Purpose: Musculoskeletal pain and insomnia frequently co-occur. Although insomnia is often treated with hypnotics, prolonged use is not recommended. The prevalence of prolonged hypnotic prescriptions among individuals with both conditions remains unknown. This descriptive epidemiological study aimed to estimate prolonged prescriptions among individuals with insomnia and chronic musculoskeletal pain.
Patients and methods: In this cross-sectional study, data from 40,790 participants in the Trøndelag Health Study (HUNT4) were linked to the Norwegian Prescription Database for Z-hypnotic prescriptions during the participation year. Prolonged prescriptions were defined as ≥90 defined daily doses. Prevalence estimates were calculated by insomnia and chronic pain status, stratified by age, sex, and pain severity.
Results: Among participants with insomnia, prolonged prescription prevalence was higher in those with chronic pain (12.9%) compared to insomnia alone (8.7%). Stratification revealed marked age and sex differences: women aged 45-69 had prevalences of 13.7% if they had pain and insomnia versus 10.2% if they had insomnia alone, increasing to 31.1% and 25.3% for women ≥70 years. For men, rates were 8.1% versus 9.3% at ages 45-69 years and 19.2% versus 14.9% at ≥70 years. Younger participants had prevalences between 1.4% and 2.7%. Pain severity influenced prevalence only among participants aged ≥70 years, and more strongly among men (22.5% with high impact pain versus 14.9% without pain).
Conclusion: Chronic musculoskeletal pain was associated with higher prescription rates, though not statistically significant within age categories, and pain severity had some influence among older individuals. Regardless of pain status, prolonged Z-hypnotic prescriptions increased with age, with women receiving more than men.
Keywords: HUNT; Norwegian prescription database; age and sex differences; musculoskeletal pain; prevalence; sleep medication.
People with long-lasting musculoskeletal pain often also have trouble sleeping. Sleep problems are usually treated with medicines called hypnotics, but using them for a long time is not recommended. We wanted to find out how often people with both pain and sleep problems receive long-term prescriptions for these medicines. We looked at data from over 40,000 adults in the Trøndelag Health Study (HUNT4) and linked it to prescription records for sleep medicine. We defined “long-term use” as getting at least 90 daily doses in one year. We found that people with both pain and sleep problems were somewhat more likely to have long-term prescriptions than those with sleep problems alone. Older adults and women were most likely to receive these prescriptions. For example, among women aged 70 and older, about one in three had long-term prescriptions. Pain severity only made a difference for older adults. In short, long-term use of sleep medicines is common among older people, especially women, and is slightly more frequent in those with long-lasting musculoskeletal pain.
© 2026 Rian et al.