Understanding the relationship between sleep, psychological and musculoskeletal health from a neuroimmune perspective

BACKGROUND: Sleep, psychological wellbeing, and musculoskeletal health are more closely interconnected than previously recognised. Shared neuroimmune pathways between these domains mean that changes in one can substantially impact the others-either beneficially or detrimentally. For clinicians, a thorough understanding of these relationships is imperative to inform more holistic and effective clinical strategies for managing and potentially preventing musculoskeletal conditions. METHODS: Narrative review of neuroimmune pathways that interconnect sleep, psychological wellbeing, and musculoskeletal health, highlighting clinical implications and identifying research gaps to guide future studies. Searches of PubMed, Scopus, EMBASE, Web of Science, and Google Scholar were performed using combinations of terms related to sleep, psychological factors (e.g., stress and depression), musculoskeletal conditions and pain, tissue health and pathology, pain mechanisms, inflammation, and the immune and nervous systems. Eligible articles were limited to those published in English. RESULTS: Research is increasingly revealing how the nervous and immune systems interact to mediate the interplay between poor sleep, psychological disturbances (such as depression), and musculoskeletal system pathologies and pain. This relationship is underpinned by two key concepts. First, both sleep and psychological functioning are highly sensitive to-and reciprocally influence-systemic inflammation. Second, systemic and local (tissue-level) inflammatory events interact with and affect each other, as well as the nervous system. Consequently, disruption in any one of these domains can potentially trigger and/or sustain a self-perpetuating cycle that adversely affects the others, leading to pathological outcomes such as recurrent or persistent pain and tissue changes (e.g., fibrosis). On the other hand, therapeutic interventions targeting any of these domains offer promising avenues to interrupt or prevent these detrimental cascades. CONCLUSIONS: This review provides a foundation for understanding how neuroimmune interactions dynamically link sleep, psychological wellbeing, and musculoskeletal health. Understanding these connections will support more integrated, system-wide, and effective approaches to musculoskeletal care.