The association of sleep and pain: an update and a path forward

Breaking the cycle: Psychological and social dimensions of pediatric functional gastrointestinal disorders

BACKGROUND

Functional gastrointestinal disorders (FGIDs) in children present with chronic symptoms like abdominal pain, diarrhea, and constipation without identifiable structural abnormalities. These disorders are closely linked to gut-brain axis dysfunction, altered gut microbiota, and psychosocial stress, leading to psychiatric comorbidities such as anxiety, depression, and behavioral issues. Understanding this bidirectional relationship is crucial for developing effective, holistic management strategies that address physical and mental health.

AIM

To examine the psychiatric impacts of FGIDs in children, focusing on anxiety and depression and their association with other neurodevelopmental disorders of childhood, such as attention-deficit/hyperactivity disorder, emphasizing the role of the gut-brain axis, emotional dysregulation, and psychosocial stress. Key mechanisms explored include neurotransmitter dysregulation, microbiota imbalance, central sensitization, heightening stress reactivity, emotional dysregulation, and symptom perception. The review also evaluates the role of family dynamics and coping strategies in exacerbating FGID symptoms and contributing to psychiatric conditions.

METHODS

A narrative review was conducted using 328 studies sourced from PubMed, Scopus, and Google Scholar, covering research published over the past 20 years. Inclusion criteria focused on studies examining FGID diagnosis, gut-brain mechanisms, psychiatric comorbidities, and psychosocial factors in pediatric populations. FGIDs commonly affecting children, including functional constipation, abdominal pain, irritable bowel syndrome, gastroesophageal reflux, and cyclic vomiting syndrome, were analyzed concerning their psychological impacts.

RESULTS

The review highlights a strong connection between FGIDs and psychiatric symptoms, mediated by gut-brain axis dysfunction, dysregulated microbiota, and central sensitization. These physiological disruptions increase children’s vulnerability to anxiety and depression, while psychosocial factors - such as chronic stress, early-life trauma, maladaptive family dynamics, and ineffective coping strategies - intensify the cycle of gastrointestinal and emotional distress.

CONCLUSION

Effective management of FGIDs requires a biopsychosocial approach integrating medical, psychological, and dietary interventions. Parental education, early intervention, and multidisciplinary care coordination are critical in mitigating long-term psychological impacts and improving both gastrointestinal and mental health outcomes in children with FGIDs.

The Role of Health Psychology in Surgical Prehabilitation: Insights From REST, a Preoperative Sleep Intervention for Total Knee Replacement Patients

BACKGROUND

Approximately 10%-34% of people experience chronic pain after total knee replacement (TKR) surgery. Prehabilitation approaches that address pre-operative risk factors for chronic post-surgical pain are a key area for research. To be effective, prehabilitation requires substantial engagement and behaviour change by patients, which can be challenging in the pre-operative period. Health psychology theory plays a valuable role in understanding how best to support behaviour change to achieve maximum patient benefit. This study provides insights from REST, a pre-operative sleep intervention for TKR patients.

METHODS

In-depth semi-structured interviews were conducted with eight TKR patients who took part in the REST feasibility trial. An abductive analysis approach was used to identify the applicability of existing health psychology theories, and to explore new insights into the relationships between stages of behaviour change.

RESULTS

Three thematic areas related to intervention engagement and enactment were identified: (i) health beliefs and readiness to change; (ii) from contemplation to enactment: the role of behaviour change techniques; (iii) and behavioural maintenance.

CONCLUSION

Findings highlighted three key stages of behaviour change that participants need to be supported in to benefit fully from prehabilitation intervention. Complex behaviour change interventions that include aspects of tailoring should consider the boundaries of acceptable adaption while maintaining core causal mechanisms, and include methods to explore real-world implementation and usability during the development process. These findings are important for surgeons and multidisciplinary teams to consider when developing new prehabilitation care pathways or when implementing evidence-based prehabilitation practices.

Revealing sleep and pain reciprocity with wearables and machine learning

Sleep disturbance and chronic pain share a bidirectional relationship with poor sleep exacerbating pain and pain disrupting sleep. Despite the substantial burden of sleep disturbance and pain, current treatments fail to address their interplay effectively, largely due to the lack of longitudinal data capturing their complex dynamics. Traditional sleep measurement methods that could be used to quantitate daily changes in sleep, such as polysomnography, are costly and unsuitable for large-scale studies in chronic pain populations. New wearable polysomnography devices combined with machine learning algorithms offer a scalable solution, enabling comprehensive, longitudinal analyses of sleep-pain dynamics. In this Perspective, we highlight how these technologies can overcome current limitations in sleep assessment to uncover mechanisms linking sleep and pain. These tools could transform our understanding of the sleep and pain relationship and guide the development of personalized, data-driven treatments.

Clinical variables associated with functional deficits in patients affected by chronic chikungunya arthralgia: A cross-sectional study

BackgroundChikungunya virus is an endemic arbovirus that affects populations worldwide. Its primary debilitating symptoms include inflammatory arthralgia, functional incapacity, and pain.ObjectiveThis study aims to identify factors predicting altered functional capacity in patients affected by chronic chikungunya arthralgia.MethodsThis is a cross-sectional study conducted from October 2023 to June 2024. Data were collected using the following instruments: the Health Assessment Questionnaire, the Visual Analogue Scale, the Brief Pain Inventory, the Pittsburgh Sleep Quality Index, and the Short Form-36 Health Survey. Regression analysis was performed to identify associations among the variables.ResultsWe included 119 individuals infected by the Chikungunya virus. Regression analysis of VAS scores revealed that age (coefficient: -0.5532, p = 0.016) and BPI Intensity (coefficient: 1.1716, p = 0.002) were significant predictors. Older age was associated with lower VAS scores, while higher BPI Intensity correlated with higher VAS scores. The model explained 25.7% of VAS score variability (R-squared: 0.257). For HAQ scores, age (coefficient: -0.0104, p = 0.039), PSQI (coefficient: 0.2250, p = 0.002), and SF36 Physical Health (coefficient: -0.0118, p = 0.005) were significant predictors, accounting for 31.6% of the variability (R-squared: 0.316).ConclusionThere is significant complexity in the signs and symptoms exhibited by individuals infected with the chikungunya virus. We highlight the identification of significant associations between pain and disability in individuals affected by the Chikungunya virus.

Prevention of Pain Interference in Insomnia Patients via Digital Cognitive-Behavioral Therapy for Insomnia

OBJECTIVES

Insomnia disorder is co-morbid with and predictive of developing pain conditions and a key factor in pain interference (PI) - the extent to which pain impedes daily living. Emerging literature suggests treating insomnia with cognitive-behavioral therapy for insomnia reduces co-occurring PI. This secondary data analysis tested the extent to which digital CBT-I (dCBT-I) vs. sleep education reduces and prevents significant PI by treating insomnia.

METHODS

Insomnia disorder participants were randomized into dCBT-I (n = 697) and sleep education (n = 623) and reported pre- and post-treatment insomnia and PI. Logistic regressions evaluated intervention effects: 1) reduction of insomnia severity changes in PI and 2) prevention of treatment condition on PI.

RESULTS

The reduction model showed that dCBT-I participants with moderate-to-severe pre-treatment PI experienced 17% odds increase in reduced PI for each one-point reduction in insomnia severity compared to control, OR = 1.17, 95% CI [1.01, 1.35]. In the prevention model, dCBT-I participants with little-to-no pre-treatment PI exhibited a 32% odds reduction of post-treatment progression to moderate-to-severe PI compared to control, OR = 0.68, 95% CI [0.51, 0.90].

CONCLUSION

dCBT-I demonstrated significant and clinically meaningful reduction and prevention effects against PI in a large sample. dCBT-I may help providers address sleep issues to restore pain-related impairments to daytime function, quality of life, and overall sleep.

Snoring as a Possible Protective Factor for Temporomandibular Joint Disorders

BACKGROUND

Previous studies have linked sleep quality to temporomandibular joint disorders (TMD), suggesting a role for snoring in this association. However, the directionality of this relationship remains a subject of debate. This investigation aimed to elucidate the connections between snoring and TMD.

METHODS

This research employed a two-sample Mendelian randomization (MR) approach, leveraging publicly available large-scale genome-wide association study (GWAS) data on snoring and TMD. We utilised a suite of analytical methods, including the inverse variance weighted (IVW) method, maximum likelihood estimation, adjusted profile score, weighted median, MR-Egger regression, and a series of sensitivity analyses, to rigorously assess the existence of relationships.

RESULTS

Our findings indicate that a greater genetic predisposition to snoring is significantly associated with a reduced risk of TMD (IVW method; odds ratio [OR] = 0.156, 95% confidence interval [CI] = 0.028-0.843, p = 0.0309). Conversely, the analysis did not support a potential influence of TMD on snoring susceptibility (IVW method; 95% CI = 0.990 to 1.002, p = 0.1926). Additionally, our sensitivity analyses did not reveal any significant pleiotropy that could bias these findings.

CONCLUSION

This MR study provides limited but novel genetic evidence supporting a potential causal link between snoring and a decreased risk of developing TMD. On the other hand, it does not substantiate an effect of TMD on the likelihood of snoring.

Feasibility and Acceptability of Using Wireless Limited Polysomnography to Capture Sleep Before, During, and After Hospitalization for Patients With Planned Cardiothoracic Surgery

BACKGROUND

Sleep disruption, a common symptom among patients requiring cardiovascular surgery, is a potential risk factor for the development of postoperative delirium. Postoperative delirium is a disorder of acute disturbances in cognition associated with prolonged hospitalization, cognitive decline, and mortality.

OBJECTIVE

The aim of this study was to evaluate the feasibility and acceptability of using polysomnography (PSG) to capture sleep in patients with scheduled cardiothoracic surgery.

METHODS

Wireless limited PSG assessed sleep at baseline (presurgery at home), postoperatively in the intensive care unit, and at home post hospital discharge. Primary outcomes were quality and completeness of PSG signals, and acceptability by participants and nursing staff.

RESULTS

Among 15 patients, PSG data were of high quality, and mean percentage of unscorable data was 5.5% ± 11.1%, 3.7% ± 5.4%, and 3.7% ± 8.4% for baseline, intensive care unit, and posthospitalization measurements, respectively. Nurses and patients found the PSG monitor acceptable.

CONCLUSIONS

Wireless, limited PSG to capture sleep across the surgical continuum was feasible, and data were of high quality. Authors of future studies will evaluate associations of sleep indices and development of postoperative delirium in this high-risk population.

