Imbalances in the Content of Sleep and Pain Assessments in Patients with Chronic Pain: A Scoping Review

Katsuyoshi Tanaka; Yuichi Isaji; Kosuke Suzuki; Kohei Okuyama; Yasuyuki Kurasawa; Masateru Hayashi; Takashi Kitagawa

doi:10.12688/f1000research.166110.2

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Systematic Review

Revised

Imbalances in the Content of Sleep and Pain Assessments in Patients with Chronic Pain: A Scoping Review

[version 2; peer review: 1 approved with reservations]

Katsuyoshi Tanaka ¹, Yuichi Isaji¹, Kosuke Suzuki², [...] Kohei Okuyama¹, Yasuyuki Kurasawa³, Masateru Hayashi⁴, Takashi Kitagawa⁵

Katsuyoshi Tanaka ¹, Yuichi Isaji¹, [...] Kosuke Suzuki², Kohei Okuyama¹, Yasuyuki Kurasawa³, Masateru Hayashi⁴, Takashi Kitagawa⁵

PUBLISHED 15 Sep 2025

Author details Author details

¹ Department of Physical Therapy, School of Health Sciences, Bukkyo University, Kyoto, Kyoto, 604-8418, Japan
² Department of Rehabilitation, Yamagata Saisei Hospital, Yamagata, Yamagata, Japan
³ Department of Rehabilitation, Faculty of Health Science, Nagano University of Health and Medicine, Nagano, Nagano, Japan
⁴ Department of Rehabilitation, Matsuoka Orthopedic Surgery and Internal Medicine Rehabilitation, Gifu, Gifu, Japan
⁵ Department of Physical Therapy, School of Health Sciences, Shinshu University, Matsumoto, Nagano, Japan

Katsuyoshi Tanaka
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Yuichi Isaji
Roles: Investigation, Writing – Review & Editing

Kosuke Suzuki
Roles: Investigation, Writing – Review & Editing

Kohei Okuyama
Roles: Investigation, Writing – Review & Editing

Yasuyuki Kurasawa
Roles: Investigation, Writing – Review & Editing

Masateru Hayashi
Roles: Investigation, Writing – Review & Editing

Takashi Kitagawa
Roles: Investigation, Supervision, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Circadian Clocks in Health and Disease collection.

Abstract

Background

Sleep disturbances frequently occur in concomitance with chronic pain, exacerbating its detrimental effects and diminishing patients’ quality of life. Although various studies have explored the relationship between chronic pain and sleep disturbances, comprehensive evidence on detailed assessment methods and their bidirectional interactions remains limited. This scoping review aimed to examine the characteristics and prevalence of assessment methods for sleep and pain-related outcomes in individuals with chronic pain.

Methods

A comprehensive search of nine databases identified observational and interventional studies examining the relationship between sleep disturbances/disorders and chronic pain in adults. A literature search was conducted in MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, PsycINFO, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) as well as gray literature sources, Open Grey. In addition, the following trial registries were searched for ongoing or unpublished trials: the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov.

Results

This review included 81 of 3,513 studies. Approximately 90.1% of studies relied on self-report sleep assessments, whereas only 9.9% incorporated objective measures. Additionally, 7.4% of studies used a combination of self-report and objective sleep assessments. The visual analog and numeric rating scales were the most frequently used methods for assessing pain-related outcomes (58.0%). Despite extensive research on sleep and chronic pain, critical gaps persist, particularly in the integration of multidimensional assessment tools.

Conclusions

This scoping review discovered imbalances in the content of both sleep and pain assessments. Future studies should integrate both objective and self-report assessment tools to provide a more comprehensive understanding of this interaction.

Keywords

pain, sleep disturbances, assessment tools

Corresponding author: Katsuyoshi Tanaka

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2025 Tanaka K et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Tanaka K, Isaji Y, Suzuki K et al. Imbalances in the Content of Sleep and Pain Assessments in Patients with Chronic Pain: A Scoping Review [version 2; peer review: 1 approved with reservations]. F1000Research 2025, 14:605 (https://doi.org/10.12688/f1000research.166110.2) First published: 20 Jun 2025, 14:605 (https://doi.org/10.12688/f1000research.166110.1) Latest published: 15 Sep 2025, 14:605 (https://doi.org/10.12688/f1000research.166110.2)

Revised Amendments from Version 1

This revised version of our article incorporates revisions made in response to reviewer feedback. We clarified terminology by consistently using the term sleep disturbances when referring to general sleep-related dysfunction, and we added references to standardized definitions (ICSD-3). We also included a citation to support the statement on the financial impact of chronic pain.
In the Methods section, we clarified adherence to all eight JBI steps and explicitly noted the use of the PRISMA-ScR checklist. We also explained how ChatGPT-4o and NotebookLM were used to facilitate data extraction and emphasized that all outputs were verified by the first author to ensure accuracy. Additionally, we specified that no dedicated systematic review software (e.g., Covidence) was used, and we highlighted that the complete PubMed search strategy is provided in Supplementary Table S1. We also acknowledged that the literature search was completed in March 2024 and may not capture more recent studies.
In the Results, we added the frequencies and percentages of studies using the PSQI and ISI and referenced Figure 2. In the Discussion, we highlighted how inadequate or inconsistent sleep assessment may influence interpretation of intervention outcomes. Finally, in the Conclusions, we replaced the term content with characteristics for improved clarity.

See the authors' detailed response to the review by Brett D Neilson

1. Introduction

The World Health Organization recognizes chronic pain as a disease, making it one of the most prevalent conditions worldwide.¹ Chronic pain results in significant disability and imposes a substantial economic strain on society.² In addition to persistent pain, individuals with chronic pain experience various consequences, including deterioration in the quality of life (QOL), higher prevalence of depressive symptoms, and greater levels of disability compared with those without pain.³ The financial impact of chronic pain, including healthcare expenses and reduced work efficiency, is substantial.⁴ This underlines the extensive influence of pain on the individual and the community as a whole. Furthermore, chronic pain often coexists with sleep disturbances, which exacerbate the adverse effects of pain, adding to the overall strain on individuals and society.^5,6

Patients with chronic pain frequently develop sleep disturbances.^7–10 Sleep disturbance including inadequate sleep, insomnia and obstructive sleep apnea, represent significant and widespread health concerns.^11,12 Notably, the prevalence of sleep disturbance is high among patients with chronic musculoskeletal pain, affecting approximately 75% and 44% of such individuals, respectively.^9,13 Previous studies have suggested a correlation between compromised sleep and reduced QOL, adverse general health outcomes, elevated levels of depression, and diminished physical function.¹⁴ Additionally, the concomitance of chronic pain and sleep disturbances leads to further deterioration in overall health and QOL. A bidirectional association has also been suggested, wherein pain negatively affects sleep, and sleep disturbances contribute to increased pain.¹⁵

Polysomnography, which is considered the gold standard for the objective assessment of sleep, has been used in various chronic pain conditions, such as fibromyalgia, rheumatoid arthritis, osteoarthritis, and temporomandibular pain.^7,16 In addition to polysomnography, sleep assessment, encompassing sleep duration and quality, has been conducted using several tools, such as actigraphy, questionnaires, and wearable devices.^17,18 Moreover, although several studies have investigated the relationship between sleep and chronic pain, most existing reviews have focused on specific populations, such as those with postsurgical pain, pediatric pain, or low back pain.^19–21 Thus, comprehensive evidence on detailed methods for assessing the relationship between chronic pain and sleep disturbance remains scarce.

Therefore, this scoping review (ScR) aimed to examine the characteristics and prevalence of methods used to assess sleep and pain-related outcomes in individuals with chronic pain and to identify gaps in the evidence, with the objective of guiding future studies.

2. Methods

This ScR was conducted according to the Joanna Briggs Institute methodology for scoping reviews, following all eight recommended steps without deviation.²² The study was registered with the Open Science Framework (https://osf.io/jc5qh/) on March 29, 2024. This review also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR) checklist. The inclusion criteria were established based on the participants, concept, and context of the study.

2.1 Eligibility criteria

This ScR included studies on individuals with chronic pain lasting for >3 months. Studies on individuals with malignancy-related or cancer-related pain or acute pain conditions, such as postoperative pain, were excluded. Moreover, studies that included children (≤18 years) and/or participants with other conditions besides chronic pain were excluded. No restrictions were imposed with respect to the sex, location, race, country, or language of the participants. This review evaluated the measurement tools used for sleep assessment in individuals with chronic pain conditions, including polysomnography, wearable devices, and questionnaires. Additionally, we identified various types of pain-related assessments, including pain intensity, severity, disability, catastrophizing, threshold, and tolerance. In other words, we included studies that involved sleep assessments in individuals with chronic pain conditions.

