insomnia, 25% of whom are of working age. Moreover, the number of cases in which patients have two or more chronic diseases, one related to the musculoskeletal system and the other related to sleep disorders, has increased. According to 2024 statistics, the prevalence of insomnia among people with musculoskeletal disorders was significantly higher than in the population without musculoskeletal disorders. Pain and sleep disorders share common pathogenic mechanisms, creating a vicious cycle: poor sleep quality, on the one hand, increases the prevalence of chronic pain; on the other, chronic pain triggers sleep disorders. Current understanding of the mechanisms of musculoskeletal pain is based on the interrelationships of various functional systems: the opioid, monoaminergic, orexinergic, immune, melatonin, and endocannabinoid systems, the hypothalamic-pituitary-adrenal axis, and adenosine and nitric oxide signaling pathways. These systems also play an important, if not decisive, role in sleep disorders. For patients with musculoskeletal pain and any comorbidity, a comprehensive diagnostic and treatment algorithm is necessary. This includes a comprehensive assessment of symptoms, polypharmacy and pharmacotherapy management, psychological assessment and support, physical rehabilitation, and cognitive behavioral therapy. Insomnia in patients with musculoskeletal pain requires early diagnosis and a comprehensive approach to treatment. Early administration of pain medications and hypnotics can improve patients’ quality of life and prevent the transition from acute to chronic pain. The first-line treatments for sleep deprivation correction in these cases are short courses of medications for the treatment of acute insomnia.
About the Author
M. V. Putilina
Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Marina V. Putilina, Dr. Sci. (Med.), Professor, Professor of the Department of Clinical Pharmacology named after Yu.B. Belousov, Institute of Clinical Medicine
1, Ostrovityanov St., Moscow, 117997
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Review
For citations:
Putilina MV. Insomnia in a patient with musculoskeletal pain: A vicious cycle of reciprocal influence. Meditsinskiy sovet = Medical Council. 2025;(22):97-103. (In Russ.) https://doi.org/10.21518/ms2025-471
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