Sex and Sleep Quality Effects on the Relationship Between Sleep Disruption and Pain Sensitivity

BACKGROUND

Chronic pain affects around 20% of the global population and is influenced by various factors, including sleep quality. Studies indicate that sleep disruption can enhance pain sensitivity; however, it is unclear how sex and baseline sleep quality impact these findings. This study examines how sex and baseline sleep quality impact the effects of three nights of sleep disruption on pain sensitivity in healthy individuals.

METHODS

Fifty-nine participants (30 females) underwent two laboratory sessions, separated by three nights of sleep disruption. Pain sensitivity was measured using cuff and handheld algometry, and participants completed a battery of questionnaires on sleep quality, positive and negative affect, and pain catastrophising. Sleep patterns were collected through wrist actigraphy and self-reported sleep diaries.

RESULTS

Temporal summation of pain was significantly facilitated in males (p < 0.01), and pain during suprathreshold stimulation was increased for females (p < 0.01) after the experimental sleep disruption. No differences in any QST parameters were found when comparing participants with good or poor sleep at baseline, but those with good baseline sleep rated the suprathreshold stimulation as more painful (p < 0.05) after the experimental sleep disruption. Finally, having good or poor sleep quality at baseline was associated with a significant reduction in self-reported sleep quality and level of rest after the experimental sleep disruption (p < 0.05).

CONCLUSION

This study indicates that sleep disruption might impact sexes differently and indicates that prior sleep quality is less likely to impact this.

SIGNIFICANCE

Sleep disruption protocols can mimic the sleep problems experienced by patients with chronic pain. The current study explains how different sexes respond to a 3-night sleep disruption protocol and explains how sleep quality at baseline might impact these results.

Widespread and prolonged pain may reduce brain clearance capacity only via sleep impairment: Evidence from participants with knee pain

The brain is key in the pain-sleep relationship, and sleep is needed for glymphatic clearance. However, no studies have examined how pain relates to the glymphatic system (GS). Characterizing the GS alongside sleep quality in well-characterized pain samples is essential for advancing this understanding. Non-invasive MRI techniques, such as Diffusion Tensor Imaging-Analysis aLong the Perivascular Space (DTI-ALPS), are particularly valuable as they are approved for humans. Although the relationship between the DTI-ALPS index and the GS is primarily deductive, the index may be a proxy for waste clearance capacity in deep white matter. Its sensitivity to interstitial space changes-known to be modulated by norepinephrine-offers a unique opportunity to investigate how sleep impairment and chronic pain regulation affect specific components of brain waste clearance. We thus fitted two longitudinal models linking pain, sleep quality and the DTI-ALPS index. We hypothesized that variations in pain characteristics would predict DTI-ALPS index changes, either directly or mediated by sleep quality changes. Alternatively, we hypothesized that variations in sleep quality would predict changes in pain characteristics via DTI-ALPS index modifications. Knee pain participants (n=87) completed an MRI and self-reported measures of pain and sleep impairment at baseline and two years later. We only found evidence supporting that more widespread and longer pain at baseline significantly influenced decreases in the DTI-ALPS index in the left hemisphere through increased sleep impairment two years later (p=0.039, corrected). PERSPECTIVE: Findings highlight the need for research on the relationship between pain and sleep quality and its implications for brain health.

Exploring academic achievement and relevant risk factors among a community sample of adolescents with chronic pain compared to peers

OBJECTIVE

To compare adolescents in the United Kingdom with chronic pain with their peers in relation to psychological and behavioral outcomes (i.e., mental health, bullying, substance use) and academic achievement.

METHODS

Participants were adolescents with chronic pain (n = 856) and peers without chronic pain (n = 3,093) from the Avon Longitudinal Study of Parents and Children (ALSPAC) who attended a research clinic in the United Kingdom at 17 years and completed data collection at multiple timepoints. Chi-square and t-tests were used to explore group differences across psychological and behavioral measures. Regression and mediation analyses examined the relationship between chronic pain and academic achievement measures, including the derived variables of pathway to higher education and educational qualifications.

RESULTS

Adolescents with chronic pain were found to experience more difficulties with mental health, bullying, and substance use. Additionally, a relationship between chronic pain and reporting a pathway to higher education was found after key variables were accounted for, although group differences were not observed across other academic achievement measures. Further analyses identified a moderate indirect effect of chronic pain on reporting a pathway to higher education when mediated by sleep difficulties.

CONCLUSIONS

The limited predictive relationship between chronic pain and academic achievement potentially indicates that, despite struggling more with factors such as mental health, bullying, and substance use, adolescents with chronic pain may utilize enhanced skills in maintaining a developmental trajectory at school or external factors such as support from their caregivers or school. The complex interrelationship between sleep and chronic pain is also an important consideration for the ability to achieve academically.

Optimizing an automated sleep detection algorithm using wrist-worn accelerometer data for individuals with chronic pain

OBJECTIVE

To optimize a wrist-worn accelerometer-based, automated sleep detection methodology for chronic pain populations.

PATIENTS AND METHODS

A cohort of 16 patients with chronic pain underwent free-living observation for one week before participating in an Interdisciplinary Pain Management Program. Patients wore ActiGraph GT9X devices and maintained a sleep diary, documenting their nightly bedtimes and wake times. To derive sleep quality measures from accelerometry data, the Tudor-Locke sleep detection algorithm was employed. However, this algorithm had not been validated for chronic pain patients. Therefore, a sensitivity analysis of the algorithm's parameters was conducted, identifying a set of parameters which maximized the agreement between sleep periods identified by the algorithm and sleep periods identified by participant's sleep logs, which were considered ground truth. Sleep measures derived when using the optimized parameters were then compared against sleep measures derived using the default parameters.

RESULTS

Our optimized parameter set achieved a mean sleep detection agreement of 67% with participant's sleep logs, while the default parameter set achieved a mean agreement of 50%. Statistically significant differences were observed between sleep measures from the optimal and default parameter sets (P < .001). These findings suggest an optimized parameter set should be favored for chronic pain populations.

CONCLUSION

The Tudor-Locke algorithm provides automated sleep detection for accelerometry data; however, caution must be exercised when applying the algorithm to populations beyond its validated scope. In this manuscript, we provide an empirically optimized parameter set for applying this algorithm to adults with chronic pain.

Teens and opioids postsurgery (TOPS): protocol for a prospective observational study describing associations between sleep deficiency and opioid use following outpatient surgery in adolescents

INTRODUCTION

The opioid crisis is a significant burden on adolescent public health in the USA. Medical use of prescription opioids is a pathway via which adolescents transition to opioid misuse, opioid use disorder and overdose. More than half of all opioids prescribed to adolescents are for pain management following surgery. Yet, little is known about the critical period following surgery during which adolescents initiate opioid misuse or the modifiable mechanisms (such as sleep deficiency) contributing to this process. This prospective observational study will broaden our knowledge by examining associations between sleep deficiency and opioid use and misuse following surgery. We will also examine behavioural, psychological, family and social factors linking sleep deficiency with opioid use and misuse.

METHODS AND ANALYSIS

Adolescents (10-19 years) undergoing outpatient orthopaedic surgery, along with one parent, will be recruited from two paediatric hospitals, for a sample of 400 dyads. Adolescents will be assessed at six timepoints. Before surgery, participants will undergo comprehensive multimodal sleep assessments (sleep surveys and actigraphy). Participants will also report on previous substance use, pain intensity and psychosocial, family and social factors. Adolescents will then be closely monitored over the first 14 days following surgery using ecological momentary assessment methods to capture real-time, naturalistic, daily data on sleep, opioid use, pain and psychological factors (including mood, affect and subjective response to opioid use). Opioid use (total number of doses and duration) will be measured with an innovative electronic medication monitoring device following surgery. Follow-up assessments at 3 months, 6 months, 12 months and 24 months will track the development of opioid misuse over time. Our primary outcomes include opioid use during the immediate 14 days following surgery and the presence of opioid misuse at 24 months after surgery. Multilevel mediation models will determine associations between predictor variables and acute postsurgical opioid use. We will apply modern machine learning algorithms to develop and validate models predicting adolescent prescription opioid misuse at 24 months from surgery.

ETHICS AND DISSEMINATION

This study was approved by Advarra's Center for Institutional Review Board Intelligence (CIRBI) (Protocol 00072049), which serves as the single IRB of record for this multisite study.

Combined Treatment With Cognitive Behavioral Therapy for Insomnia and Acceptance and Commitment Therapy Enhances Objective and Subjective Reports of Sleep in Patients With Advanced Cancer

BACKGROUND

Sleep difficulties are common for people with advanced cancer and are associated with poorer mood, lower quality of life, and reduced survival. For these patients, insomnia severity ratings are tied to nighttime awakenings, but little is known about the reasons for awakenings.

AIMS

This study reports actigraphy sleep outcomes, longitudinal self-reported insomnia severity, and circadian rhythm disruptions from a randomized pilot study comparing a multi-symptom intervention with a wait-list control group for people with advanced cancer.

METHODS

Twenty-eight people with advanced cancer completed a brief intervention, Finding Our Center Under Stress (FOCUS), designed to enhance sleep and alleviate worry, depression, and fatigue. Participants completed questionnaires and wore an Actiwatch for 7 consecutive 24-h periods pre- and post-intervention.

RESULTS

There were no significant group × time actigraphy effects. However, sensitivity analyses with the full intervention sample including the wait-list control arm demonstrated significant effects on actigraphy sleep efficiency, minutes awake after sleep onset (WASO), number of awakenings, naps, and activity at rest. Insomnia severity ratings on the Insomnia Severity Index were maintained longitudinally with 61% meeting the cut-off for insomnia at baseline compared to 18% at 1 year. Participants demonstrated reductions in key reasons for awakenings.

CONCLUSIONS

Multi-symptom interventions may be necessary for sustained insomnia improvements for people with advanced cancer. The FOCUS intervention is one of the first to demonstrate improvements on self-reported and actigraphic measures of sleep in addition to other symptoms (i.e., worry, uncertainty, depression, fatigue interference, distress) for this population. Future effectiveness studies are warranted given results of this pilot trial.

TRIAL REGISTRATION

Cognitive-behavioral intervention for worry, uncertainty, and insomnia for cancer survivors (NCT01929720).