This ScR included randomized controlled trials (RCTs), crossover trials, quasi-RCTs, non-RCTs, cross-sectional studies, and prospective and retrospective cohort studies, encompassing both observational and interventional designs. Protocols and conference abstracts were included in the initial screening, with a secondary screening conducted to verify the existence of published articles. Case reports, case-control studies, systematic reviews, meta-analyses, and narrative reviews were excluded.

2.2 Search strategy

The search strategy was designed to identify both published and unpublished studies. A literature search was conducted in MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, PsycINFO, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) as well as gray literature sources, Open Grey. In addition, the following trial registries were searched for ongoing or unpublished trials: the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov.

The text words found in the titles and abstracts of relevant articles, along with the index terms used to describe the articles, were used to develop a comprehensive search strategy across nine databases (the complete PubMed search strategy is provided in Table S1). Previous studies were also referenced.^19,23,24 Studies published in any language were included, with no restrictions on the publication date. The final comprehensive search was conducted on March 29, 2024.

2.3 Study selection and source of evidence

All identified citations were collated and uploaded into Rayyan (Qatar Computing Research Institute, Ar Rayyan, Qatar, https://www.rayyan.ai/), and duplicates were removed. Following a pilot test, two or more independent reviewers (K.T. and Y.I.) screened the study titles and abstracts based on the eligibility criteria. The full text of relevant sources was retrieved, and their citation details were imported into Rayyan. Two or more independent reviewers (K.T., Y.I., K.S., M.H., K.O., and Y.K.) assessed the full text of the selected studies based on the eligibility criteria. The reasons for excluding sources that did not meet the eligibility criteria were documented and reported in this ScR. Any disagreements between reviewers at each stage of selection were resolved through discussion or by consulting additional reviewers.

The results of the search and study inclusion process were comprehensively reported in the final ScR and illustrated in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for ScR flow diagram.²⁵

2.4 Data extraction

Data were extracted from the included studies using Microsoft Excel (Microsoft Corp., Redmond, WA, USA) by the first author (K.T.), with the assistance of ChatGPT-4o (San Francisco, CA, USA) and NotebookLM (Mountain View, CA, USA).^26,27 These AI tools were used to facilitate the extraction and preliminary organization of information from the included studies. All outputs generated by AI were reviewed and verified against the original sources by the first author (K.T.) to ensure accuracy, and all final decisions were made by the research team. No dedicated systematic review software (e.g., Covidence) was used for data extraction. The extracted data included the first author’s name, country of origin, study design, sample size, participant characteristics (age, sex, and diagnosis), and tools used for assessing sleep disturbance and pain-related outcomes. The draft data extraction tool was modified and refined as necessary throughout the data extraction process. Where necessary, the authors of the included studies were contacted to obtain any missing or additional data.

3. Results

3.1 Study selection

A total of 3,513 articles were retrieved during the database search. After eliminating 1,296 duplicates, the titles and abstracts of 2,217 articles were screened. Thereafter, the full texts of the remaining 415 articles were assessed for eligibility. Ultimately, only 81 studies that met the eligibility criteria were included in the analysis ( Figure 1).

Figure 1. PRISMA flow diagram illustrating the structure of the search and screening process.

3.2 Study and participant characteristics

Of the 81 included studies, 26 (32.1%) were RCTs,^28–53 while the remaining studies were non-RCTs.^54–108 The included studies were published between 1998 and 2024, with nearly half (45.7%, 37 of 81) published within the last 5 years.^{30–32,34–36,40,41,43,48,51–54,58,59,63,67,68,73,76,78–82,85–87,90–93,95,96,101,106} The distribution of participants varied across studies: 31 studies (38.3%) focused on examining patients with chronic pain, irrespective of pain type, accounting for 40.5% of the total participants (7,413 out of 18,316).^{32,38,42,47,51,52,54,57,58,65,67,69–73,76,79,80,82,85,88,89,91,92,94,97,99,101,103,106} Eleven studies (13.6%) investigated patients with chronic low back pain, accounting for 12.4% of the total participants (2,266 participants).^{33,36,46,48,56,81,90,95,98,107,108} Eight studies (9.9%) examined patients with chronic musculoskeletal pain, irrespective of location, accounting for 9.1% of the total participants (1,667 individuals).^{41,62–64,77,78,86,105} Six studies (7.4%) assessed patients with chronic neck pain, comprising 5.2% of the total participants (950 participants).^{34,40,60,61,96,100}

3.3 Outcome measurements

An overview of the included studies is presented in supplemental materials (Table S2, S3). Various methods have been used to assess sleep disturbances and pain-related outcomes, with patient-reported outcomes (PROs) being the most frequently utilized.

The Pittsburgh Sleep Quality Index (PSQI) (45 of 81 studies, 55.6%) and Insomnia Severity Index (ISI) (21 of 81 studies, 25.9%) were the most commonly used tools for the assessment of sleep problems ( Figure 2). Other self-reported sleep assessment methods used included the Athens Insomnia Scale and sleep diaries. Sleep problems were predominantly assessed based on the participant’s entries in sleep diaries. In terms of study methodology, 73 of 81 studies (90.1%) relied solely on PROs (90.1% [73/81]).^{30–53,60–108} Only 2 of 81 studies (2.5%) relied solely objective assessments,^58,59 such as actigraphy, whereas 6 of 81 studies (7.4%) used a combination of PROs and objective assessments.^{28,29,54–57} Other objective sleep assessment methods used included polysomnography and electroencephalography.

Figure 2. Percentage of the combined use of sleep problem and pain-related outcome assessments.

For PRO assessments, the outcomes were frequently evaluated using the numeric rating scale (NRS) or visual analog scale (VAS) (58.0% [47/81]).^{32,34–41,44,45,49,50,52,53,55–62,64–66,70–72,77,79,81,85,87,88,90,91,94–98,100,103,105,107,108} The Brief Pain Inventory (BPI) was the second most frequently used pain assessment tool (28.4% [23/81]).^{28,30,31,33,42–44,46,47,51,57,63,67–69,73,76,78,80,82,86,89,99} Additional pain-related outcome measures included the Multidimensional Pain Inventory and Pain Disability Questionnaire. Psychometric factors were evaluated in more than half of the included studies (60.5% [49/81]).^{30,32,35–38,41,42,44,47,49,50,52,54,55,58,60–63,69–79,83–85,87,90–95,97–99,102,103,105,106,108} Objective pain assessment was rarely performed, with only one study utilizing quantitative sensory testing.⁹⁸

Figure 2 presents the detailed percentages of the combined use of sleep problems and pain-related outcome assessments. The NRS/VAS was frequently used in combination with the PSQI (31.4%), followed by combination of the NRS/VAS with the ISI (15.6%). The simultaneous use of both self-report and objective sleep assessments, along with the NRS or VAS and the BPI, was extremely rare, occurring in only 0.6% of studies ( Figure 2).

4. Discussion

This ScR highlighted the use of various measurement tools for assessing sleep and pain. The review emphasized the diversity of assessment tools used to evaluate sleep and pain, revealing substantial inconsistencies and the lack of standardization. Despite the large body of research on this topic, critical gaps persist, particularly the absence of generalizable objective measurements for sleep assessment, which may hinder the reliability and applicability of the current findings.

A key finding of this review is the predominant reliance on self-report measures for evaluating sleep disturbances. Over 90% of the included studies utilized PROs, such as the PSQI or the ISI. Although these tools provide practical and accessible methods of assessing perceived sleep quality, they are inherently limited by individual biases and self-reported variability.^109,110 In contrast, objective measures such as actigraphy and polysomnography provide precise and quantifiable data on sleep architecture, including sleep stages, latency, and fragmentation.^111,112 However, these tools were employed by only a small portion of the included studies, with objective methods utilized by 9.9% (8/81) of studies. This imbalance likely stems from the challenges, which traditionally include cost and other constraints, hindering the use of objective measures, thereby complicating the comprehensive assessment of sleep disturbances.^113,114 Future research should prioritize the integration of these objective tools to provide a more robust understanding of sleep disturbances in individuals with chronic pain.

