Relationship between insomnia and pain in patients with chronic orofacial pain

Objective: Few studies have investigated specific associations between insomnia and orofacial pain (OFP). The aim of this cross-sectional study was to examine relationships of insomnia with pain, mental health, and physical health variables among treatment-seeking patients with chronic OFP.

Methods: . OFP diagnosis, demographics, insomnia symptoms, pain intensity, interference, and duration, mental health measures, and number of medical comorbidities were extracted from the medical records of 450 patients receiving an initial appointment at a university-affiliated tertiary OFP clinic. T-tests compared differences between patients with and without insomnia symptomatology, and between patients with different insomnia subtypes (delayed onset/early-wakening).

Results: Compared to patients without insomnia, those with elevated insomnia symptomatology (45.1%) reported higher pain intensity (60.70 ± 20.61 vs 44.15 ± 21.69; p < 0.001) and interference (43.81 ± 29.84 vs 18.40 ± 23.43; p < 0.001), depression/anxiety symptomatology (5.53 ± 3.32 vs 2.72 ± 2.66; p < 0.001), dissatisfaction with life (21.63 ± 6.95 vs 26.50 ± 6.21; p < 0.001), and number of medical comorbidities (6.72 ± 5.37 vs 4.37 ± 4.60; p < 0.001). Patients with Sleep Onset Latency insomnia (SOL-insomnia) (N = 76) reported higher pain intensity (t = 3.57; p < 0.001), and pain interference (t = 4.46; p < 0.001) compared to those without SOL-insomnia. Those with Early Morning Awakening insomnia (EMA-insomnia) (N = 71) did not significantly differ from those without EMA-insomnia on any of the variables. Differences remained significant after adjusting for age, sex, primary OFP diagnosis, and pain intensity.

Conclusions: Insomnia is associated with pain outcomes and should be appropriately managed when treating patients with chronic OFP.