Psychophysical changes after total sleep deprivation and experimental muscle pain

Sleep disturbances exacerbate chronic pain, increase psychological load, and increase inflammation. Delayed onset muscle soreness (DOMS) mimics aspects of chronic pain, predominantly affecting peripheral pain mechanisms, while experimental sleep provocations have been shown to impact central pain mechanisms. This study aimed to combine a DOMS model with total sleep deprivation (TSD) to create a novel model affecting both peripheral and central pain mechanisms. A total of 30 healthy participants attended two sessions (baseline and follow-up) separated by 24 h of TSD and a home rating after 48 h. Assessments of interleukin 6 (IL-6) levels, sleep quality, pain catastrophising, affect, and symptoms of depression and anxiety were included in the baseline and follow-up sessions. Additionally, pressure pain and tolerance thresholds, temporal summation, and conditioned pain modulation (CPM) were assessed using cuff-pressure algometry in the baseline and follow-up sessions. DOMS was induced with eccentric calf raises during the baseline session followed by 24 h of TSD. At follow-up pain tolerance (p = 0.012) was significantly reduced, and CPM (p = 0.036) was significantly impaired compared to baseline. Psychological changes included decreases in pain catastrophising (p = 0.027), positive affect (p < 0.001), negative affect (p = 0.003), and anxiety (p = 0.012). Explorative regression models predicted 58% and 68% of DOMS pain intensity after 24 and 48 h, respectively, based on baseline body mass index, pain thresholds, psychological measures, and IL-6 (p < 0.01). Combining DOMS with 1 night of TSD induced pain hypersensitivity, impaired CPM, and altered psychological states. A combination of baseline inflammation, psychological measures, and pain sensitivity significantly predicted DOMS pain intensity after 24 and 48 h.

Youth With Functional Abdominal Pain Disorders Have More Sleep Disturbances. A School-Based Study

BACKGROUND

There is a bidirectional relationship between sleep and pain disturbances. Sleep disturbances increase the risk for chronic pain, while chronic pain can interfere with sleep. Hence, we assessed the subjective sleep characteristics of youth with functional abdominal pain disorders (FAPDs) compared to healthy youth and examined associations with gastrointestinal symptoms.

METHODS

We included youth ages 10-18 years without a sleep or organic GI disorder diagnosis from a large private school. Participants completed demographics, sleep history, and validated questionnaires: sleep quality (ASWS-SF), insomnia (PISI), daytime sleepiness (ESS), sleep disturbance (PROMIS SD), sleep-related impairment (PROMIS SRI), and Rome 4 diagnostic questionnaire. Cases (FAPDs) completed abdominal pain index (API), nausea severity (NSS), anxiety, depression (PROMIS), and functional disability (FDI). Parents filled sleep hygiene metrics (SHIP). Cases were matched 1:1 with controls based on age and gender.

RESULTS

Of 120 youth (60 cases and 60 controls), the mean age was 13.5 ± 1.9 years and 50% were females. Youth with FAPDs had higher insomnia, sleep disturbance, sleep-related impairment, daytime sleepiness, sleep hygiene, gasping, and nightmares than healthy youth (p < 0.05). Higher insomnia severity was associated with worse abdominal pain (r = 0.41, p < 0.01), higher daytime sleepiness with a family history of disorders of gut-brain interaction (DGBIs, OR = 14.7, p = 0.002), and higher sleep-related impairment (OR = 5.6, p = 0.02) and depression (OR = 6.1, p = 0.01) with black race.

CONCLUSION

Youth with FAPDs have worse sleep than healthy youth and multiple sleep parameters are associated with abdominal pain. Future studies could focus on determining mechanisms by which sleep disturbances affect abdominal pain and vice versa.

Fatigue, sleep disturbance, and pain interference in children and adolescents with chronic pain: a longitudinal study

ABSTRACT

Research has shown that pain and sleep disturbance often co-occur and influence each other over time in children and adolescents with chronic pain. Longitudinal studies examining the underlying mechanisms of this association are scarce and have focused primarily on the role of internalizing mental health symptoms and mood. This longitudinal study aimed to determine whether fatigue underlies the co-occurrence and mutual maintenance of sleep disturbance and pain over time in children and adolescents with chronic pain. Participants were 355 school-aged children and adolescents (mean age = 11.63 year old; 67% female) with chronic pain. The participants provided sociodemographic information and responded a survey that included measures of pain (duration, intensity, interference), sleep disturbance, and fatigue at first assessment and 12 months later. Partially latent, cross-lagged, panel, structural equation models revealed that sleep disturbance, pain intensity, and pain interference co-occurred at both time points. Higher levels of sleep disturbance, pain intensity, and pain interference at first assessment predicted higher levels of sleep disturbance, pain intensity, and pain interference at follow-up, respectively. Higher levels of pain interference at first assessment predicted higher levels of sleep disturbance at follow-up while controlling for initial levels of sleep disturbance. Furthermore, fatigue was found to mediate the association between first assessment and follow-up sleep disturbance, the association between first assessment and follow-up pain interference, and the association between first assessment pain interference and follow-up sleep disturbance. The findings highlight the need to assess and address fatigue in children and adolescents with chronic pain and sleep disturbance.

Painful Mondays: Exploring Weekly Sleep Variations and Pain Perception in Healthy Women-An Experimental Study

BACKGROUND

Acute experimental sleep deprivation induces pain hypersensitivity, particularly in females. While the impact of extreme sleep loss on pain perception has been largely studied, how subtle sleep fluctuations, for example, sleep variations across the week, affect pain perception remains unclear. This study investigated how weekly sleep variations affect pain perception in young healthy women.

METHODS

A sleep-monitoring headband and self-reported questionnaire were used to assess sleep. Quantitative sensory testing was conducted on Monday and Friday, including heat, cold, pressure pain thresholds, tonic pain summation and conditioned pain modulation.

RESULTS

A total of 26 healthy young (23.9 ± 0.9 years) women were included. Repeated measures ANOVAs revealed significant sleep variation across the week, including differences in N3 sleep stage duration (M = 89.2 ± 5.42 min; p = 0.022, lowest on Friday and Sunday nights), bedtime (M = 00:56 AM ± 0.29; p = 0.038, latest on Friday vs. Sunday night) and wake-up time (M = 07:04 AM ± 0.30; p = 0.007 latest on Saturday vs. Monday morning). With most changes affecting Sunday night and Monday morning, pain sensitivity was higher on Monday compared to Friday, with a lower heat pain threshold (B = -11.89; p = 0.002) and increased heat pain summation (B = 1.65; p < 0.001).

CONCLUSIONS

The results showed higher heat pain hyperalgesia on Mondays due to weekly sleep variation. Since sleep is a modifiable factor, maintaining a consistent sleep schedule throughout the week could benefit pain management, particularly in chronic pain patients with less effective pain modulatory pathways.

STATEMENT OF SIGNIFICANCE

How weekly sleep variations in real life between weekends and weekdays affect pain perception has not been studied before. This paper provides the first evidence that natural weekend-weekday sleep alterations, including shifts in bedtime and wake-up time over the weekend and the transition back on Sunday night, heighten pain sensitivity on Monday-known as the 'Monday effect'. The compromised pain pathways on Monday underscore the importance of maintaining a consistent sleep schedule throughout the week, potentially benefiting patients with chronic pain.

STUDY PREREGISTRATION STATEMENT

The authors have nothing to report.

Mechanisms of the Native American pain inequity: predicting chronic pain onset prospectively at 5 years in the Oklahoma Study of Native American Pain Risk

ABSTRACT

A pain inequity exists for Native Americans (NAs), but the mechanisms are poorly understood. The Oklahoma Study of Native American Pain Risk (OK-SNAP) addressed this issue and recruited healthy, pain-free NAs and non-Hispanic Whites (NHWs) to attend 2 laboratory visits and assessed mechanisms consistent with the biopsychosocial model of pain: demographics, physical variables, psychosocial factors, and nociceptive/pain phenotypes. Then participants were surveyed every 6 months to assess for chronic pain onset. Results at the 2-year follow-up found that NAs were ∼3x more likely than NHWs to develop chronic pain. Moreover, psychosocial factors (discrimination, stress, pain-related anxiety), cardiometabolic load (higher body mass index and blood pressure, lower heart rate variability), and impaired inhibition of spinal nociception partly mediated the pain inequity. The present study examined mechanisms of chronic pain at the 5-year follow-up for OK-SNAP. Results found that the NA pain inequity worsened-NAs were 4x more likely to develop chronic pain (OR = 4.025; CI = 1.966, 8.239), even after controlling for baseline age, sex assigned at birth, income, and education. Moreover, serial mediation models replicated paths from the 2-year follow-up that linked psychosocial variables, cardiometabolic load, and impaired inhibition of spinal nociception to chronic pain onset. Further, 2 new significant paths were observed. One linked discrimination, stress, sleep problems, and facilitated pain perception to increased pain risk. The other linked discrimination with higher spinal nociceptive threshold and pain risk. These results provide further evidence for a NA pain inequity and identify multiple psychosocial, cardiometabolic, and pronociceptive targets for primary interventions.

Sleep Quality of Patients on a General Department During the First Days of Hospitalization

Purpose

The main aim of the study was to record subjective assessment of sleep quality between men and woman in hospitalised patients over 3 nights and look for associations with other basic hospitalisation data (age, type of department, surgery, pain, type of admission, previous hospitalisation, sleep-inducing medication). The secondary aim was to determine whether the Ford Insomnia Response to Stress Test (FIRST) questionnaire is an appropriate tool for identifying hospitalised individuals prone to situational sleep disturbance.

Methods

A multicentre descriptive cross-sectional study was conducted in regular surgical and medical departments of seven selected hospitals in the Czech Republic. On the first day of hospitalization, patients completed the FIRST screening questionnaire. Their subjectively perceived sleep quality for the previous night was assessed from the second to the fourth day of hospitalization using the Richards-Campbell Sleep Questionnaire (RCSQ).

Results

The study included 340 patients (172 females and 168 males; mean age 58.9 ± 14.9 years and 57.3 ± 15.0 years, respectively). No significant differences in RCSQ scores were observed between men and women or across the three nights of hospitalization. Moderate correlations were identified between hospitalization data and RCSQ scores, with the strongest positive correlation for alprazolam use (Ra = 0.604). Other positive correlations included surgical department hospitalization, sleep-inducing medications, surgery, male sex, and age. The strongest negative correlation was with pain (Ra = -0.498), while other negative correlations included elective admission, medical department hospitalization, and previous hospitalization. The studied factors explained 18% of the RCSQ variability. The association between FIRST scores and RCSQ was statistically significant (p < 0.001) but weak (Spearman's -0.1734, Kendall's tau -0.1234).