Beyond sleep assessment, this review also identified variability and potential bias in the pain-related outcome evaluations. Most studies focused primarily on examining pain intensity, often measured using the NRS or the VAS. Although these tools are widely used and validated,^115,116 they only capture one aspect of the complex pain experience.^117–119 Approximately half of the studies assessed the psychological factors associated with pain, but other important domains, such as pain-related disability and sensitization, were less frequently explored. Notably, only one study included in this review utilized quantitative sensory testing.⁹⁸ This limited focus restricts the understanding of pain mechanisms and hinders the development of targeted treatment strategies. More comprehensive pain assessment protocols that incorporate these additional dimensions are necessary to produce clinically relevant evidence.¹²⁰

The complex relationship between sleep disturbances and chronic pain necessitates a multidimensional research approach. Existing evidence suggests that sleep disturbances can exacerbate pain through mechanisms such as increased central sensitization, impaired descending pain inhibition, and heightened emotional distress.^121–123 Addressing these gaps in assessment methodologies is crucial for advancing the field. Incorporating objective sleep assessments and multidimensional pain measures into research and clinical practice will enhance the quality of evidence and support the development of precision medicine approaches tailored to individual patient needs. Given the bidirectional relationship between sleep and pain, inadequate or inconsistent assessment of sleep disturbances may obscure the true effects of intervention for chronic pain. This limitation could lead to underestimation or misinterpretation of treatment efficacy and reduce the comparability of results across studies. Addressing this issue is essential for developing effective multimodal interventions and advancing precision medicine. Furthermore, interdisciplinary collaboration that brings together experts in neurology, psychology, and bioinformatics could facilitate the development of innovative assessment tools and therapeutic interventions.

This review has some limitations. The lack of synthesis of the findings restricted our ability to evaluate methodological rigor and the overall reliability of the evidence. Additionally, the possibility of overlooking relevant studies cannot be completely excluded, which may have introduced selection bias. However, this review included gray literature and non-English studies to mitigate this potential bias. A further limitation is that the literature search was last conducted in March 2024, and more recent studies may not have been captured.

5. Conclusions

This ScR highlights the imbalance in the characteristics of sleep and pain assessments, indicating the need for a more comprehensive evaluation of sleep disturbances and pain-related outcomes. Addressing the gaps in objective and multidimensional assessments could facilitate the development of personalized interventions that improve patient outcomes and overall quality of care.

Ethics and consent

This scoping review did not involve human participants directly, and therefore ethical approval was not required.

Data availability

All data underlying the results are available in the Open Science Framework repository: (https://doi.org/10.17605/OSF.IO/5JK63), licensed under CC0 1.0 Universal.¹²⁴

This includes the PRISMA-ScR checklist, flowchart, data for figure and supplementary tables.

Acknowledgements

The authors utilized artificial intelligence tools for data extraction and the preparation of preliminary drafts. Data interpretation and final manuscript revisions were solely performed by human researchers.

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Version 2

VERSION 2 PUBLISHED 20 Jun 2025

Author details Author details

Yuichi Isaji
Roles: Investigation, Writing – Review & Editing

Kosuke Suzuki
Roles: Investigation, Writing – Review & Editing

Kohei Okuyama
Roles: Investigation, Writing – Review & Editing

Yasuyuki Kurasawa
Roles: Investigation, Writing – Review & Editing

Masateru Hayashi
Roles: Investigation, Writing – Review & Editing

Takashi Kitagawa
Roles: Investigation, Supervision, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (2)

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Published: 15 Sep 2025, 14:605

https://doi.org/10.12688/f1000research.166110.2

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https://doi.org/10.12688/f1000research.166110.1

© 2025 Tanaka K et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Tanaka K, Isaji Y, Suzuki K et al. Imbalances in the Content of Sleep and Pain Assessments in Patients with Chronic Pain: A Scoping Review [version 2; peer review: 1 approved with reservations]. F1000Research 2025, 14:605 (https://doi.org/10.12688/f1000research.166110.2)

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Reviewer Report 27 Aug 2025

Brett D Neilson, Hawai'i Pacific University, Hawaii, Japan

Approved with Reservations

https://doi.org/10.5256/f1000research.182981.r399708

General Comments
This is a well-organized and clearly written scoping review (ScR) that addresses an important topic: the methods used to assess sleep and pain-related outcomes in individuals with chronic pain. The authors articulate a clear aim, follow a structured methodology, and present their findings with clarity. The manuscript would benefit from some clarifications and adjustments, particularly regarding terminology, methodological rigor, and reporting of results.

Abstract

The abstract is clear and concisely conveys the purpose and scope of the review.
The aim is well articulated.
No major revisions are needed for the abstract.

Introduction
The introduction is generally well written and provides appropriate context for the review. However, the use of inconsistent terminology for sleep-related issues may create confusion for the reader.
Recommendations:

Consider defining or consistently using terms such as “sleep problems,” “sleep disorders,” “compromised sleep,” and “sleep disturbances.”
Reference standardized definitions or diagnostic criteria where appropriate.
The statement: “The financial impact of chronic pain, including healthcare expenses and reduced work efficiency, is substantial.” should be supported with a citation. There is robust literature available on this topic.

Methods
The methodology appears rigorous, with an extensive search strategy across nine databases and inclusion of grey literature. However, a few clarifications and enhancements are suggested.
Recommendations:

Clarify adherence to all eight JBI steps, or note deviations.
Consider referencing the PRISMA-ScR checklist.
Search was completed in March 2024; consider updating if required by the journal.
Describe how ChatGPT-4o outputs were validated to ensure data accuracy.
Mention if data extraction software (e.g., Covidence) was used.
Include a sample search strategy for at least one database to enhance reproducibility of the review process.

Results
The results are clearly reported, with appropriate use of tables and figures.
Recommendation:

Provide percentages or refer to Figure 2 when discussing the use of PSQI and ISI.

Discussion
The discussion section is well constructed and effectively summarizes the key findings of the review.
Recommendations:

Use consistent and defined terminology for sleep-related terms.
Discuss how inadequate sleep assessment may affect intervention outcomes, given the bidirectional relationship between sleep and pain.

Conclusions
The conclusions are appropriate and do not overreach.
Recommendation:

Replace the term “content” with “characteristics” or “types” where appropriate.

Summary of Key Revisions for Authors

Ensure consistent and defined terminology for sleep-related dysfunction.
Add citation(s) to support claims regarding the financial impact of chronic pain.
Clarify adherence to JBI methodology and consider referencing PRISMA-ScR.
Provide detail on how ChatGPT-4o was used and how its outputs were validated.
Include numerical data or clear reference to figures for key result statements.
Explore how measurement inconsistencies could impact intervention outcomes.
Replace the term “content” with “characteristics” or “types” where appropriate.
Acknowledge that the PRISMA-ScR checklist was used, as mentioned in the Data Availability section. Consider integrating this earlier in the Methods to emphasize adherence to reporting standards.
Include a sample search strategy for at least one database to enhance reproducibility of the review process.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Yes
Are the conclusions drawn adequately supported by the results presented in the review?

Yes
If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.)

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: I am a physical therapist educator in the Hawai‘i Pacific University Doctor of Physical Therapy Program. My research focuses on the intersection of sleep and pain, with several publications in this area. I have previously published two ScRs on a similar topic: Feda J, Miller T, Young JL, Neilson B, Rhon DI. Measures of sleep are not routinely captured in trials assessing treatment outcomes in knee osteoarthritis - A scoping systematic review and call to action. Osteoarthr Cartil Open. 2023;(100400):100400. Neilson BD, Dickerson C, Young JL, Shepherd MH, Rhon DI. Measures of sleep disturbance are not routinely captured in trials for chronic low back pain: a systematic scoping review of 282 trials. J Clin Sleep Med. 2023;19(11):1961–1970.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Author Response 23 Sep 2025

Katsuyoshi Tanaka, Department of Physical Therapy, School of Health Sciences, Bukkyo University, Kyoto, 604-8418, Japan

23 Sep 2025

Author Response
Response to Brett D Neilson
We greatly appreciate the reviewer’s insightful comments. Our responses to your comments are given below.

Introduction
Comment: The introduction is generally well written and ... Continue reading
Response to Brett D Neilson
We greatly appreciate the reviewer’s insightful comments. Our responses to your comments are given below.

Introduction
Comment: The introduction is generally well written and provides appropriate context for the review. However, the use of inconsistent terminology for sleep-related issues may create confusion for the reader.
Recommendations:

Consider defining or consistently using terms such as “sleep problems,” “sleep disorders,” “compromised sleep,” and “sleep disturbances.”

Reference standardized definitions or diagnostic criteria where appropriate.

The statement: “The financial impact of chronic pain, including healthcare expenses and reduced work efficiency, is substantial.” should be supported with a citation. There is robust literature available on this topic.

