n South African Journal of Diabetes - Chronic pain : addressing the triad of pain, sleep and depression/anxiety : original

Volume 9, Issue 3
  • ISSN :


Epidemiological studies indicate that the increasing worldwide prevalence of chronic pain may be as high as 20-50 %. Furthermore, chronic pain is strongly associated with psychiatric comorbidities, and in particular, anxiety, depression and insomnia. Accordingly, pain is associated with decrements of many aspects of patient's lives including physical and emotional functioning, affective symptoms and sleep problems. The negative impact is higher in patients with greater pain severity. However, there is a bidirectional relationship between chronic pain and these symptoms. Patients with somatisation, health-seeking behaviours and poor sleep are at high risk of developing chronic widespread pain. The risk increases in tandem with severity of anxiety, depression or sleep problems, and those with multiple predisposing factors are at the highest risk (Figure 1)

Therefore, clinically, it may be prudent to consider pain, sleep problems and anxiety/depression as co-existent components of a triad, where the presence of symptoms of one component should prompt investigation for the others.

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