Conclusion

Subjective sleep quality during hospitalization is related to the type of department, care provided, and pain, age, and sex. There were no significant changes in subjective sleep quality ratings during the first three days of hospitalization. The FIRST questionnaire is not a suitable screening tool for identifying individuals with situational sleep disturbance in hospital.

Effects of sleep and circadian rest-activity rhythms on daily pain severity in women with temporomandibular disorders

ABSTRACT

Although a robust connection between sleep and pain is established, the extent to which circadian rest-activity rhythms contribute toward unique variations in pain, beyond what is elucidated by sleep, remains uncertain. Furthermore, it is largely unknown whether sleep and circadian rest-activity rhythms have interactive effects on daily pain severity. Using wrist actigraphy and daily pain diaries, data from 140 women with temporomandibular disorders and insomnia symptoms were analyzed over a 14-day period. Sleep duration and continuity were quantified by using total sleep time (TST) and wake after sleep onset (WASO), and circadian rest-activity rhythms were characterized with the Relative Amplitude (indicating strength/robustness of rest-activity rhythm) and Intradaily Variability metrics (representing rhythm fragmentation). Linear mixed-effects modeling revealed that both TST (b = -0.11, P = 0.006) and WASO (b = 0.18, P = 0.006) from the previous night, along with Relative Amplitude (b = -2.56, P = 0.001) from the past 24 hours, predicted next-day pain severity. Among the 4 interaction effects tested, both Intradaily Variability (b = 1.52, P = 0.034) and Relative Amplitude (b = -1.52, P = 0.003) moderated the relationship between WASO and next-day pain severity; on days characterized by less robustness (lower Relative Amplitude) or greater fragmentation (higher Intradaily Variability) in the circadian rest-activity rhythm, the positive association between previous night WASO and next-day pain severity intensified. These findings highlight the complex interplay among sleep, circadian rest-activity rhythms, and pain. While preliminary, our findings indicate that interventions aimed at improving both sleep and restoring circadian rhythms may provide enhanced benefits for managing chronic pain.

CCL25 in the cerebrospinal fluid is negatively correlated with fatigue in chronic pain patients

BACKGROUND AND AIM

Chronic pain is often accompanied by other symptoms such as fatigue and sleep disturbance, and these symptoms all correlate with neuroimmune activation. However, their relation to one another on a neuroimmune axis remains elusive. Based on a recent review, cytokines in the cerebrospinal fluid (CSF) seem to be generally upregulated in patients with chronic pain compared to controls, disregarding pain type. Some of these have the possilibity of altering blood-brain barrier (BBB) permeability. Therefore, cytokine levels in serum and CSF, as well as BBB permeability, were measured in a cohort of patients suffering from either degenerative disc disease (DDD), lumbar disc herniation (LDH) or osteoarthritis (OA). In this exploratory study, we were interested in whether cytokines in the serum or CSF are associated with sleep disturbance or fatigue, with special consideration of the effect of BBB permeability, and whether functional clusters can be found among these cytokines.

METHOD

One-hundred-twenty patients with DDD/LDH/OA, all awaiting surgery, were included. Blood and CSF were collected on the day of surgery. Pain was measured with a visual analog scale 0-100 mm, sleep disturbance was assessed using Pittsburgh Sleep Quality Index (PSQI), and fatigue was measured using the Multidimensional Fatigue Inventory (MFI). A 92-protein multiplex panel (OLINK, Sweden) was used to analyze cytokine expression in serum and CSF, respectively. CSF-serum albumin quotient was measured using ELISA. Non-parametric statistics were used for univariate analyses, and a false discovery rate (FDR) < 0.10 was considered statistically significant. Bonferroni correction was applied to all multivariable protein analyses to obtain conservative effect estimates.

MAIN RESULTS

There was an association between BBB permeability and serum-CSF dynamics: thirty-one cytokines showed significant CSF-serum correlation, and BBB permeability was significantly correlated to the quotients of 35 cytokines and to the CSF levels of 11 cytokines. Several cytokines were negatively correlated to both pain at rest and general fatigue. No correlations were found between sleep disturbance and cytokines. Network analyses of serum and CSF cytokines that were correlated with fatigue revealed functional clusters in both compartments. Anxiety, depression, and pain during rest were important regressors for sleep disturbance with an R2 = 0.41. In addition to depression and pain during rest, CSF levels of CCL25 was a significant regressor regarding general fatigue, with an R2 = 0.47.

DISCUSSION AND CONCLUSION

In this exploratory study of immune profiles in chronic pain cohorts awaiting surgery, the importance of BBB dynamics on serum-CSF cytokine dynamics, and to a lesser extent on central levels of cytokines, is highlighted. Surprisingly, there were no associations between any cytokines in serum or CSF and sleep disturbance, despite a high prevalence of clinically significantly disturbed sleep. In contrast, several associations between general fatigue and cytokine levels in both serum and CSF were found. Cytokines of note are CXCL11 and CCL25 in the CSF, especially because of their direct functional association. CXCL11 has been found to exert neuroprotective effects in animal models, while CCL25 is known as a proinflammatory cytokine and is the only cytokine to fall out as a significant negative contributor to degree of fatigue. While causality cannot be addressed, the negative correlation between CCL25 and fatigue in both univariate and multivariate analyses implies that neuroimmune activity might have an ameliorating effect on the degree of fatigue. This study further adds to existing evidence that centrally acting cytokines are associated with severity of symptomatology, and highlights that pain and fatigue seem to have slightly different cytokine profiles. Sleep disturbance needs to be further addressed, ideally using both subjective and objective assessment methods. CCL25 and CXCL11 are interesting biomarkers for future research on pain and associated symptoms.

Assessment of sleep patterns in migraine sufferers using the Epworth Sleepiness Scale

BACKGROUND

Migraine, a debilitating neurological disorder, is often co-occurring with sleep disturbances. This study used the Epworth Sleepiness Scale (ESS) to explore changes in sleep quality between individuals with migraine and healthy controls. Additionally, we examined associations between ESS scores and migraine frequency, severity, and demographic factors.

METHODS

This cross-sectional study included 404 participants, 204 with chronic migraine (diagnosed using ICHD-3 criteria) and 200 controls without neurological disorders. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Demographic and clinical data were analyzed using Python3 and SPSS, using t-tests and ANOVA (P < 0.05).

RESULTS

The study analyzed demographics, clinical characteristics, and daytime sleepiness in 204 migraine participants compared with 200 controls. Individuals with chronic migraine had higher Epworth Sleepiness Scale scores, with increased sleepiness associated with higher BMI, age, and female gender. Significant differences in sleepiness levels were observed with migraine severity, highlighting the impact of migraine on sleep patterns and quality, and no significant differences were found between control and migraine groups in ESS scores, sleep duration, or physical activity. Reliability testing confirmed high ESS consistency.

CONCLUSION

This study highlights the prevalence of daytime sleepiness among individuals with chronic. Managing sleep quality emerges as an important treatment strategy. The use of standardized tools such as the Epworth Sleep Scale can guide personalized interventions, improve patient outcomes, and emphasize the role of lifestyle and overall health management.

Sleep Disturbances and Pain Subtypes in Parkinson's Disease

Background and Objectives: Sleep and pain are non-motor symptoms encountered frequently in Parkinson's disease (PD). Several subtypes of pain have been identified in PD, with different associations with other non-motor symptoms. To evaluate the prevalence of various subtypes of pain in a PD cohort and their associations with sleep disturbances and quality of sleep. Materials and Methods: In this study, 131 consecutive PD patients were assessed, focusing on pain and sleep using several validated scales and questionnaires. Results: According to KPPQ, the most reported types of pain were musculoskeletal pain (82.44%), nocturnal pain (58.77%), and radicular pain (55.72%). "Bad sleepers" (PSQI score > 5) reported significantly more pain than "good sleepers" regarding all KPPS subdomains, with statistically significant differences observed in the following domains: musculoskeletal pain (5.48 ± 3.50 vs. 2.70 ± 2.67, p < 0.001), chronic pain, specifically central pain (1.19 ± 2.01 vs. 0.15 ± 0.71, p = 0.004), nocturnal pain, specifically pain related to akinesia (2.26 ± 2.74 vs. 0.64 ± 1.22, p = 0.001), and radicular pain (4.35 ± 4.20 vs. 2.45 ± 3.55, p = 0.022). The prevalence of sleep disturbances was higher in patients with nocturnal pain (odds = 1.165, 95% CI: 1.064-1.276, p = 0.001), orofacial pain (odds = 1.108, 95% CI: 1.051-1.167, p < 0.001), and radicular pain (odds = 1.015, 95% CI: 1.015-1.149, p = 0.015). Conclusions: Pain is common in PD patients with sleep disorders. Identifying specific types of pain that are associated with sleep disorders and their correct management may improve sleep quality.

Psychometric Evaluation of an Arabic Language Version of the Geriatric Sleep Questionnaire-6 Items (GSQ-6) in Community-Dwelling Older Adults

OBJECTIVES

Assessing sleep quality and patterns in later life is essential for accurately diagnosing and effectively treating sleep problems and their associated consequences. The Geriatric Sleep Questionnaire-6 (GSQ-6) is a widely used self-report questionnaire that assesses sleep quality and disturbances specifically among older adults. This study aimed to translate the scale into Arabic and evaluate its psychometric properties in an older Arabic-speaking adults' population.

METHODS

The GSQ-6 was translated into Arabic using forward and backward translation procedures, and was administered to a convenience sample of 539 older adults.

RESULTS

The CFA results supported the unidimensional factor structure proposed by the developers. The McDonald's omega value was of 0.70, indicating acceptable internal consistency. The measurement model had an equivalent factor structure across sex. GSQ-6 scores correlated negatively with quality of life and resilience, and positively with neglect and abuse scores, supporting the validity of our Arabic translation.

CONCLUSIONS

The Arabic GSQ-6 demonstrated good psychometric properties. The findings support its use as a valid and reliable measure for evaluating sleep quality among the Arabic-speaking older adult population.

CLINICAL IMPLICATIONS

The Arabic GSQ-6 now provides clinicians with an evidence-based means of incorporating routine sleep quality evaluation as part of their patient assessments.