Responses:
We appreciate the reviewer’s suggestion. To avoid confusion, we have revised the manuscript to use the term “sleep disturbances” consistently when referring to general sleep-related dysfunction. In the Introduction, we also added a clarifying statement with references to the International Classification of Sleep Disorders, Third Edition (ICSD-3).
Additionally, as recommended, we have added a citation to support the statement regarding the financial impact of chronic pain.
We have added the references as follow:
“Rikard SM, Strahan AE, Schmit KM, Guy GP Jr. Chronic pain among adults - United States, 2019-2021. MMWR Morb Mortal Wkly Rep. 2023;72:379-385.”
“Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146:1387-1394.”

Methods
Comment: The methodology appears rigorous, with an extensive search strategy across nine databases and inclusion of grey literature. However, a few clarifications and enhancements are suggested.
Recommendations:

Clarify adherence to all eight JBI steps, or note deviations.

Consider referencing the PRISMA-ScR checklist.

Search was completed in March 2024; consider updating if required by the journal.

Describe how ChatGPT-4o outputs were validated to ensure data accuracy.

Mention if data extraction software (e.g., Covidence) was used.

Include a sample search strategy for at least one database to enhance reproducibility of the review process.

Responses:
We appreciate the reviewer’s suggestions. We have responded to each recommendation as below:
1. Adherence to JBI steps
We clarified that our review followed all eight steps of the Joanna Briggs Institute (JBI) methodology for scoping review without deviation. We revised the sentence as below:
“This ScR was conducted according to the Joanna Briggs Institute methodology for scoping reviews, following all eight recommended steps without deviation.”
2. PRISMA-ScR checklist
We appreciate the reviewer’s recommendation. In addition to noting in the Data Availability section that the completed PRISMA-ScR checklist is provided, we have now explicitly stated in the Methods section that the review adhered to the PRISMA-ScR checklist. The following sentence was added:
“This review also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR) checklist.”
3. Search update
We appreciate the reviewer’s suggestion. The final comprehensive search was conducted on March 29, 2024, as already noted in the Methods section. Given the publication model of F1000Research, the Version 1 preprint of this review was made publicly available shortly after submission, and thus the search reflects the literature available at that time. As the journal does not require an updated search for scoping reviews, we have not repeated the search. Nevertheless, we have noted in the Discussion that more recent studies may not have been captured. The following sentence was added:
“A limitation of this review is that the literature search was last conducted in March 2024, and more recent studies may not have been capture.”

4. Use of ChatGPT-4o
We thank the reviewer for this important comment. In the revised manuscript, we have clarified how ChatGPT-4o and NotebookLM were used during data extraction. These AI tools were used to facilitate the extraction and preliminary organization of information from the included studies. All outputs were reviewed and verified against the original studies by the first author (K.T.) to ensure accuracy. Thus, while AI was utilized as part of the data extraction process, no information was included without human verification, and all final decisions were made by the research team. The following sentence was added:
“These AI tools were used to facilitate the extraction and preliminary organization of information from the included studies. All outputs generated by AI were reviewed and verified against the original sources by the first author (K.T.) to ensure accuracy, and all final decisions were made by the research team.”
5. Data extraction software
We thank the reviewer’s helpful comment. In the revised manuscript, we have clarified that no dedicated systematic review software such as Covidence was used for data extraction. Instead, data were extracted using Microsoft Excel, supported by ChatGPT-4o and NotebookLM, with all outputs reviewed and verified by the first author (K.T.) to ensure accuracy. The following sentence was added:
“No dedicated systematic review software (e.g., Covidence) was used for data extraction.”
6. Sample search strategy
We thank the reviewer’s valuable suggestion. To ensure reproducibility, we have clarified in the Methods section that the full PubMed search strategy is provided as Supplementary Table S1. The sentence was revised as follow:
“The text words found in the titles and abstracts of relevant articles, along with the index terms used to describe the articles, were used to develop a comprehensive search strategy across nine databases (the complete PubMed search strategy is provided in Table S1).”

Results
Comment: The results are clearly reported, with appropriate use of tables and figures.
Recommendation:

Provide percentages or refer to Figure 2 when discussing the use of PSQI and ISI.

Response:
We appreciate the reviewer’s suggestion. To improve clarity, we have added the frequencies and percentages of studies that used the PSQI and ISI, and we now reference Figure 2 in the text. We revised the sentences as follow:
“The Pittsburgh Sleep Quality Index (PSQI) (45 of 81 studies, 55.6%) and Insomnia Severity Index (ISI) (21 of 81 studies, 25.9%) were the most commonly used tools for the assessment of sleep problems (Figure 2).”

Discussion
Comment: The discussion section is well constructed and effectively summarizes the key findings of the review.
Recommendations:

Use consistent and defined terminology for sleep-related terms.

Discuss how inadequate sleep assessment may affect intervention outcomes, given the bidirectional relationship between sleep and pain.

Responses:
We appreciate the reviewer’s comments. In the revised manuscript, we have ensured consistent use of the term “sleep disturbances” in the Discussion section. We have also added text to highlight how inadequate or inconsistent sleep assessment may influence the interpretation of intervention outcomes, given the bidirectional relationship between sleep and pain. The following sentences were added:
“Given the bidirectional relationship between sleep and pain, inadequate or inconsistent assessment of sleep disturbances may obscure the true effects of intervention for chronic pain. This limitation could lead to underestimation or misinterpretation of treatment efficacy and reduce the comparability of results across studies. Addressing this issue is essential for developing effective multimodal interventions and advancing precision medicine.”

Conclusions
Comment: The conclusions are appropriate and do not overreach.
Recommendation:

Replace the term “content” with “characteristics” or “types” where appropriate.

Response:
We appreciate the reviewer’s suggestion. In the revised manuscript, we have replaced the term content with characteristics in the Conclusions section to improve clarity as follows:
“This ScR highlights the imbalance in the characteristics of sleep and pain assessments, indicating the need for a more comprehensive evaluation of sleep disturbances and pain-related outcomes.”

Summary of Key Revisions
We sincerely thank the reviewer for the thorough and constructive feedback. In response to the comments, we have made the following key revisions to the manuscript:

Terminology: We ensured consistent use of the term sleep disturbances across the Introduction and Discussion, and provided standardized definitions with citations to the ICSD-3.

Introduction: We added a citation to support the statement regarding the financial impact of chronic pain.

Methods:

Clarified adherence to all eight JBI steps.

Explicitly stated adherence to the PRISMA-ScR checklist.

Explained that the final search was conducted in March 2024 and noted this as a limitation.

Clarified how ChatGPT-4o and NotebookLM were used to facilitate data extraction, and described human verification procedures.

Stated that no dedicated systematic review software (e.g., Covidence) was used.

Specified that the complete PubMed search strategy is provided in Supplementary Table S1.

Results: Added the frequencies and percentages of studies using the PSQI and ISI, with reference to Figure 2.

Discussion: Ensured consistent terminology and added a statement on how inadequate sleep assessment may affect the interpretation of intervention outcomes, given the bidirectional relationship between sleep and pain.

Conclusions: Replaced the term content with characteristics for improved clarity.

These revisions improve the clarity, methodological transparency, and interpretability of our review.
Response to Brett D Neilson
We greatly appreciate the reviewer’s insightful comments. Our responses to your comments are given below.

Introduction
Comment: The introduction is generally well written and provides appropriate context for the review. However, the use of inconsistent terminology for sleep-related issues may create confusion for the reader.
Recommendations:

Consider defining or consistently using terms such as “sleep problems,” “sleep disorders,” “compromised sleep,” and “sleep disturbances.”

Reference standardized definitions or diagnostic criteria where appropriate.

The statement: “The financial impact of chronic pain, including healthcare expenses and reduced work efficiency, is substantial.” should be supported with a citation. There is robust literature available on this topic.

Responses:
We appreciate the reviewer’s suggestion. To avoid confusion, we have revised the manuscript to use the term “sleep disturbances” consistently when referring to general sleep-related dysfunction. In the Introduction, we also added a clarifying statement with references to the International Classification of Sleep Disorders, Third Edition (ICSD-3).
Additionally, as recommended, we have added a citation to support the statement regarding the financial impact of chronic pain.
We have added the references as follow:
“Rikard SM, Strahan AE, Schmit KM, Guy GP Jr. Chronic pain among adults - United States, 2019-2021. MMWR Morb Mortal Wkly Rep. 2023;72:379-385.”
“Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146:1387-1394.”

Methods
Comment: The methodology appears rigorous, with an extensive search strategy across nine databases and inclusion of grey literature. However, a few clarifications and enhancements are suggested.
Recommendations:

Clarify adherence to all eight JBI steps, or note deviations.

Consider referencing the PRISMA-ScR checklist.

Search was completed in March 2024; consider updating if required by the journal.

