Sleep, inflammation, and pain in musculoskeletal rehabilitation: a structured integrative review of neurobiological mechanisms and non-pharmacological pain management strategies.

BACKGROUND

Sleep disturbance, inflammation, and persistent pain may reinforce one another, compromising musculoskeletal rehabilitation.

PURPOSE: To synthesize evidence on mechanisms linking sleep, inflammation, and pain and identify relevant non-pharmacological interventions.

METHODS

This structured integrative review examined peer-reviewed studies published from January 2010 to December 2025, identified through PubMed, Scopus, PEDro, and SciELO. Reporting and synthesis were guided by SANRA and EQUATOR recommendations.

RESULTS

Fifty-seven studies were included: 24 experimental or observational studies, 17 systematic reviews or meta-analyses, and 16 narrative or integrative reviews. Sleep restriction was associated with changes in interleukin-6, tumor necrosis factor-α, and C-reactive protein, with responses varying across populations and protocols. Prostaglandins and bradykinin may promote nociceptive sensitization, while disrupted sleep may impair descending pain inhibition. Exercise, manual therapy, neuromuscular electrical stimulation, low-level laser therapy, and sleep-focused behavioral interventions showed mechanistic plausibility, although confirmatory trials remain limited.

CONCLUSION

Sleep assessment and sleep-focused interventions should be considered within multimodal musculoskeletal pain management, while further controlled research clarifies clinical effectiveness.