FUTURE DIRECTIONS IN RESEARCH AND MANAGEMENT
It is obvious that prospective and systematic studies need to be made regarding costs to health care of the interaction between chronic pain and poor sleep quality. The analysis will have to be corrected for concomitant conditions such as diabetes, obesity, cardiovascular problems, sleep disorders (e.g., sleep breathing disorders, PLMS, insomnia), depression and anxiety. Moreover, indirect costs related to absenteeism, low working performance, low familial activities and transportation or work accident risks also need to be included in the calculations. Five priorities are suggested: (1) assessment of risk factors of ‘pain and poor sleep’ interactions; (2) estimation of ‘pain and poor sleep’ consequences and/or impacts; (3) development of prevention programs; (4) development of guidelines about best management strategies (e.g., cognitive behavioral therapies vs. pain and sleep medications); (5) accessibility of pain or sleep prevention strategies and therapies to developing countries according to their values and respecting strategies already in place (e.g., lifestyle, medicinal products).