Describe how ChatGPT-4o outputs were validated to ensure data accuracy.

Mention if data extraction software (e.g., Covidence) was used.

Include a sample search strategy for at least one database to enhance reproducibility of the review process.

Responses:
We appreciate the reviewer’s suggestions. We have responded to each recommendation as below:
1. Adherence to JBI steps
We clarified that our review followed all eight steps of the Joanna Briggs Institute (JBI) methodology for scoping review without deviation. We revised the sentence as below:
“This ScR was conducted according to the Joanna Briggs Institute methodology for scoping reviews, following all eight recommended steps without deviation.”
2. PRISMA-ScR checklist
We appreciate the reviewer’s recommendation. In addition to noting in the Data Availability section that the completed PRISMA-ScR checklist is provided, we have now explicitly stated in the Methods section that the review adhered to the PRISMA-ScR checklist. The following sentence was added:
“This review also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR) checklist.”
3. Search update
We appreciate the reviewer’s suggestion. The final comprehensive search was conducted on March 29, 2024, as already noted in the Methods section. Given the publication model of F1000Research, the Version 1 preprint of this review was made publicly available shortly after submission, and thus the search reflects the literature available at that time. As the journal does not require an updated search for scoping reviews, we have not repeated the search. Nevertheless, we have noted in the Discussion that more recent studies may not have been captured. The following sentence was added:
“A limitation of this review is that the literature search was last conducted in March 2024, and more recent studies may not have been capture.”

4. Use of ChatGPT-4o
We thank the reviewer for this important comment. In the revised manuscript, we have clarified how ChatGPT-4o and NotebookLM were used during data extraction. These AI tools were used to facilitate the extraction and preliminary organization of information from the included studies. All outputs were reviewed and verified against the original studies by the first author (K.T.) to ensure accuracy. Thus, while AI was utilized as part of the data extraction process, no information was included without human verification, and all final decisions were made by the research team. The following sentence was added:
“These AI tools were used to facilitate the extraction and preliminary organization of information from the included studies. All outputs generated by AI were reviewed and verified against the original sources by the first author (K.T.) to ensure accuracy, and all final decisions were made by the research team.”
5. Data extraction software
We thank the reviewer’s helpful comment. In the revised manuscript, we have clarified that no dedicated systematic review software such as Covidence was used for data extraction. Instead, data were extracted using Microsoft Excel, supported by ChatGPT-4o and NotebookLM, with all outputs reviewed and verified by the first author (K.T.) to ensure accuracy. The following sentence was added:
“No dedicated systematic review software (e.g., Covidence) was used for data extraction.”
6. Sample search strategy
We thank the reviewer’s valuable suggestion. To ensure reproducibility, we have clarified in the Methods section that the full PubMed search strategy is provided as Supplementary Table S1. The sentence was revised as follow:
“The text words found in the titles and abstracts of relevant articles, along with the index terms used to describe the articles, were used to develop a comprehensive search strategy across nine databases (the complete PubMed search strategy is provided in Table S1).”

Results
Comment: The results are clearly reported, with appropriate use of tables and figures.
Recommendation:

Provide percentages or refer to Figure 2 when discussing the use of PSQI and ISI.

Response:
We appreciate the reviewer’s suggestion. To improve clarity, we have added the frequencies and percentages of studies that used the PSQI and ISI, and we now reference Figure 2 in the text. We revised the sentences as follow:
“The Pittsburgh Sleep Quality Index (PSQI) (45 of 81 studies, 55.6%) and Insomnia Severity Index (ISI) (21 of 81 studies, 25.9%) were the most commonly used tools for the assessment of sleep problems (Figure 2).”

Discussion
Comment: The discussion section is well constructed and effectively summarizes the key findings of the review.
Recommendations:

Use consistent and defined terminology for sleep-related terms.

Discuss how inadequate sleep assessment may affect intervention outcomes, given the bidirectional relationship between sleep and pain.

Responses:
We appreciate the reviewer’s comments. In the revised manuscript, we have ensured consistent use of the term “sleep disturbances” in the Discussion section. We have also added text to highlight how inadequate or inconsistent sleep assessment may influence the interpretation of intervention outcomes, given the bidirectional relationship between sleep and pain. The following sentences were added:
“Given the bidirectional relationship between sleep and pain, inadequate or inconsistent assessment of sleep disturbances may obscure the true effects of intervention for chronic pain. This limitation could lead to underestimation or misinterpretation of treatment efficacy and reduce the comparability of results across studies. Addressing this issue is essential for developing effective multimodal interventions and advancing precision medicine.”

Conclusions
Comment: The conclusions are appropriate and do not overreach.
Recommendation:

Replace the term “content” with “characteristics” or “types” where appropriate.

Response:
We appreciate the reviewer’s suggestion. In the revised manuscript, we have replaced the term content with characteristics in the Conclusions section to improve clarity as follows:
“This ScR highlights the imbalance in the characteristics of sleep and pain assessments, indicating the need for a more comprehensive evaluation of sleep disturbances and pain-related outcomes.”

Summary of Key Revisions
We sincerely thank the reviewer for the thorough and constructive feedback. In response to the comments, we have made the following key revisions to the manuscript:

Terminology: We ensured consistent use of the term sleep disturbances across the Introduction and Discussion, and provided standardized definitions with citations to the ICSD-3.

Introduction: We added a citation to support the statement regarding the financial impact of chronic pain.

Methods:

Clarified adherence to all eight JBI steps.

Explicitly stated adherence to the PRISMA-ScR checklist.

Explained that the final search was conducted in March 2024 and noted this as a limitation.

Clarified how ChatGPT-4o and NotebookLM were used to facilitate data extraction, and described human verification procedures.

Stated that no dedicated systematic review software (e.g., Covidence) was used.

Specified that the complete PubMed search strategy is provided in Supplementary Table S1.

Results: Added the frequencies and percentages of studies using the PSQI and ISI, with reference to Figure 2.

Discussion: Ensured consistent terminology and added a statement on how inadequate sleep assessment may affect the interpretation of intervention outcomes, given the bidirectional relationship between sleep and pain.

Conclusions: Replaced the term content with characteristics for improved clarity.

These revisions improve the clarity, methodological transparency, and interpretability of our review.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 23 Sep 2025

Katsuyoshi Tanaka, Department of Physical Therapy, School of Health Sciences, Bukkyo University, Kyoto, 604-8418, Japan

23 Sep 2025

Author Response
Response to Brett D Neilson
We greatly appreciate the reviewer’s insightful comments. Our responses to your comments are given below.

Introduction
Comment: The introduction is generally well written and ... Continue reading
Response to Brett D Neilson
We greatly appreciate the reviewer’s insightful comments. Our responses to your comments are given below.

Introduction
Comment: The introduction is generally well written and provides appropriate context for the review. However, the use of inconsistent terminology for sleep-related issues may create confusion for the reader.
Recommendations:

Consider defining or consistently using terms such as “sleep problems,” “sleep disorders,” “compromised sleep,” and “sleep disturbances.”

Reference standardized definitions or diagnostic criteria where appropriate.

The statement: “The financial impact of chronic pain, including healthcare expenses and reduced work efficiency, is substantial.” should be supported with a citation. There is robust literature available on this topic.

Responses:
We appreciate the reviewer’s suggestion. To avoid confusion, we have revised the manuscript to use the term “sleep disturbances” consistently when referring to general sleep-related dysfunction. In the Introduction, we also added a clarifying statement with references to the International Classification of Sleep Disorders, Third Edition (ICSD-3).
Additionally, as recommended, we have added a citation to support the statement regarding the financial impact of chronic pain.
We have added the references as follow:
“Rikard SM, Strahan AE, Schmit KM, Guy GP Jr. Chronic pain among adults - United States, 2019-2021. MMWR Morb Mortal Wkly Rep. 2023;72:379-385.”
“Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146:1387-1394.”

Methods
Comment: The methodology appears rigorous, with an extensive search strategy across nine databases and inclusion of grey literature. However, a few clarifications and enhancements are suggested.
Recommendations:

Clarify adherence to all eight JBI steps, or note deviations.

Consider referencing the PRISMA-ScR checklist.

Search was completed in March 2024; consider updating if required by the journal.

Describe how ChatGPT-4o outputs were validated to ensure data accuracy.

Mention if data extraction software (e.g., Covidence) was used.

Include a sample search strategy for at least one database to enhance reproducibility of the review process.

