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Sleep-Wake Disturbances in Patients With Chronic Pain-Associations With Physical Activity Levels

Emma Varkey^1,2, Martin Olsson^3,4,5, Adam Piasecki^3,6

¹Department of Occupational Therapy and Physical Therapy, Sahlgrenska University Hospital/Östra, Gothenburg, Region Västra Götaland, Sweden.

European Journal of Pain (London, England)

|July 7, 2026

Abstract

Background:

Sleep-wake disturbances are frequently reported by patients with chronic pain. Physical activity, recommended as a first-line treatment for chronic pain, can be difficult to implement due to pain severity. This study aimed to assess the prevalence of insomnia and other sleep-wake disturbances in a cohort of patients with chronic pain and to explore the influence of physical activity, opioid use, reported pain, and symptoms of depression and anxiety.

Methods:

This clinical cross-sectional study included 100 patients with chronic pain attending a specialist-level pain clinic. Participants were consecutively enrolled, and sleep and physical activity were evaluated using accelerometers. Additional assessments included the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), symptoms of restless legs syndrome (RLS), STOP-Bang score, pain intensity assessed by Numeric Rating Scale (NRS), Hospital Anxiety and Depression Scale (HADS), and self-reported level of physical activity.

Results:

Overall, nearly all participants experienced sleep-wake disturbances. Average sleep duration (hh:mm) was 5:30 (range, 1:46-9:52), and sleep efficiency was 64% (range, 28-81). Based on PSQI scores, 95% were classified as having poor sleep quality. Clinical insomnia (ISI ≥ 15p) was reported by 67%. A statistically significant correlation (r_s = 0.31, 95% CI, 0.10-0.50) was found between sleep efficiency and level of physical activity and between ISI and HADS depression (r_s = 0.41, 95% CI, 0.22-0.57).

Conclusions:

A wide range of sleep-wake disturbances were present in the examined cohort, highlighting the possible benefit of assessing sleep to optimise pain rehabilitation.

Significance Statement:

In this cohort, nearly all patients with chronic pain experienced sleep-wake disturbances, and none reached 85% sleep efficiency indicating stable sleep. These findings emphasise the need for a comprehensive assessment of sleep problems to improve the understanding and management of severe pain.

Trial Registration:

ClinicalTrials.gov: NCT04649281.

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