Challenges in the Management of Patients With Co-existing Sleep and Pain Disturbances

Thomas Roth, PhD; Michael J. Thorpy, MD
Credit Type
Credit Amount
Release Date
Expiration Date
Activity Type

Jointly sponsored by Albert Einstein College of Medicine, Montefiore Medical Center, and Asante Communications

Activity Description

This educational activity will allow clinicians to acquire a more in-depth understanding of the relationship between chronic pain and sleep. Practical aspects that facilitate recognition of sleep problems in pain conditions, as well as treatment modalities that reduce pain and improve sleep will be discussed.

Intended Audience

This activity is intended for sleep clinicians, pain specialists, primary care physicians, physician assistants, nurse practitioners, and other healthcare providers interested in improving their knowledge base and skill sets in the management of patients with co-occuring sleep problems and pain conditions

Statement of Need/Learner's Gap

Sleep disturbances are highly prevalent among virtually all chronic pain conditions. A complex relationship exists such that chronic pain conditions disturb sleep and poor sleep exacerbates pain.1, 2 In fact, sleep problems among chronic pain patients include difficulty falling asleep, awakening throughout the night, poor sleep quality, and nonrestorative sleep. Conversely, effective management of sleep reduces pain and sleep improves with appropriate pain management. Accordingly, comorbid sleep problems and pain adversely affect biological, psychological, and social aspects of one’s well-being. Indeed, sleep disturbances and chronic pain exacerbate already existing medical and psychologic morbidities, impair cognition and mood, and strain personal relationships among other things. The importance of sleep is not lost to patients. Difficulty falling and staying asleep at night are some of the most important quality-of-life domains that distress pain patients.3 Despite patient concerns and the high prevalence of comorbid sleep and pain problems, sleep is often not assessed and patients are left undertreated.4, 5

Prompt diagnosis is critical to initiate appropriate care, reduce morbidity associated with sleep and pain, and improve patient quality of life. A variety of approaches including self-administered questionnaires, sleep/pain diaries or logs, patient/partner interviews, as well as objective measures such as polysomnography are available to characterize a patient’s sleep and pain symptoms. In addition, behavioral and pharmacologic treatment modalities are available. Thus, it is incumbent on physicians to be aware of approaches that facilitate recognition of patients with comorbid sleep and pain, as well as available treatment approaches to ameliorate or reduce the adverse effects.


 1. Roehrs TA. Does effective management of sleep disorders improve pain symptoms? Drugs. 2009;69 Suppl 2:5-11.
2. Roehrs T, Roth T. Sleep and pain: interaction of two vital functions. Semin Neurol. Mar 2005;25(1):106-116.
3. Turk DC, Dworkin RH, Revicki D, et al. Identifying important outcome domains for chronic pain clinical trials: an IMMPACT survey of people with pain. Pain. Jul 15 2008;137(2):276-285.
4. Ontiveros CS, Kappler JA, Clark DF, Thorpy MJ, Roth T. Sleep/wake medicine among self-identified sleep specialists and primary care providers: gaps in knowledge and effectiveness of continuing education. Sleep. 2011;34(Abstract supplement):A336.
5. NSF. 1997 Sleep in America Poll-Sleeplessness, Pain and the Workplace. 1997.

Learning Objectives

At the conclusion of this activity, participants will be better prepared to:

 • Understand the interactions between sleep and pain
• Describe the consequences of sleep disturbances in patients with chronic pain
• Assess sleep problems in patients with chronic pain
• Provide behavioral and pharmacologic approaches to improve symptoms in patients with co-existing chronic pain and sleep disturbances

Accrediation Statement

This activity has been planned and implemented in accordance with the essential areas and Policies of the accreditation Council for Continuing Medical education (ACCME) through the joint sponsorship of Albert Einstein College of Medicine and Montefiore Medical Center, and Asante Communications, LLC. Albert Einstein College of Medicine is accredited by the AACME to provide continuing medical education for physicians.

Credit Designation

Albert Einstein College of Medicine designates this enduring materials for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Conflict of Interest Statement

The conflict of interest disclosure Policy of Albert Einstein College of Medicine requires that faculty participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical, product, or device company. Faculty whose disclosed relationships prove to create a conflict of interest with regard to their contribution to the activity will not be permitted to participate.

Albert Einstein College of Medicine also requires that faculty participating in any CME activity disclose to the audience when discussing any unlabeled or investigational use of any commercial product or device not yet approved for the use in the United States.

Course Director/Authors and Planning Committee Disclosures

Course director/authors and planning committee members of this program have indicated the following disclosure information:

Thomas Roth, PhD—Abbott Laboratories (Consultant); Cephalon, Inc. (Consultant, Speakers Bureau); Eisai Inc. (Consultant); Eli Lilly and Company (Consultant); GlaxoSmithKline PlC (Consultant); Merck & Co., inc. (Advisory Board, Consultant, Grant/Research); Novartis (Consultant); Ortho-Mcneil-Janssen Pharmaceuticals, Inc. (advisory Board, Consultant); Otsuka America Pharmaceutical, Inc. (Consultant); Sanofi -Aventis (advisory Board, Consultant, Grant/Research); Schering-Plough Pharmaceuticals (Consultant); Sepracor Inc. (Advisory Board, Consultant, Speakers Bureau); Shire Specialty Pharmaceuticals (Consultant); Takeda Pharmaceuticals North America, Inc. (Consultant)

Michael J. Thorpy—Cephalon, Inc. (Consultant, Speakers Bureau)
Chris Ontiveros, PhD—Has no relevant financial relationships to disclose.

The staff of CCME of Albert Einstein College of Medicine have no conflicts of interests to report with commercial interests related or indirectly to this educational activity.

The staff of CCME of Albert Einstein College of Medicine have no disclosures to report with commercial interests other than the following:

Steven Jay Feld, or a member of his household own securities in:  Bioheart, Inc., Chelsea Therapeutics, Inc. and Pharmacopeia, Inc.


Method of Participation

There are no fees for participating in and receiving credit for this activity.  The participant will have two opportunities to a score of at least 70% to successfully complete this activity. Credit is available through November 11, 2012


The opinions, ideas, recommendations, and perspectives expressed in the accompanying materials are those of the course director and authors only and do not necessarily refl ect the opinions, ideas, recommendations, or perspectives of their affiliated institutions, Albert Einstein College of Medicine, Montefiore Medical Center, Asante Communications, LLC, or the activity’s commercial supporter.

Copyright Information

© 2011 Albert Einstein College of Medicine, Montefiore Medical Center, and Asante Communications, LLC. all rights reserved. no part of this report may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in articles or reviews.


Begin Activity