Responses:
We appreciate the reviewer’s suggestions. We have responded to each recommendation as below:
1. Adherence to JBI steps
We clarified that our review followed all eight steps of the Joanna Briggs Institute (JBI) methodology for scoping review without deviation. We revised the sentence as below:
“This ScR was conducted according to the Joanna Briggs Institute methodology for scoping reviews, following all eight recommended steps without deviation.”
2. PRISMA-ScR checklist
We appreciate the reviewer’s recommendation. In addition to noting in the Data Availability section that the completed PRISMA-ScR checklist is provided, we have now explicitly stated in the Methods section that the review adhered to the PRISMA-ScR checklist. The following sentence was added:
“This review also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR) checklist.”
3. Search update
We appreciate the reviewer’s suggestion. The final comprehensive search was conducted on March 29, 2024, as already noted in the Methods section. Given the publication model of F1000Research, the Version 1 preprint of this review was made publicly available shortly after submission, and thus the search reflects the literature available at that time. As the journal does not require an updated search for scoping reviews, we have not repeated the search. Nevertheless, we have noted in the Discussion that more recent studies may not have been captured. The following sentence was added:
“A limitation of this review is that the literature search was last conducted in March 2024, and more recent studies may not have been capture.”

4. Use of ChatGPT-4o
We thank the reviewer for this important comment. In the revised manuscript, we have clarified how ChatGPT-4o and NotebookLM were used during data extraction. These AI tools were used to facilitate the extraction and preliminary organization of information from the included studies. All outputs were reviewed and verified against the original studies by the first author (K.T.) to ensure accuracy. Thus, while AI was utilized as part of the data extraction process, no information was included without human verification, and all final decisions were made by the research team. The following sentence was added:
“These AI tools were used to facilitate the extraction and preliminary organization of information from the included studies. All outputs generated by AI were reviewed and verified against the original sources by the first author (K.T.) to ensure accuracy, and all final decisions were made by the research team.”
5. Data extraction software
We thank the reviewer’s helpful comment. In the revised manuscript, we have clarified that no dedicated systematic review software such as Covidence was used for data extraction. Instead, data were extracted using Microsoft Excel, supported by ChatGPT-4o and NotebookLM, with all outputs reviewed and verified by the first author (K.T.) to ensure accuracy. The following sentence was added:
“No dedicated systematic review software (e.g., Covidence) was used for data extraction.”
6. Sample search strategy
We thank the reviewer’s valuable suggestion. To ensure reproducibility, we have clarified in the Methods section that the full PubMed search strategy is provided as Supplementary Table S1. The sentence was revised as follow:
“The text words found in the titles and abstracts of relevant articles, along with the index terms used to describe the articles, were used to develop a comprehensive search strategy across nine databases (the complete PubMed search strategy is provided in Table S1).”

Results
Comment: The results are clearly reported, with appropriate use of tables and figures.
Recommendation:

Provide percentages or refer to Figure 2 when discussing the use of PSQI and ISI.

Response:
We appreciate the reviewer’s suggestion. To improve clarity, we have added the frequencies and percentages of studies that used the PSQI and ISI, and we now reference Figure 2 in the text. We revised the sentences as follow:
“The Pittsburgh Sleep Quality Index (PSQI) (45 of 81 studies, 55.6%) and Insomnia Severity Index (ISI) (21 of 81 studies, 25.9%) were the most commonly used tools for the assessment of sleep problems (Figure 2).”

Discussion
Comment: The discussion section is well constructed and effectively summarizes the key findings of the review.
Recommendations:

Use consistent and defined terminology for sleep-related terms.

Discuss how inadequate sleep assessment may affect intervention outcomes, given the bidirectional relationship between sleep and pain.

Responses:
We appreciate the reviewer’s comments. In the revised manuscript, we have ensured consistent use of the term “sleep disturbances” in the Discussion section. We have also added text to highlight how inadequate or inconsistent sleep assessment may influence the interpretation of intervention outcomes, given the bidirectional relationship between sleep and pain. The following sentences were added:
“Given the bidirectional relationship between sleep and pain, inadequate or inconsistent assessment of sleep disturbances may obscure the true effects of intervention for chronic pain. This limitation could lead to underestimation or misinterpretation of treatment efficacy and reduce the comparability of results across studies. Addressing this issue is essential for developing effective multimodal interventions and advancing precision medicine.”

Conclusions
Comment: The conclusions are appropriate and do not overreach.
Recommendation:

Replace the term “content” with “characteristics” or “types” where appropriate.

Response:
We appreciate the reviewer’s suggestion. In the revised manuscript, we have replaced the term content with characteristics in the Conclusions section to improve clarity as follows:
“This ScR highlights the imbalance in the characteristics of sleep and pain assessments, indicating the need for a more comprehensive evaluation of sleep disturbances and pain-related outcomes.”

Summary of Key Revisions
We sincerely thank the reviewer for the thorough and constructive feedback. In response to the comments, we have made the following key revisions to the manuscript:

Terminology: We ensured consistent use of the term sleep disturbances across the Introduction and Discussion, and provided standardized definitions with citations to the ICSD-3.

Introduction: We added a citation to support the statement regarding the financial impact of chronic pain.

Methods:

Clarified adherence to all eight JBI steps.

Explicitly stated adherence to the PRISMA-ScR checklist.

Explained that the final search was conducted in March 2024 and noted this as a limitation.

Clarified how ChatGPT-4o and NotebookLM were used to facilitate data extraction, and described human verification procedures.

Stated that no dedicated systematic review software (e.g., Covidence) was used.

Specified that the complete PubMed search strategy is provided in Supplementary Table S1.

Results: Added the frequencies and percentages of studies using the PSQI and ISI, with reference to Figure 2.

Discussion: Ensured consistent terminology and added a statement on how inadequate sleep assessment may affect the interpretation of intervention outcomes, given the bidirectional relationship between sleep and pain.

Conclusions: Replaced the term content with characteristics for improved clarity.

These revisions improve the clarity, methodological transparency, and interpretability of our review.
Response to Brett D Neilson
We greatly appreciate the reviewer’s insightful comments. Our responses to your comments are given below.

Introduction
Comment: The introduction is generally well written and provides appropriate context for the review. However, the use of inconsistent terminology for sleep-related issues may create confusion for the reader.
Recommendations:

Consider defining or consistently using terms such as “sleep problems,” “sleep disorders,” “compromised sleep,” and “sleep disturbances.”

Reference standardized definitions or diagnostic criteria where appropriate.

The statement: “The financial impact of chronic pain, including healthcare expenses and reduced work efficiency, is substantial.” should be supported with a citation. There is robust literature available on this topic.

Responses:
We appreciate the reviewer’s suggestion. To avoid confusion, we have revised the manuscript to use the term “sleep disturbances” consistently when referring to general sleep-related dysfunction. In the Introduction, we also added a clarifying statement with references to the International Classification of Sleep Disorders, Third Edition (ICSD-3).
Additionally, as recommended, we have added a citation to support the statement regarding the financial impact of chronic pain.
We have added the references as follow:
“Rikard SM, Strahan AE, Schmit KM, Guy GP Jr. Chronic pain among adults - United States, 2019-2021. MMWR Morb Mortal Wkly Rep. 2023;72:379-385.”
“Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146:1387-1394.”

Methods
Comment: The methodology appears rigorous, with an extensive search strategy across nine databases and inclusion of grey literature. However, a few clarifications and enhancements are suggested.
Recommendations:

Clarify adherence to all eight JBI steps, or note deviations.

Consider referencing the PRISMA-ScR checklist.

Search was completed in March 2024; consider updating if required by the journal.

Describe how ChatGPT-4o outputs were validated to ensure data accuracy.

Mention if data extraction software (e.g., Covidence) was used.

Include a sample search strategy for at least one database to enhance reproducibility of the review process.

Responses:
We appreciate the reviewer’s suggestions. We have responded to each recommendation as below:
1. Adherence to JBI steps
We clarified that our review followed all eight steps of the Joanna Briggs Institute (JBI) methodology for scoping review without deviation. We revised the sentence as below:
“This ScR was conducted according to the Joanna Briggs Institute methodology for scoping reviews, following all eight recommended steps without deviation.”
2. PRISMA-ScR checklist
We appreciate the reviewer’s recommendation. In addition to noting in the Data Availability section that the completed PRISMA-ScR checklist is provided, we have now explicitly stated in the Methods section that the review adhered to the PRISMA-ScR checklist. The following sentence was added:
“This review also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR) checklist.”
3. Search update
We appreciate the reviewer’s suggestion. The final comprehensive search was conducted on March 29, 2024, as already noted in the Methods section. Given the publication model of F1000Research, the Version 1 preprint of this review was made publicly available shortly after submission, and thus the search reflects the literature available at that time. As the journal does not require an updated search for scoping reviews, we have not repeated the search. Nevertheless, we have noted in the Discussion that more recent studies may not have been captured. The following sentence was added:
“A limitation of this review is that the literature search was last conducted in March 2024, and more recent studies may not have been capture.”

