Living with HIV and Insomnia: Implications for sleep quality, experimental pain sensitivity, and clinical pain severity

Caroline K Webb; Shannon R Gilstrap Wilson; Joanna M Hobson; Halla N Stallworth; Dyan M White-Gilliam; Michael A Owens; Shameka L Cody; S Justin Thomas; Robert E Sorge; Burel R Goodin

doi:10.1016/j.jpain.2026.106283

Living with HIV and Insomnia: Implications for sleep quality, experimental pain sensitivity, and clinical pain severity

J Pain. 2026 Apr 15:44:106283. doi: 10.1016/j.jpain.2026.106283. Online ahead of print.

Authors

Affiliations

¹ College of Arts and Sciences, Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: ckwebb@uab.edu.
² Howard College of Arts and Sciences, Department of Psychology, Samford University, Birmingham, AL, USA.
³ Department of Community Dentistry & Behavioral Sciences, The University of Florida, Gainesville, FL, USA.
⁴ College of Arts and Sciences, Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, USA.
⁵ Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA.
⁶ Department of Psychiatry & Behavioral Neurobiology, The University of Alabama at Birmingham, Birmingham, AL, USA.
⁷ Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL, USA.

Abstract

Prior research has established a bidirectional relationship between sleep and pain, yet this relationship remains understudied in people living with HIV (PLWH). The current cross-sectional study examined differences in sleep quality, experimental pain sensitivity using quantitative sensory testing (QST), and clinical pain severity by HIV and insomnia status. Participants included people with and without HIV as well as those with and without insomnia according to a structured clinical interview for diagnosing sleep disorders based on the DSM-5 guidelines. Participants were grouped based on the presence or absence of HIV (H+/H-) and insomnia (I+/I-) as follows: H-/I- (n=46), H-/I+ (n=37), H+/I- (n=14), and H+/I+ (n=39) (N=136). For subjective and objective sleep assessment, participants completed the Insomnia Severity Index, the RU-SATED, Dysfunctional Beliefs and Attitudes about Sleep, and actigraphy. Participants subsequently completed a standardized QST battery and reported the severity of bodily pain experienced over the past seven days. The H+/I+ group had the absolute worst quality of sleep on all subjective and objective measures. Further, the H+/I+ group demonstrated the greatest endogenous pain facilitation to cold and pressure stimuli and the least endogenous inhibition of pain via conditioned pain modulation. A greater proportion of participants in the H+/I+ group reported experiencing "severe" or "very severe" bodily pain over the past seven days compared to all other groups. Greater clinical pain severity was associated with poorer subjective and objective sleep. Future research should investigate whether behavioral treatments for insomnia also improve pain outcomes among PLWH to inform targeted and accessible interventions. PERSPECTIVE: This study explores the relationship between sleep disturbance and pain sensitivity across HIV and insomnia status. This work highlights the potential additive impact of HIV and insomnia on sleep and pain, which may be used to create accessible future behavioral treatments within this population. TRIAL REGISTRATION: This study used data collected as part of the parent trial entitled "The Impact of Insomnia on Pain in HIV" (ClinicalTrials.gov ID: NCT04298658).

Keywords: Chronic pain; HIV; Insomnia; Quantitative Sensory Testing.

Associated data

ClinicalTrials.gov/NCT04298658

Abstract

Associated data

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