Suicidal risk, insomnia symptoms, and interoceptive sensitivity: Network analysis in a university student population

Objective: This cross-sectional study examines the relationships between insomnia symptoms, suicidal risk, and interoceptive sensitivity in university students. Participants: A sample of 288 students from French universities was recruited. Methods: The Sleep Condition Indicator, the Suicide Behaviors Questionnaire-Revised, and the Multidimensional Assessment of Interoceptive Awareness were used to assess insomnia, suicidal risk, and interoception. Network analysis explored the connections between insomnia and suicidal risk, while mediation analysis examined the role of the interoceptive sensitivity dimensions. Results: 46.18% of participants had clinical insomnia, and 37.84% had elevated suicide risk. Nocturnal insomnia symptoms were more strongly associated with suicidal risk than daytime symptoms. Trusting body signals was found to partially mediate this association. Conclusions: These findings suggest that nocturnal insomnia may have a greater impact on suicide risk, with trust influencing this relationship. Addressing both insomnia and trust in interventions could help reduce suicide risk in university students.

Mendelian Randomization Analysis Identifies Causal Effects of Multi-Site Chronic Pain on Obstructive Sleep Apnea

Background

Observational studies have suggested an association between obstructive sleep apnea (OSA) and chronic pain disorders, but causal evidence have not been confirmed.

Methods

Here we performed Mendelian randomization (MR) study to explore the potential causal association and mediating roles of modifiable factors between multi-site chronic pain (MCP) and OSA. Independent single nucleotide polymorphisms (SNPs) (N=26) from MCP GWAS (n=387,649) in the UK Biobank were used as instrumental variables to test associations with OSA from the FinnGen consortium, which encompassed 16,761 individuals with OSA cases and 201,194 individuals without OSA.

Results

MR analyses provide genetic evidence to predict MCP on the risk of OSA. Specifically, a per-site increase in multi-site chronic pain was linked to a 184% higher risk of OSA (ORIVW = 1.84, 95% CI = 1.29-2.63, p = 7.24×10-4). However, we also performed reverse association analyses and found no significant casual effect of OSA on MCP. MR estimates were in agreement regardless of the method used, such as MR-egger, weighted median and weighted mode, thereby demonstrating the accuracy of the causal associations. Through mediation analyses, we found that body mass index (BMI), waist circumference, and educational attainment explained a substantial proportion of the association between MCP and OSA (proportion mediated=21.13%; 26.57% and 9.66% respectively).

Conclusion

Our findings suggest that both pain management interventions, prevention of obesity and health education are likely to be effective strategies to reduce OSA risk in individuals with MCP.

Feasibility of brief behavioral telehealth interventions for sleep and pain in adults with chronic musculoskeletal orofacial pain: An idiographic clinical trial

OBJECTIVE

Brief behavioral interventions targeting pain (Physical Self-Regulation, PSR) or sleep (Brief Behavioral Intervention for Insomnia, BBTI) show promise for interdisciplinary management of chronic pain, though their feasibility with chronic musculoskeletal orofacial pain (MSK-OFP) populations remains underexplored. This pilot study assessed the feasibility of a randomized clinical trial (RCT) of these interventions in a university-affiliated tertiary OFP clinic and explored clinical changes in pain, sleep, and other secondary outcomes.

METHODS

Treatment-seeking participants (N=19) with chronic MSK-OFP and insomnia were randomized to three-session PSR or BBTI. At pre- and post-intervention, participants completed questionnaires (assessing pain intensity, insomnia symptomatology, sleep quality, headache disability, fatigue, jaw-movement limitations, and quality of life), 8 consecutive days of actigraphy and morning/evening diaries. Feasibility outcomes were recruitment, retention, and adherence rates. Clinical outcomes included clinically-meaningful reductions in insomnia symptoms (Insomnia Severity Index [ISI]<15) and pain intensity (>2.5 point on 0-10 Numerical Rating Scale).

RESULTS

Over a 17-month period, of 19 consenting participants (88.9% females, 38.4±12.2y/o, recruitment rate: 1.1/month),12 (92% females, 38.5±11.5y/o) completed the study (retention rate: 63.2%) with high completion rate (questionnaires: 95.8%, daily diaries: 95%, actigraphy: 100%). Despite no significant changes in pain, ISI scores decreased by 6.0 and 4.8-points among BBTI and PSR groups. Improvements in sleep quality, headache disability, fatigue, jaw-movement limitations, and quality of life wereobserved.

CONCLUSION

RCTs of brief behavioral interventions are feasible in tertiary-OFP clinics.

Temporomandibular disorder confounders in motor vehicle accident patients

BACKGROUND

Motor vehicle accidents (MVA) are associated with the onset of temporomandibular disorder (TMD) symptoms. However, diagnosing TMD-related pain is challenging due to various entities that can refer pain to the region. This study aims to identify prevalent radiographic confounders to pain diagnosis in MVA patients who were subsequently referred for temporomandibular joint imaging using cone-beam computed tomography (CBCT) by comparing these patients to a cohort of patients without MVA history.

METHODS

CBCTs of 738 temporomandibular joints were reviewed, with cases stratified by MVA history. This research explored the demographics and calculated the prevalence of radiographic confounders (RC) in each category, comparing the findings for both groups. The chi-square test was used to assess statistical significance.

RESULTS

Patients in the MVA cohort (n = 151, mean age = 41.3 years, S.D (Standard Deviation) = 13.3 years) averaged 1.10 confounders/patient compared to a significantly lower 0.68 confounders/patient in the non-MVA cohort (n = 218, mean age = 33.6 years, S.D = 18.2 years). The most frequently identified RCs include sinus pathologies (39.1% (MVA) vs. 28.0% (non-MVA), p = 0.025) and endodontic lesions (22.5% (MVA) vs.10.1% (non-MVA), p = 0.001).

CONCLUSIONS

Clinicians must be vigilant about confounders when managing patients suspected of TMD. We recommend patients undergo a complete dental evaluation before being referred to a specialist to avoid unnecessary medical costs and treatment delays.

Migraine and insufficient sleep: The effect of sleep restriction on nociceptive evoked potentials in migraine

BackgroundThe association between insufficient sleep and migraine is largely unexplained. In this blinded cross-over study we investigate whether insufficient sleep disturbs processing of nociceptive signals more in individuals with migraine compared to those without migraine.MethodsEvoked potentials to nociceptive laser stimuli and high density electrical dermal stimuli were recorded in migraine and control subjects after two nights of habitual sleep and after two nights of sleep restriction (4 h sleep/night). Researchers conducting the measurements and data processing were blinded to diagnosis and sleep condition. Both recordings were interictal in 21 migraine subjects. Amplitudes, amplitude habituation and latencies were compared to measurements in 31 controls.ResultsElectrically induced N2P2 amplitude showed more habituation after sleep restriction compared to habitual sleep in the migraine group (p < 0.025). The migraine group also had less N2P2 amplitude habituation after habitual sleep compared to the control group (p < 0.035). We found no effect of sleep restriction on N2P2 amplitude habituation to laser stimulation, and no effect of sleep restriction on N2P2 amplitudes.ConclusionInsufficient sleep may slightly increase cortical inhibitory responses in migraine. Our findings support that migraine is associated with a vulnerability for insufficient sleep between attacks.

Rest assured: High sleep efficiency reduces postoperative complications and opioid prescriptions in patients undergoing surgeries with gynecologic oncologists

OBJECTIVE

To assess the relationship between preoperative sleep efficiency (percentage of time asleep while in bed) and postoperative outcomes in gynecologic oncology patients.

METHODS

This is a secondary analysis of a prospective cohort study that included 90 patients undergoing gynecologic surgeries from March 2021 to November 2023. Preoperative sleep efficiency was measured via Oura rings over the seven days prior to surgery and analyzed as a continuous variable and in quartiles. Primary outcomes were 30-day postoperative complications, with secondary outcomes including total morphine milligram equivalents (MME) prescribed at discharge and pain scores on postoperative day 1 (POD1). Multivariable analyses controlled for age, body mass index, frailty status, neoadjuvant chemotherapy, use of preoperative sleep medications, and surgical approach.

RESULTS

Higher preoperative sleep efficiency was independently associated with fewer 30-day postoperative complications. On multivariable analysis, each 1 % increase in sleep efficiency was associated with 6 % lower adjusted odds of complications. (aOR: 0.94; 95 % CI: 0.89-0.996) and significantly lower total MME prescribed at discharge (β = -13.94; 95 % CI: -19.35 to -8.53). Patients in the highest sleep efficiency quartile (>89.0 %) had lower odds of experiencing a complication compared to those in the lowest quartile (aOR: 0.28; 95 % CI: 0.09-0.92). Sleep efficiency was not significantly associated with POD1 pain scores (β = -0.06; 95 % CI: -0.13 to 0.01).

CONCLUSION

Preoperative sleep efficiency is associated with fewer postoperative complications and lower MME prescribed at discharge. This may be modifiable risk factor to improve recovery and outcomes.

Sleep disturbances in older surgical patients with and without suspected cognitive impairment: A multicenter cohort study

AIMS

Early detection and management of sleep disturbances can improve postoperative outcomes given the high prevalence of sleep disturbances and unrecognized cognitive impairment in older surgical patients. There is an association between sleep disturbances and cognitive impairment in the general population. However, the relationship in older surgical patients has not been systematically investigated. The objective of this study was to assess the prevalence and trajectory of preoperative and postoperative sleep disturbances in older surgical participants with and without suspected cognitive impairment (sCI).

METHODS

Two hundred and fifty-two participants aged ≥ 65 years undergoing non-cardiac surgery were recruited. The primary outcome was the prevalence and trajectory of sleep disturbances measured by the Pittsburgh Sleep Quality Index (PSQI) in participants with and without sCI preoperatively, 30, 90, and 180 days postoperatively. The main exposure, preoperative sCI, was operationalized as screening positive on one or more of the following cognitive screening tools: Centers for Disease Control and Prevention cognitive question (answered "yes"), Ascertain Dementia Eight-item Questionnaire (≥2), Telephone Montreal Cognitive Assessment (≤18), and Modified Telephone Interview for Cognitive Status (≤31). Sleep disturbances were defined as a PSQI score > 5. Mixed effects logistic regression models with random intercepts were used for the dichotomous outcome of sleep disturbances.

RESULTS

One hundred and eight participants (43%) screened positive for preoperative sCI. The prevalence of preoperative sleep disturbances was higher in participants with sCI versus without (63% vs 47%, P = 0.02). Postoperatively in both groups, the prevalence of sleep disturbances was lower at 30, 90, and 180 days, compared to the preoperative assessment and overall trajectories did not differ significantly. Female sex and depression were associated with poorer postoperative sleep, regardless of cognitive status.

CONCLUSION

Sleep disturbances and suspected cognitive impairment are highly prevalent in surgical cohorts. Targeting conditions such as depression which affect sleep, may improve postoperative outcomes.