4. Use of ChatGPT-4o
We thank the reviewer for this important comment. In the revised manuscript, we have clarified how ChatGPT-4o and NotebookLM were used during data extraction. These AI tools were used to facilitate the extraction and preliminary organization of information from the included studies. All outputs were reviewed and verified against the original studies by the first author (K.T.) to ensure accuracy. Thus, while AI was utilized as part of the data extraction process, no information was included without human verification, and all final decisions were made by the research team. The following sentence was added:
“These AI tools were used to facilitate the extraction and preliminary organization of information from the included studies. All outputs generated by AI were reviewed and verified against the original sources by the first author (K.T.) to ensure accuracy, and all final decisions were made by the research team.”
5. Data extraction software
We thank the reviewer’s helpful comment. In the revised manuscript, we have clarified that no dedicated systematic review software such as Covidence was used for data extraction. Instead, data were extracted using Microsoft Excel, supported by ChatGPT-4o and NotebookLM, with all outputs reviewed and verified by the first author (K.T.) to ensure accuracy. The following sentence was added:
“No dedicated systematic review software (e.g., Covidence) was used for data extraction.”
6. Sample search strategy
We thank the reviewer’s valuable suggestion. To ensure reproducibility, we have clarified in the Methods section that the full PubMed search strategy is provided as Supplementary Table S1. The sentence was revised as follow:
“The text words found in the titles and abstracts of relevant articles, along with the index terms used to describe the articles, were used to develop a comprehensive search strategy across nine databases (the complete PubMed search strategy is provided in Table S1).”

Results
Comment: The results are clearly reported, with appropriate use of tables and figures.
Recommendation:

Provide percentages or refer to Figure 2 when discussing the use of PSQI and ISI.

Response:
We appreciate the reviewer’s suggestion. To improve clarity, we have added the frequencies and percentages of studies that used the PSQI and ISI, and we now reference Figure 2 in the text. We revised the sentences as follow:
“The Pittsburgh Sleep Quality Index (PSQI) (45 of 81 studies, 55.6%) and Insomnia Severity Index (ISI) (21 of 81 studies, 25.9%) were the most commonly used tools for the assessment of sleep problems (Figure 2).”

Discussion
Comment: The discussion section is well constructed and effectively summarizes the key findings of the review.
Recommendations:

Use consistent and defined terminology for sleep-related terms.

Discuss how inadequate sleep assessment may affect intervention outcomes, given the bidirectional relationship between sleep and pain.

Responses:
We appreciate the reviewer’s comments. In the revised manuscript, we have ensured consistent use of the term “sleep disturbances” in the Discussion section. We have also added text to highlight how inadequate or inconsistent sleep assessment may influence the interpretation of intervention outcomes, given the bidirectional relationship between sleep and pain. The following sentences were added:
“Given the bidirectional relationship between sleep and pain, inadequate or inconsistent assessment of sleep disturbances may obscure the true effects of intervention for chronic pain. This limitation could lead to underestimation or misinterpretation of treatment efficacy and reduce the comparability of results across studies. Addressing this issue is essential for developing effective multimodal interventions and advancing precision medicine.”

Conclusions
Comment: The conclusions are appropriate and do not overreach.
Recommendation:

Replace the term “content” with “characteristics” or “types” where appropriate.

Response:
We appreciate the reviewer’s suggestion. In the revised manuscript, we have replaced the term content with characteristics in the Conclusions section to improve clarity as follows:
“This ScR highlights the imbalance in the characteristics of sleep and pain assessments, indicating the need for a more comprehensive evaluation of sleep disturbances and pain-related outcomes.”

Summary of Key Revisions
We sincerely thank the reviewer for the thorough and constructive feedback. In response to the comments, we have made the following key revisions to the manuscript:

Terminology: We ensured consistent use of the term sleep disturbances across the Introduction and Discussion, and provided standardized definitions with citations to the ICSD-3.

Introduction: We added a citation to support the statement regarding the financial impact of chronic pain.

Methods:

Clarified adherence to all eight JBI steps.

Explicitly stated adherence to the PRISMA-ScR checklist.

Explained that the final search was conducted in March 2024 and noted this as a limitation.

Clarified how ChatGPT-4o and NotebookLM were used to facilitate data extraction, and described human verification procedures.

Stated that no dedicated systematic review software (e.g., Covidence) was used.

Specified that the complete PubMed search strategy is provided in Supplementary Table S1.

Results: Added the frequencies and percentages of studies using the PSQI and ISI, with reference to Figure 2.

Discussion: Ensured consistent terminology and added a statement on how inadequate sleep assessment may affect the interpretation of intervention outcomes, given the bidirectional relationship between sleep and pain.

Conclusions: Replaced the term content with characteristics for improved clarity.

These revisions improve the clarity, methodological transparency, and interpretability of our review.
Competing Interests: No competing interests were disclosed. Close
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Version 2

VERSION 2 PUBLISHED 20 Jun 2025

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Version 2 (revision) 15 Sep 25
Version 1 20 Jun 25	read

Brett D Neilson, Hawai'i Pacific University, Hawaii, Japan

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Reviewer Report

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27 Aug 2025 | for Version 1

Brett D Neilson, Hawai'i Pacific University, Hawaii, Japan

7 Views Cite this report Responses(1)

Approved With Reservations

The abstract is clear and concisely conveys the purpose and scope of the review.
The aim is well articulated.
No major revisions are needed for the abstract.

Consider defining or consistently using terms such as “sleep problems,” “sleep disorders,” “compromised sleep,” and “sleep disturbances.”
Reference standardized definitions or diagnostic criteria where appropriate.
The statement: “The financial impact of chronic pain, including healthcare expenses and reduced work efficiency, is substantial.” should be supported with a citation. There is robust literature available on this topic.

Clarify adherence to all eight JBI steps, or note deviations.
Consider referencing the PRISMA-ScR checklist.
Search was completed in March 2024; consider updating if required by the journal.
Describe how ChatGPT-4o outputs were validated to ensure data accuracy.
Mention if data extraction software (e.g., Covidence) was used.
Include a sample search strategy for at least one database to enhance reproducibility of the review process.

Results
The results are clearly reported, with appropriate use of tables and figures.
Recommendation:

Provide percentages or refer to Figure 2 when discussing the use of PSQI and ISI.

Discussion
The discussion section is well constructed and effectively summarizes the key findings of the review.
Recommendations:

Use consistent and defined terminology for sleep-related terms.
Discuss how inadequate sleep assessment may affect intervention outcomes, given the bidirectional relationship between sleep and pain.

Conclusions
The conclusions are appropriate and do not overreach.
Recommendation:

Replace the term “content” with “characteristics” or “types” where appropriate.

Summary of Key Revisions for Authors

Ensure consistent and defined terminology for sleep-related dysfunction.
Add citation(s) to support claims regarding the financial impact of chronic pain.
Clarify adherence to JBI methodology and consider referencing PRISMA-ScR.
Provide detail on how ChatGPT-4o was used and how its outputs were validated.
Include numerical data or clear reference to figures for key result statements.
Explore how measurement inconsistencies could impact intervention outcomes.
Replace the term “content” with “characteristics” or “types” where appropriate.
Acknowledge that the PRISMA-ScR checklist was used, as mentioned in the Data Availability section. Consider integrating this earlier in the Methods to emphasize adherence to reporting standards.
Include a sample search strategy for at least one database to enhance reproducibility of the review process.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Yes
Are the conclusions drawn adequately supported by the results presented in the review?

Yes
If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.)

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

I am a physical therapist educator in the Hawai‘i Pacific University Doctor of Physical Therapy Program. My research focuses on the intersection of sleep and pain, with several publications in this area. I have previously published two ScRs on a similar topic: Feda J, Miller T, Young JL, Neilson B, Rhon DI. Measures of sleep are not routinely captured in trials assessing treatment outcomes in knee osteoarthritis - A scoping systematic review and call to action. Osteoarthr Cartil Open. 2023;(100400):100400. Neilson BD, Dickerson C, Young JL, Shepherd MH, Rhon DI. Measures of sleep disturbance are not routinely captured in trials for chronic low back pain: a systematic scoping review of 282 trials. J Clin Sleep Med. 2023;19(11):1961–1970.

