Sleep Quality and Cognitive Performance in Chronic Primary Musculoskeletal Pain

Background

Chronic primary musculoskeletal pain (CPMP) is a recently defined diagnosis that is characterized by persistent pain alongside emotional distress and/or functional disability. Individuals suffering from chronic pain often experience sleep disturbances and cognitive complaints, highlighting a potential association that warrants further exploration. Despite this, research specifically examining the interplay of sleep quality and cognitive performance in CPMP is limited. This observational study aims to investigate the impact of sleep quality on cognitive functioning in individuals diagnosed with CPMP, assessing its contribution to various cognitive domains pertinent to the neuropsychological profile of this condition.

Methods

The study was designed as a cross-sectional investigation involving 60 adult participants. Among these, 30 individuals were diagnosed with CPMP, while the remaining 30 were healthy controls. Participants engaged in a range of assessments, which included the Numeric Pain Rating Scale to quantify their pain, the Symptom Checklist-90-Revised to evaluate psychological symptoms, and the Pittsburgh Sleep Quality Index to assess sleep quality. Following these evaluations, participants underwent a standardized neuropsychological assessment incorporating the Stroop test, the Test of Everyday Attention (TESEN), the Rings Test, and the Working Memory Index derived from the Wechsler Adult Intelligence Scale.

Results

The findings revealed that patients suffering from chronic pain experienced mild cognitive impairments affecting dimensions such as selective attention, sustained attention, processing speed, working memory, planning, problem-solving, inhibition, and interference resistance. Importantly, individuals with poorer sleep quality were found to have significantly greater cognitive impairments, especially in the areas of sustained attention, processing speed, and working memory. Notably, sleep quality emerged as a significant independent predictor of cognitive performance within these domains, even when controlling for sociodemographic factors, pain intensity, and psychological distress.

Conclusions

This study makes a valuable contribution to understanding the neuropsychological profile of individuals with CPMP, emphasizing the importance of sleep quality for cognitive functioning. The evidence suggests that sleep is a critical factor influencing cognitive performance, which can inform future interventions aimed at enhancing executive function in populations experiencing chronic pain.

Significance Statement

This research provides important insights into the cognitive difficulties that individuals with chronic primary musculoskeletal pain encounter, a diagnosis recently formalized in the 11th revision of the International Classification of Diseases. The study underscores the significant role of sleep quality as a predictor of cognitive performance, particularly in the realms of attention, processing speed, and working memory, independent of pain intensity and psychological distress. These findings advocate for the incorporation of sleep-centric strategies within assessment and treatment approaches directed towards chronic pain populations.

Reference

Arévalo-Martínez A, Barbosa-Torres C, García-Baamonde ME, Díaz-Muñoz CL, Moreno-Manso JM. Sleep Quality and Cognitive Performance in Chronic Primary Musculoskeletal Pain: An Observational Study With Healthy Controls. Eur J Pain. 2025 Sep;29(8):e70085. doi: 10.1002/ejp.70085. PMID: 40704395; PMCID: PMC12287900.