The Potential of Wearable, Modular Devices in Monitoring Functional Clinical Metrics in Patients Suffering from Chronic Pain

PURPOSE OF REVIEW

This review assesses the role of wearable technologies in pain management, emphasizing their capability to transcend subjective pain evaluations with objective functional outcome tracking. We explore the types and veracity of health metrics wearable devices track, illustrating how this technological evolution can significantly enhance patient care in the context of chronic pain prevention and management.

RECENT FINDINGS

The advancements in modular wearable technology offer new avenues to track a variety of health outcomes, including aerobic capacity, physical activity, stress, and sleep quality. This provides objective measurements that can aid in the management of chronic conditions and can offer a more comprehensive assessment of a patient's pain and function. Although the initial approach to pain management that emphasized pain as the fifth vital sign had unintended devastating consequences, leveraging wearable technology for objective outcomes tracking presents an opportunity to optimize pain management strategies. Wearable technologies capture functional metrics that provide insight into many aspects of the biopsychosocial model of pain. Utilizing function as the key performance indicator has the potential to improve treatment outcomes and, ultimately, patient care.

The Impact of Standard Care Versus Intrinsic Relaxation at Home on Physiological Parameters in Patients with Fibromyalgia: A Comparative Cohort Study from Romania

Background and Objectives: Fibromyalgia (FM), through the presence of widespread chronic pain, stiffens the musculoskeletal system and causes sleep disturbances and fatigue. Through this study, we aimed to compare the effectiveness of two different recovery interventions for improving sleep quality: a standard, multidisciplinary intervention in a recovery hospital versus a therapy focused on intrinsic relaxation at home. Materials and Methods: This study included 60 adult patients who participated voluntarily and were diagnosed with FM by a rheumatologist, randomly divided into two groups. During this study, 30 patients out of the 60 were randomly assigned to experimental group 1 and underwent treatment at the Recovery Clinical Hospital in Băile Felix. The other 30 patients were assigned to experimental group 2 and underwent treatment at home. They were assessed on the first and last day of the recovery program using the Fatigue Severity Scale (FSS) and the Pittsburgh Sleep Quality Index (PSQI). Results: In experimental group 1, where by patients underwent hospital recovery (EG1), the results show that the severity of fatigue (FSS) was significantly reduced, with p = 0.00 and an effect size of 0.77, which suggests a general improvement in the state of fatigue, as well as in the quality of sleep evaluated with the PSQI (p = 0.00, effect size = 0.55). In experimental group 2 (EG2), no change was observed between assessments in terms of the FSS, but in terms of the quality of sleep, there was a small decrease in the PSQI score (p = 0.083), with a small effect size of 0.09. Conclusions: The results show that, from a clinical point of view, a complex treatment carried out daily improves sleep quality and reduces fatigue.

Fibromyalgia: Understanding, Diagnosis and Modern Approaches to Treatment

Fibromyalgia (FM) is a chronic condition characterized by generalized musculoskeletal pain associated with other symptoms, especially sleep and mood disorders, fatigue, and cognitive dysfunctions. The etiopathogenesis of FM is not sufficiently known, and regardless of numerous research, the clinical presentation is nonspecific, which makes it difficult to approve a timely diagnosis and, subsequently, an adequate therapeutic approach. Genetic, hormonal, immunological, and environmental factors are cited as potential factors in the development of this condition. Diagnosis is based on a clinical approach and known diagnostic criteria, while additional methods, such as radiographic, magnetic resonance, or laboratory analyses, can be useful to exclude other conditions. The heterogeneity of FM significantly impacts both diagnosis and treatment, as it presents a wide spectrum of symptoms that vary in severity, combinations, and underlying contributing factors. This variability is a challenge for clinicians and requires a holistic, comprehensive, multidisciplinary, patient-centered approach. According to The European League Against Rheumatism (EULAR) from 2016, treatment begins with patient education and involves the simultaneous application of pharmacological and nonpharmacological treatments. The application of only pharmacological or nonpharmacological treatment is most often not successful. Due to differences in pain threshold, psychological factors, and comorbidities, patients may respond differently to the same interventions. Although there is no universal treatment, this review brings up the fact that the timely recognition of symptoms and a tailored treatment with a patient-centered plan can significantly improve the quality of life of patients.

Correlates of chronic pain onset and recovery in the CoLaus cohort

BACKGROUND

Only few previous cohort studies examined simultaneously predictors of chronic pain (CP) onset and recovery. Furthermore, these studies used various sociodemographic and pain-related characteristics, without standardized measures of sleep and depression. The present study aimed at expanding and strengthening these findings in a large Swiss population.

METHODS

We analysed data from a longitudinal cohort (n = 4602) collected at two time points separated by 5 years in Lausanne, Switzerland. We studied through two independent multivariable logistic regression models, the predictors of CP onset and recovery, including socio-demographic data as well as standardized measures of sleep and mood.

RESULTS

Chronic pain was reported by 43.1% and 44.4% of participants, with 11.6% at the second follow-up reporting moderate or intense pain. Neuropathic pain, regardless of intensity, had a more negative impact on quality of life. An inferential model (n = 1331) identified the male sex as predictive for recovering from CP. Older age, being overweight or obese (compared to normal weight), higher depression scores and pain medication intake were predictive for sustained pain at the second follow-up. A second model (n = 1886) identified being overweight or obese (compared to normal weight), low quality of sleep and being a former smoker (compared to a non-smoker) as predictive for developing CP, while the male sex was lowering the risk.

CONCLUSIONS

While sex and weight are associated with both recovery and new CP onset, separate variables also need to be considered in these processes, underlining specific factors to be addressed, depending on the context, whether preventive or therapeutic.

SIGNIFICANCE STATEMENT

Multivariable models in a Swiss cohort (N = 4602) associate male sex, not taking pain medication, normal weight, lower depression scores and younger age with recovery from chronic pain, while females, obese or overweight, having worse sleep and former smokers are associated with onset of new chronic pain. These common and separate factors need to be considered in treatment and prevention efforts.

Day-to-day associations between pain intensity and sleep outcomes in an adult chronic musculoskeletal pain population: A systematic review

BACKGROUND

In individuals with chronic musculoskeletal pain, a reciprocal relationship between sleep and pain across short and long-term evaluations exists. Sleep influences pain levels, while the level of pain also impairs sleep. However, given the day-to-day variability of both sleep and pain intensity, assessing this relationship within a daily time frame should be considered.

OBJECTIVES

To systematically review the literature concerning the bidirectional day-to-day relationship between night-time sleep variables and day-time pain intensity in individuals with chronic musculoskeletal pain.

METHODS

A systematic search (final search on October 12, 2023) in four databases (PubMed, Web of Science, Embase, PsycInfo) identified eligible articles based on pre-defined criteria. Three independent reviewers executed data extraction and risk of bias assessment using the "Quality In Prognosis Studies" tool. The study findings were synthesized narratively.

RESULTS

Eleven articles (1014 study participants; 83 associations) were included. A bidirectional relationship between pain intensity and sleep was found. Nine articles indicated night-time sleep quality to be a more consistent predictor for next day pain intensity than vice versa.

CONCLUSION

Nonetheless the bidirectional day-to-day sleep-pain relationship in individuals with chronic musculoskeletal pain, results suggest that self-reported sleep quality has a stronger predictive value on pain intensity then vice versa.

The relationship between preoperative sleep disturbance and acute postoperative pain control: A systematic review and meta-analysis

Poor preoperative sleep quality and impaired sleep continuity may heighten acute postoperative pain intensity and increase analgesic consumption, with negative implications for recovery, mental and physical health. The main objective of the current review was to investigate the relationship between preoperative sleep disturbance and acute postoperative pain control. Four electronic databases were systematically searched from inception to December 2023. Two reviewers screened articles, extracted data, and assessed risk of bias for each included study. The search identified 26 prospective cohort studies and 3 retrospective cohort studies (16104 participants). Of the 29 included studies, 23 focused on preoperative insomnia symptoms, and three studies each focused on preoperative objective sleep continuity or sleep-disordered breathing. Meta-analysis, based on five studies with 1226 participants, showed that clinically significant preoperative insomnia symptoms were associated with moderate to severe pain intensity on the first postoperative day (odds ratio 2.69 (95 % confidence interval 2.03-3.57), p < 0.0001). Qualitative analysis showed relatively robust associations between preoperative insomnia symptoms, impaired sleep continuity and poorer acute, as well as subacute, postoperative pain control. Findings related to obstructive sleep apnea syndrome were mixed. Given that insomnia is a potentially modifiable risk factor, interventions targeting sleep prior to surgery may improve postoperative pain control.

Exploring Pain and Opioid Misuse Among Patients With Sickle Cell Anemia: Associations With Health Literacy and Pain Catastrophizing

PURPOSE

This study aimed to investigate pain characteristics, opioid misuse prevalence, and the relationship between healthliteracy and pain catastrophising in patients with Sickle Cell Disease (SCD).

DESIGN

This was a cross-sectional study.

METHODS

Data were collected from patients with SCD in Oman. Validated tools were used to assess pain (Brief Pain Inventory), healthliteracy (HLS-Q12), opioid misuse (Current Opioid Misuse Measure [COMM]), and pain catastrophising (Pain Catastrophising Scale).

RESULTS

The study included 169 patients with SCD, with an average age of 34.4 (SD = 12.9) years, of whom 51.5% werefemale. A total of 79.3% of the participants reported experiencing pain, with an average total pain score of 3.8 (SD = 2.6).Additionally, 74% of the patients were identified as being at risk of opioid misuse. The risk of opioid misuse was positivelyassociated with pain catastrophising (r = 0.302, p < 0.001) and negatively associated with health literacy (r = -0.220, p = 0.005). Pain severity and interference are also linked to the risk of opioid misuse. Sociodemographic factors, such as age, sex, and education, showed no significant association with the risk of opioid misuse.

CONCLUSIONS

Patients with SCD face high rates of chronic pain and considerable risk of opioid misuse. Psychological factors, particularly pain catastrophising and lower healthliteracy, were strongly associated with misuse risk, while sociodemographic factors had less impact.

CLINICAL IMPLICATIONS

These findings highlight the need for targeted interventions addressing psychological support and health literacy to reduce opioidmisuse in SCD patients. Healthcare providers should integrate pain management strategies with educational programs to enhancehealth literacy and mitigate the psychological burden of pain.

