Sleep and Pain in Fibromyalgia

By Seth Lederman, M.D. Seth High Res Fibromyalgia is a condition characterized by a confusing array of symptoms. These can include chronic diffuse musculoskeletal pain, psychological stress, disturbed sleep and fatigue. The generally accepted criteria for diagnosis of fibromyalgia, as defined by the American College of Rheumatology, are widespread pain persisting for a period of at least three months and the lack of a disorder that would otherwise explain the pain. As many as 15 million U.S. adults may be affected by fibromyalgia. Increasingly, some researchers believe there exists a link between two of these symptoms—a link that could hold the key to better treatment for fibromyalgia. Those two symptoms are pain and sleep problems. Could better-quality, restorative sleep be the key to alleviating the pain that comes with fibromyalgia? Interestingly, the vast majority of fibromyalgia patients complain of poor sleep quality, yet there is no drug currently approved by the U.S. Food and Drug Administration that targets the sleep component of the condition. But the tide is starting to turn with investigators who are now paying increasing attention to the sleep-pain connection. They are taking this link seriously because there is increasing evidence that poor sleep quality plays a fundamental role in the development and persistence of widespread pain. For example, the 2015 Sleep in America Poll, conducted by the National Sleep Foundation, found that only 37 percent of respondents with chronic pain and 45 percent of those with acute pain reported “good or very good” sleep quality. A direct connection between sleep and pain was shown experimentally, in a classic study published in Psychosomatic Medicine conducted by Dr. Harvey Moldofsky at the University of Toronto, when a group of college students were kept from entering deep sleep for three days straight—the students reported feeling pain all over: a key symptom of fibromyalgia.  Not surprisingly, poor sleep quality was highlighted in the FDA’s “The Voice of the Patient” October 2014 fibromyalgia report. Further new research by Ernest H. S. Choy published in Nature Reviews Rheumatology notes that traditionally sleep disturbance has been considered a feature of fibromyalgia that is a consequence of severe pain and depression. However, both experimental and epidemiologic studies suggest that sleep dysfunction can cause fibromyalgia. Choy additionally notes that interventions to improve sleep quality in patients with early-stage fibromyalgia could possibly prevent the establishment of a vicious cycle of depression, pain and sleep dysfunction. Further research is likely to give us even better insights into the relationship between sleep quality and the pain that comes with fibromyalgia—and how enhancing the former can reduce the latter. Seth Lederman, M.D. is co-founder, CEO and chairman of Tonix Pharmaceuticals Holding Corp., a clinical-stage pharmaceutical company dedicated to the development of novel medicines for common yet challenging disorders of the central nervous system, including fibromyalgia, post-traumatic stress disorder (PTSD), and episodic tension-type headache.


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