Respond to this report

Responses (1)

Author Response

23 Sep 2025

Katsuyoshi Tanaka, Department of Physical Therapy, School of Health Sciences, Bukkyo University, Kyoto, 604-8418, Japan

Response to Brett D Neilson
We greatly appreciate the reviewer’s insightful comments. Our responses to your comments are given below.

Introduction
Comment: The introduction is generally well written and provides appropriate context for the review. However, the use of inconsistent terminology for sleep-related issues may create confusion for the reader.
Recommendations:

Consider defining or consistently using terms such as “sleep problems,” “sleep disorders,” “compromised sleep,” and “sleep disturbances.”
Reference standardized definitions or diagnostic criteria where appropriate.
The statement: “The financial impact of chronic pain, including healthcare expenses and reduced work efficiency, is substantial.” should be supported with a citation. There is robust literature available on this topic.

Responses:
We appreciate the reviewer’s suggestion. To avoid confusion, we have revised the manuscript to use the term “sleep disturbances” consistently when referring to general sleep-related dysfunction. In the Introduction, we also added a clarifying statement with references to the International Classification of Sleep Disorders, Third Edition (ICSD-3).
Additionally, as recommended, we have added a citation to support the statement regarding the financial impact of chronic pain.
We have added the references as follow:
“Rikard SM, Strahan AE, Schmit KM, Guy GP Jr. Chronic pain among adults - United States, 2019-2021. MMWR Morb Mortal Wkly Rep. 2023;72:379-385.”
“Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146:1387-1394.”

Methods
Comment: The methodology appears rigorous, with an extensive search strategy across nine databases and inclusion of grey literature. However, a few clarifications and enhancements are suggested.
Recommendations:

Clarify adherence to all eight JBI steps, or note deviations.
Consider referencing the PRISMA-ScR checklist.
Search was completed in March 2024; consider updating if required by the journal.
Describe how ChatGPT-4o outputs were validated to ensure data accuracy.
Mention if data extraction software (e.g., Covidence) was used.
Include a sample search strategy for at least one database to enhance reproducibility of the review process.

Responses:
We appreciate the reviewer’s suggestions. We have responded to each recommendation as below:
1. Adherence to JBI steps
We clarified that our review followed all eight steps of the Joanna Briggs Institute (JBI) methodology for scoping review without deviation. We revised the sentence as below:
“This ScR was conducted according to the Joanna Briggs Institute methodology for scoping reviews, following all eight recommended steps without deviation.”
2. PRISMA-ScR checklist
We appreciate the reviewer’s recommendation. In addition to noting in the Data Availability section that the completed PRISMA-ScR checklist is provided, we have now explicitly stated in the Methods section that the review adhered to the PRISMA-ScR checklist. The following sentence was added:
“This review also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR) checklist.”
3. Search update
We appreciate the reviewer’s suggestion. The final comprehensive search was conducted on March 29, 2024, as already noted in the Methods section. Given the publication model of F1000Research, the Version 1 preprint of this review was made publicly available shortly after submission, and thus the search reflects the literature available at that time. As the journal does not require an updated search for scoping reviews, we have not repeated the search. Nevertheless, we have noted in the Discussion that more recent studies may not have been captured. The following sentence was added:
“A limitation of this review is that the literature search was last conducted in March 2024, and more recent studies may not have been capture.”

4. Use of ChatGPT-4o
We thank the reviewer for this important comment. In the revised manuscript, we have clarified how ChatGPT-4o and NotebookLM were used during data extraction. These AI tools were used to facilitate the extraction and preliminary organization of information from the included studies. All outputs were reviewed and verified against the original studies by the first author (K.T.) to ensure accuracy. Thus, while AI was utilized as part of the data extraction process, no information was included without human verification, and all final decisions were made by the research team. The following sentence was added:
“These AI tools were used to facilitate the extraction and preliminary organization of information from the included studies. All outputs generated by AI were reviewed and verified against the original sources by the first author (K.T.) to ensure accuracy, and all final decisions were made by the research team.”
5. Data extraction software
We thank the reviewer’s helpful comment. In the revised manuscript, we have clarified that no dedicated systematic review software such as Covidence was used for data extraction. Instead, data were extracted using Microsoft Excel, supported by ChatGPT-4o and NotebookLM, with all outputs reviewed and verified by the first author (K.T.) to ensure accuracy. The following sentence was added:
“No dedicated systematic review software (e.g., Covidence) was used for data extraction.”
6. Sample search strategy
We thank the reviewer’s valuable suggestion. To ensure reproducibility, we have clarified in the Methods section that the full PubMed search strategy is provided as Supplementary Table S1. The sentence was revised as follow:
“The text words found in the titles and abstracts of relevant articles, along with the index terms used to describe the articles, were used to develop a comprehensive search strategy across nine databases (the complete PubMed search strategy is provided in Table S1).”

Results
Comment: The results are clearly reported, with appropriate use of tables and figures.
Recommendation:

Provide percentages or refer to Figure 2 when discussing the use of PSQI and ISI.

Response:
We appreciate the reviewer’s suggestion. To improve clarity, we have added the frequencies and percentages of studies that used the PSQI and ISI, and we now reference Figure 2 in the text. We revised the sentences as follow:
“The Pittsburgh Sleep Quality Index (PSQI) (45 of 81 studies, 55.6%) and Insomnia Severity Index (ISI) (21 of 81 studies, 25.9%) were the most commonly used tools for the assessment of sleep problems (Figure 2).”

Discussion
Comment: The discussion section is well constructed and effectively summarizes the key findings of the review.
Recommendations:

Use consistent and defined terminology for sleep-related terms.
Discuss how inadequate sleep assessment may affect intervention outcomes, given the bidirectional relationship between sleep and pain.

Responses:
We appreciate the reviewer’s comments. In the revised manuscript, we have ensured consistent use of the term “sleep disturbances” in the Discussion section. We have also added text to highlight how inadequate or inconsistent sleep assessment may influence the interpretation of intervention outcomes, given the bidirectional relationship between sleep and pain. The following sentences were added:
“Given the bidirectional relationship between sleep and pain, inadequate or inconsistent assessment of sleep disturbances may obscure the true effects of intervention for chronic pain. This limitation could lead to underestimation or misinterpretation of treatment efficacy and reduce the comparability of results across studies. Addressing this issue is essential for developing effective multimodal interventions and advancing precision medicine.”

Conclusions
Comment: The conclusions are appropriate and do not overreach.
Recommendation:

Replace the term “content” with “characteristics” or “types” where appropriate.

Response:
We appreciate the reviewer’s suggestion. In the revised manuscript, we have replaced the term content with characteristics in the Conclusions section to improve clarity as follows:
“This ScR highlights the imbalance in the characteristics of sleep and pain assessments, indicating the need for a more comprehensive evaluation of sleep disturbances and pain-related outcomes.”

Summary of Key Revisions
We sincerely thank the reviewer for the thorough and constructive feedback. In response to the comments, we have made the following key revisions to the manuscript:

Terminology: We ensured consistent use of the term sleep disturbances across the Introduction and Discussion, and provided standardized definitions with citations to the ICSD-3.
Introduction: We added a citation to support the statement regarding the financial impact of chronic pain.
Methods:
- Clarified adherence to all eight JBI steps.
- Explicitly stated adherence to the PRISMA-ScR checklist.
- Explained that the final search was conducted in March 2024 and noted this as a limitation.
- Clarified how ChatGPT-4o and NotebookLM were used to facilitate data extraction, and described human verification procedures.
- Stated that no dedicated systematic review software (e.g., Covidence) was used.
- Specified that the complete PubMed search strategy is provided in Supplementary Table S1.
Results: Added the frequencies and percentages of studies using the PSQI and ISI, with reference to Figure 2.
Discussion: Ensured consistent terminology and added a statement on how inadequate sleep assessment may affect the interpretation of intervention outcomes, given the bidirectional relationship between sleep and pain.
Conclusions: Replaced the term content with characteristics for improved clarity.

These revisions improve the clarity, methodological transparency, and interpretability of our review.

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Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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Imbalances in the Content of Sleep and Pain Assessments in Patients with Chronic Pain: A Scoping Review

Abstract

Background

Methods

Results

Conclusions

Keywords

Revised Amendments from Version 1

1. Introduction

2. Methods

2.1 Eligibility criteria

2.2 Search strategy

2.3 Study selection and source of evidence

2.4 Data extraction

3. Results

3.1 Study selection

Figure 1. PRISMA flow diagram illustrating the structure of the search and screening process.

3.2 Study and participant characteristics

3.3 Outcome measurements

Figure 2. Percentage of the combined use of sleep problem and pain-related outcome assessments.

4. Discussion

5. Conclusions

Ethics and consent

Data availability

Acknowledgements

References

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