Effects of Dexmedetomidine as an Adjuvant in Preoperative Ultrasound-Guided Internal Branch of Superior Laryngeal Nerve Block on Postoperative Sore Throat and Hemodynamics in Patients With Double-Lumen Endotracheal Intubation: A Randomized Controlled Trial

Background

Postoperative sore throat (POST) is a significant adverse effect after endotracheal intubation, especially with double-lumen endotracheal tubes (DLTs). Ultrasound-guided internal branch of the superior laryngeal nerve block (US-guided iSLNB) presents a potential intervention for POST. In this first randomized controlled trial to date, we aimed to investigate the effects of US-guided iSLNB, with or without perineural dexmedetomidine, on the incidence and severity of POST following DLTs.

Methods

A total of 159 patients were randomly assigned to three groups: control, bilateral US-guided iSLNB (2 mL 0.20% ropivacaine + 1 mL saline on each side), and bilateral US-guided iSLNB combined with perineural dexmedetomidine group (2 mL 0.20% ropivacaine + 1 mL 0.5 μg·kg-1 dexmedetomidine on each side). The incidence and severity of POST, hemodynamic fluctuations during intubation and extubation, the incidence and severity of cough and agitation during extubation, and perioperative complications were assessed. The primary outcome was the incidence of POST at 6 h after surgery.

Results

Compared with the control group, preoperative US-guided iSLNB significantly reduced the incidence and severity of POST at 1 and 6 h after surgery, mitigated the incidence and severity of cough during extubation, and attenuated hemodynamic responses, including heart rate, mean arterial pressure, and rate-pressure product during intubation, 1 min after intubation, and 1 min after extubation (all P < 0.01). Compared with US-guided iSLNB alone, the combination of US-guided iSLNB with perineural dexmedetomidine reduced the incidence and severity of POST at 1, 6, and 12 h, as well as coughing during extubation (all P < 0.01). However, it demonstrated little effect on hemodynamics (all P > 0.05). No significant perioperative complications were observed in the three groups (all P > 0.05).

Conclusion

Preoperative US-guided iSLNB combined with perineural dexmedetomidine effectively reduced the incidence, severity, and duration of POST and cough during extubation. No additional hemodynamic benefits were observed.

Clinical Trial Registration

Chinese Clinical Trial Registry (ChiCTR2200061001).

The Knee-SCHOOL: a brief patient-centered multidisciplinary educational program for knee osteoarthritis

Background

Knee osteoarthritis (KOA) is the most common form of arthritis in adults and a leading cause of years lived with disability, representing a significant burden on healthcare worldwide.

Objective

Describe the structure and educational elements of the Knee-SCHOOL, a brief patient-centered multidisciplinary educational program for patients with KOA.

Design

Observational prospective study.

Setting

Academically affiliated rehabilitation outpatient center in Brazil.

Methods

The program consisted of three in-person educational sessions (4.5 hr each) for 55 community dwelling adults, aged ≥50 years, with primary KOA-related pain. Study measures included demographic data (age, sex, and educational level), pain duration (years), pain intensity (visual analogue scale), affected knee (right, left, or both knees), comorbidities (presence of hypertension, diabetes, and hypercholesterolemia), Body Mass Index (BMI), Bristol Stool Scale, Adapted Healthy Eating Index (AHEI), bioelectrical impedance, daytime sleepiness, and the impact of the KOA on pain, symptoms, activities of daily living, recreation, and quality of life. Participants attended educational sessions delivered by a multidisciplinary team (two physicians, two nurses, two physical therapists, one occupational therapist, one dietitian, one psychologist, one social worker, and one physical educator) addressing several aspects of KOA. They also participated in supervised exercise practice and a home exercise program.

Results

Fifty-five subjects completed the study. The mean age was 67.73 (± 7.73) years; most were females (70.9%), 92.7% had bilateral KOA, with mean pain duration of 12.41 (± 10.17) years. The mean BMI was 32.52 (± 5.99), 65.5% were obese, and 96.4% reported an inadequate diet. KOA had a more negative impact on sports, recreation and quality of life. Daytime sleepiness was uncommon. The mean pain intensity, measured with visual analogue scale, score reduced from 5.52 (± 2.11) at baseline to 4.04 (± 2.38) after the program (week 2). The effect size was 0.7 (95% CI 0.32 to 1.07). All participants received the program well, with no drop-out rates or reported adverse events.

Conclusion

The Knee-SCHOOL utilized a multidisciplinary educational approach and an exercise practice addressing multiple aspects of KOA pain. While more studies are needed to assess the longitudinal impact of the program, it was promising in managing pain.

Well-being in pain questionnaire: A novel, reliable, and valid tool for assessment of the personal well-being in individuals with chronic low back pain

BACKGROUND

Well-being is closely related to health, recovery, and longevity. Chronic musculoskeletal pain (CMP) is a major health challenge in the general population, which can have a negative effect on subjective well-being. The ability to identify patients' well-being protective factors, including psychological, social, and lifestyle components, can help guide the therapeutic process in the management of CMP. Recognizing the absence of a dedicated well-being questionnaire, tailored specifically for CMP populations, an 11-item well-being in pain questionnaire (WPQ) was developed.

OBJECTIVES

The objectives were to develop a valid and reliable patient-reported measure of personal pain-specific well-being protective factors and to evaluate its psychometric properties, including (i) internal consistency; (ii) known-group validity between subjects with chronic low back pain (CLBP) and healthy pain-free controls; (iii) convergent validity between the WPQ and measures of health-related quality of life, catastrophizing, sleep quality, symptoms of central sensitization, and anxiety; and (iv) structural validity with exploratory factor analysis.

DESIGN

This is a cross-sectional validation study.

METHODS

After reviewing previous CMP and well-being literature, the novel WPQ items were constructed by expert consensus and target population feedback. The psychometric properties of the WPQ were evaluated in a sample of 145 participants, including 92 subjects with CLBP and 53 pain-free controls.

RESULTS

Feedback from a preliminary group of CMP patients about the relevance, content, and usability of the test items was positive. Internal consistency showed acceptable results (α = 0.89). The assessment of convergent validity showed moderate correlations (≤0.4 or ≥-0.4.) with well-established subject-reported outcome measures. The assessment of structural validity yielded a one-factor solution, supporting the unidimensionality of the WPQ.

CONCLUSIONS

The psychometric results provided evidence of acceptable reliability and validity of the WPQ. Further research is needed to determine the usability of the WPQ as an assessment and outcome tool in the comprehensive management of subjects with CMP.

Cryoneurolysis Associated With Improved Pain, Function, and Sleep in Patients Following total Knee Arthroplasty: Use of a New Real-World Registry

BACKGROUND

Total knee arthroplasty (TKA) is performed on approximately 790,000 patients annually in the United States and is projected to increase to 1.5 million by 2050. This study aimed at assessing the use of preoperative cryoneurolysis on patients undergoing TKA by analyzing: (1) pain severity; (2) opioid use; (3) functional status; and (4) sleep disturbance (SD) over 6 months following discharge.

METHODS

Patients enrolled in the Innovations in Genicular Outcomes Registry between September 2021 and February 2024 were followed for 6 months. Our analyses included patients undergoing unilateral primary TKA with no preoperative opioid prescription, who either received cryoneurolysis, or did not. Baseline patient demographics were collected before TKA and tabulated. Pain management was assessed via the Brief Pain Inventory-Short Form instrument for pain severity. SD was measured using the patient-reported outcomes measurement information system questionnaire. Each outcome measure was assessed prior to TKA, weekly, and at monthly follow-up. Data were analyzed by a generalized linear mixed-effect regression model to compare cryoneurolysis versus control patients, with a P < .05 as significant.

RESULTS

There were 80 patients who were treated with preoperative cryoneurolysis, while 60 control patients did not have treatment. Patients receiving cryoneurolysis experienced significantly lower pain severity and SD over the 6-month follow-up than control patients (P = .046). Cryoneurolysis was also associated with a trend toward greater functional improvement that did not reach statistical significance (P = .061). Further, patients who underwent cryoneurolysis were 72% less likely than control group patients to take opioids over 6 months following discharge (P < .001).

CONCLUSIONS

Preoperative cryoneurolysis therapy in opioid-naive patients undergoing TKA is associated with improved pain, decreased opioid use, and improved SD for 6 months postoperatively. Cryoneurolysis, a nonopioid pain relief modality administered preoperatively, demonstrated substantial benefits in patients who underwent TKA.

Neighborhood Disadvantage and Knee Osteoarthritis Pain: Do Sleep and Catastrophizing Play a Role?

OBJECTIVE

The objective was to examine potential pathways linking neighborhood disadvantage to pain severity in individuals with knee pain consistent with or at risk for knee osteoarthritis (KOA).

METHODS

The current investigation is a cross-sectional analysis. Data were collected from 140 middle-aged to older non-Hispanic White and non-Hispanic Black adults from the Understanding Pain and Limitations in Osteoarthritic Disease Study 2 (UPLOAD-2). Relationships among neighborhood disadvantage, sleep efficiency, pain catastrophizing, and pain severity were assessed. Neighborhood disadvantage was quantified using the Area Deprivation Index, and actigraphy data were used to assess sleep efficiency. The Coping Strategies Questionnaire-Revised catastrophizing subscale and the Western Ontario and McMaster Universities Osteoarthritis Index pain severity scale were used to assess pain catastrophizing and pain severity, respectively. A serial mediation model assessed the neighborhood-sleep-catastrophizing-pain pathway, as well as the neighborhood-sleep-pain and the neighborhood-catastrophizing-pain pathways.

RESULTS

Greater neighborhood disadvantage was associated with worse sleep efficiency, ultimately contributing to greater pain severity. Although neither neighborhood disadvantage nor sleep efficiency were associated with pain catastrophizing, pain catastrophizing itself was associated with greater KOA pain.

CONCLUSION

Neighborhood disadvantage impacts KOA pain outcomes through sleep efficiency but not pain catastrophizing, thereby highlighting environmental aspects that impact sleep as potential targets for intervention.

The effect of peer group management intervention on chronic pain intensity, number of areas of pain, and pain self-efficacy

OBJECTIVES

Chronic pain causes loss of workability, and pharmacological treatment is often not sufficient, whereas psychosocial treatments may relieve continual pain. This study aimed to investigate the effect of peer group management intervention among patients with chronic pain.

