STRESS, ANXIETY, DEPRESSION AND SLEEP DISTURBANCES IN PAIN

Abstract

Chronic pain is a complex condition linked with distress and sleep pathology. This chapter explores the bidirectional relationship between pain, stress, anxiety, depression, and sleep disturbances. These co- morbidities share central nervous pathways involving the HPA axis, monoaminergic neurotransmission, and descending pain modulation networks. Prolonged stress triggers systemic inflammation and central sensitization, compounding the impact of anxiety and depression. At the same time, fragmented sleep interferes with the body’s natural opioid systems, which lowers pain thresholds and increases hyperalgesia. In physical rehabilitation settings, healthcare professionals must comprehend this cluster of symptoms. When underlying psychosocial factors are ignored, traditional unimodal methods fall short. To break this cycle and enhance patient long-term results, an integrated approach that incorporates targeted physiotherapy, cognitive behavioural techniques, and sleep hygiene therapies is crucial.