The interplay between symptoms of insomnia and pain in people with osteoarthritis: A narrative review of the current evidence

Liesbet De Baets, Nils Runge, Céline Labie, Olivier Mairesse, Anneleen Malfliet, Sabine Verschueren, Dieter Van Assche, Kurt de Vlam, Frank P Luyten, Iris Coppieters, Alberto Herrero Babiloni, Marc O Martel, Gilles J Lavigne, Jo Nijs

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Osteoarthritis (OA) is a leading cause of disability worldwide and clinical pain is the major symptom of OA. This clinical OA-related pain is firmly associated with symptoms of insomnia, which are reported in up to 81% of people with OA. Since understanding the association between both symptoms is critical for their appropriate management, this narrative review synthesizes the existing evidence in people with OA on i) the mechanisms underlying the association between insomnia symptoms and clinical OA-related pain, and ii) the effectiveness of conservative non-pharmacological treatments on insomnia symptoms and clinical OA-related pain. The evidence available identifies depressive symptoms, pain catastrophizing and pain self-efficacy as mechanisms partially explaining the cross-sectional association between insomnia symptoms and pain in people with OA. Furthermore, in comparison to treatments without a specific insomnia intervention, the ones including an insomnia intervention appear more effective for improving insomnia symptoms, but not for reducing clinical OA-related pain. However, at a within-person level, treatment-related positive effects on insomnia symptoms are associated with a long-term pain reduction. Future longitudinal prospective studies offering fundamental insights into neurobiological and psychosocial mechanisms explaining the association between insomnia symptoms and clinical OA-related pain will enable the development of effective treatments targeting both symptoms.

Original languageEnglish
Article number101793
Number of pages10
JournalSleep Medicine Reviews
Issue number1
Publication statusPublished - Aug 2023

Bibliographical note

Funding Information:
This work was funded by the Applied Biomedical Research Program, Research Foundation Flanders (Fonds voor Wetenschappelijk Onderzoek Vlaanderen), Belgium (FWO-TBM project no. TBM2021 - T000521 N - 54252 , “Towards PREcision MEdicine for Osteoarthritis: Added value of cognitive behavioural therapy for insomnia (the PREMEO trial)”), and by Strategic Research Program SRP90 (‘Pain Never Sleeps: Unravelling the Sleep-Pain Interaction in Patients with Chronic Pain’) funded by the research council of the Vrije Universiteit Brussel, Brussels, Belgium . We thank Tom Jesson and Dr. Clair Draper for their writing assistance.

Publisher Copyright:
© 2023 Elsevier Ltd

Copyright 2023 Elsevier B.V., All rights reserved.


  • Humans
  • Sleep Initiation and Maintenance Disorders/therapy
  • Cross-Sectional Studies
  • Prospective Studies
  • Cognitive Behavioral Therapy
  • Osteoarthritis/complications
  • Pain/etiology


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