METHODS

The participants were 18-65-year-old employees of the Municipality of Helsinki (women 83%) who visited an occupational health care physician, nurse, psychologist, or physiotherapist for chronic pain lasting at least 3 months. An additional inclusion criterion was an elevated risk of work disability. Our study was a stepped wedge cluster, randomized controlled trial, and group interventions used mindfulness, relaxation, cognitive behavioral therapy, and acceptance and commitment therapy. We randomized sixty participants to either a pain management group intervention or to a waiting list with the same intervention 5 months later. After dropouts, 48 employees participated in 6 weekly group meetings. We followed up participants from groups A, B, and C for 12 months and groups D, E, and F for 6 months. As outcome measures, we used the pain Self-Efficacy Questionnaire, the number of areas of pain, the visual analog scale of pain, and the pain self-efficacy. We adjusted the results before and after the intervention for panel data, clustering effect, and time interval.

RESULTS

The peer group intervention decreased the number of areas of pain by 40%, from 5.96 (1-10) to 3.58 (p < 0.001), and increased the pain self-efficacy by 15%, from 30.4 to 37.5 (p < 0.001). Pain intensity decreased slightly, but not statistically significantly, from 7.1 to 6.8.

CONCLUSIONS

Peer group intervention for 6 weeks among municipal employees with chronic pain is partially effective. The number of areas of pain and pain self-efficacy were more sensitive indicators of change than the pain intensity. Any primary care unit with sufficient resources may implement the intervention.

UK medical cannabis registry: A clinical outcome analysis of medical cannabis therapy in chronic pain patients with and without co-morbid sleep impairment

INTRODUCTION

Chronic pain (CP) affects 35.0%-51.3% of the UK population, with 67%-88% reporting sleep disturbances. Cannabis-based medicinal products (CBMPs) have shown therapeutic potential in managing CP. Evidence suggests poor sleep worsens pain perception; therefore, this study aimed to assess patient-reported outcome measures (PROMs) following CBMP treatment in CP patients with and without co-morbid sleep impairment.

METHODS

A prospective cohort study of CP patients from the UK Medical Cannabis Registry was conducted. Participants were separated by baseline single-item sleep quality scale (SQS) score into sleep impaired (SQS ≤3) and unimpaired (SQS ≥4) cohorts. The primary outcome assessed changes in PROMs from baseline to 1-, 3-, 6-, and 12-months. Participants completed the following: SQS, General Anxiety Disorder-7, EQ-5D-5L, Brief Pain Inventory (BPI), and Short-Form McGill Pain Questionnaire-2. Significance was defined as p < 0.050.

RESULTS

1139 participants met the inclusion criteria (sleep impaired: n = 517, 45.4%; sleep unimpaired: n = 622, 54.61%). The sleep impaired cohort showed improvements in all PROMs at each follow-up (p < 0.010). The sleep unimpaired cohort showed similar results (p < 0.050), except in SQS and ED-5Q-5L: self-care and anxiety/depression scores (p > 0.050). However, the sleep impaired cohort observed greater improvements in BPI pain severity (p < 0.050) and SQS (p < 0.001) than the sleep unimpaired cohort at all follow-ups. 2817 adverse events were self-reported between both cohorts (p = 0.197).

DISCUSSION

These findings align with literature that shows associated improvements in pain outcomes following CBMP administration. Sleep impaired individuals were more likely to experience greater pain severity improvements. However, this was not confirmed on multivariate logistic regression analysis and instead may be confounded by baseline pain severity.

CONCLUSION

Whilst these results show promise for the effects of CBMPs on CP, they must be examined within the limitations of the study design. These findings provide further evidence to support the design of subsequent randomized controlled trials to verify causality between CBMPs and pain outcomes.

Sleep misperception in women with myofascial temporomandibular disorder

STUDY OBJECTIVES

Temporomandibular disorders (TMDs) were linked to poor sleep on the Pittsburgh Sleep Quality Index (PSQI), whereas polysomnography revealed no major sleep disturbances, implying sleep state misperception. This study investigates sleep state misperception in TMD and control participants; correlates sleep state misperception with objective short sleep duration (SSD), depression symptoms, daytime sleepiness, and orofacial pain; and compares objective SSD between the groups.

METHODS

General linear models were used to compare second-night polysomnography total sleep time, sleep latency, sleep efficiency (SE), and wake after sleep onset with homologous PSQI-derived variables in 124 women with myofascial TMD and 46 age and body mass index matched controls. PSQI variables were regressed onto objective SSD, depression symptoms, daytime sleepiness, and pain. Lastly, objective SSD was related to TMD presence.

RESULTS

Compared to controls, TMD cases misperceived SE (P = .02); depression symptoms explained PSQI-derived SE (P = .002) and mediated the effect of pain (P < .001). PSQI variables were unrelated to respective polysomnography measures or objective SSD, except a significant self-reported-objective correlation in SE among controls only (P = .002). Objective SSD was more frequent in TMD cases (P = .02, odds ratio = 2.95), but it was unrelated to depression symptoms, daytime sleepiness, or prepolysomnography pain.

CONCLUSIONS

The study demonstrates misperception of SE among TMD cases, which was accounted for by depression symptoms. Objective SSD nearly tripled in TMD cases; however, it was unrelated to PSQI variables, depression, daytime sleepiness, or pain, suggesting that sleep state misperception and objective SSD are 2 independent sleep features in TMD.

CITATION

Chan C, Dubrovsky B, Bouchard M, Tartter VC, Raphael KG. Sleep misperception in women with myofascial temporomandibular disorder. J Clin Sleep Med. 2025;21(1):55-64.

Relationships between orofacial pain and sleep: Analysis of UK biobank and genome-wide association studies data

Background/purpose

Orofacial pain is common in dental practices. This study aimed to explore relationships between orofacial pain and sleep using the UK Biobank dataset and, based on epidemiological associations, to investigate the causal association using genome-wide association studies data.

Materials and methods

First, a cross-sectional study was conducted with 196,490 participants from UK Biobank. Information on pain conditions and sleep traits was collected. Multivariable models were used to explore the relationships with odds ratio (OR). Second, Mendelian randomization analyses were conducted using data for orofacial pain, including temporomandibular joint disorders-related pain (n = 377,277) and atypical facial pain (n = 331,749), and sleep traits, including sleep duration (n = 446,118), short sleep (n = 411,934), long sleep (n = 339,926), snoring (n = 359,916), ease of getting up (n = 385,949), insomnia (n = 453,379), daytime dozing (n = 452,071), daytime napping (n = 452,633), and chronotype (n = 403,195).

Results

The cross-sectional study confirmed the bidirectionality between pain and sleep. Participants experiencing pain all over the body showed a significant association with an unhealthy sleep pattern (OR = 1.18, P < 0.001) and other sleep traits (P < 0.05). Risks of chronic orofacial pain were associated with sleep duration in a non-linear relationship (P = 0.032). The Mendelian randomization analyses indicated that long sleep was causally associated with temporomandibular joint disorders-related pain (OR = 6.77, P = 0.006).

Conclusion

The relationship between pain and sleep is bidirectional. Long sleep is found to be causally associated with chronic orofacial pain.

Sleeping Beauty? A Prospective Study on the Prevalence of Sleep Problems and Their Potential Determinants in Professional Dancers

BACKGROUND

Sleep is important for health and performance but has rarely been studied in professional dancers. The aim was to analyse the prevalence of sleep problems in professional dancers and their potential determinants at the beginning of and during the season.

METHODS

Professional dancers of six German companies answered a comprehensive baseline questionnaire on physical and mental health, including the Sleep Difficulty Score of the Athletic Sleep Screening questionnaire (ASSQ-SDS) in the beginning of the season and weekly health reports during the season. Numerical rating scales were used for severity of poor sleep, musculoskeletal pain, being stressed/overloaded, all health problems, impaired ability to dance, and workload in the previous seven days.

RESULTS

Of the 147 dancers who answered the baseline questionnaire, 104 (70.7%) completed in total 3186 weekly health reports (response rate: 71.2%). In the beginning of the season 53% of the dancers reported sleep problems of mild (34.0%), moderate (13.6%) or severe extent (5.4%), without differences between sexes, age groups, ranks of the dancers, company sizes or dance styles. The average weekly prevalence of "poor sleep" during the season was 68.8%. Multivariate regression analyses showed that symptoms of depression were significant determinants of sleep problems and the rating of "poor sleep" at baseline; while musculoskeletal pain, being stresses/overloaded, all health problems, impaired ability to dance, and physical and mental workload were significant determinants of "poor sleep" during the season. Variables of the baseline questionnaire were not significantly related to the individual mean rating of "poor sleep" during the season, except of the quality and duration of sleep.

CONCLUSION

Sleep problems are frequent in professional dancers and related to their physical and mental health and workload. An assessment of sleep should be part of routine health screenings and interventions to improve sleep should be implemented, especially for dancers with pre-existing sleep problems and for periods of high workload.

Identifying the Brain Circuits that Regulate Pain-Induced Sleep Disturbances

Pain therapies that alleviate both pain and sleep disturbances may be the most effective for pain relief, as both chronic pain and sleep loss render the opioidergic system, targeted by opioids, less sensitive and effective for analgesia. Therefore, we first studied the link between sleep disturbances and the activation of nociceptors in two acute pain models. Activation of nociceptors in both acute inflammatory (AIP) and opto-pain models led to sleep loss, decreased sleep spindle density, and increased sleep fragmentation that lasted 3 to 6 hours. This relationship is facilitated by the transmission of nociceptive signals through the spino-parabrachial pathways, converging at the wake-active PBelCGRP (parabrachial nucleus expressing Calcitonin Gene-Related Peptide) neurons, known to gate aversive stimuli. However, it has never been tested whether the targeted blocking of this wake pathway can alleviate pain-induced sleep disturbances without increasing sleepiness. Therefore, we next used selective ablations or optogenetic silencing and identified the key role played by the glutamatergic PBelCGRP in pain-induced sleep disturbances. Inactivating the PBelCGRP neurons by genetic deletion or optogenetic silencing prevented these sleep disturbances in both pain models. Furthermore, to understand the wake pathways underlying the pain-induced sleep disturbances, we silenced the PBelCGRP terminals at four key sites in the substantia innominata of the basal forebrain (SI-BF), the central nucleus of Amygdala (CeA), the bed nucleus of stria terminalis (BNST), or the lateral hypothalamus (LH). Silencing of the SI-BF and CeA also significantly reversed pain-induced sleep loss, specifically through the action on the CGRP and NMDA receptors. This was also confirmed by site-specific blockade of these receptors pharmacologically. Our results highlight the significant potential for selectively targeting the wake pathway to effectively treat pain and sleep disturbances, which will minimize risks associated with traditional analgesics.