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Zambelli Z, Halstead EJ, Fidalgo AR, Mangar S, Dimitriou D. Telehealth delivery of adapted CBT-I for insomnia in chronic pain patients: a single arm feasibility study. Front Psychol 2024; 14:1266368. [PMID: 38274683 PMCID: PMC10808483 DOI: 10.3389/fpsyg.2023.1266368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Objectives A large proportion of individuals with chronic pain experience insomnia-related symptoms which can be persistent in nature, and negatively impact one's quality of life. This single arm trial aimed to investigate the feasibility and preliminary efficacy of CBT-I, adapted for people with chronic musculoskeletal pain, delivered via telehealth. Methods We conducted a single arm feasibility trial in which 10 adult women (M age = 50.76 years, SD = 8.03 years) with self-reported insomnia and a diagnosed chronic musculoskeletal chronic pain received six CBT-I individual treatment sessions over 6-10 weeks. Treatment was delivered via telehealth. Participants completed weekly sleep diaries, and self-reported measures of insomnia, pain, anxiety and depression pre-treatment, post-treatment, and one-month follow-up. Results The trial yielded, high levels of compliance with intervention protocols, and affirmative feedback on satisfaction which demonstrated feasibility. The enrolment rate into the study was 37% (27 participants screened, 10 participants enrolled). The intervention was associated with statistically and clinically meaningful improvements in self-reported insomnia severity. There were statistically significant improvements in sleep efficiency, wake after sleep onset, sleep onset latency, anxiety and depression. Conclusion Adapted CBT-I delivered via telehealth may be a feasible, acceptable, and efficacious therapeutic approach for individuals with co-existent sleep and chronic pain. Future trials should adopt a randomized design against usual care.
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Affiliation(s)
- Zoe Zambelli
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London, United Kingdom
| | - Elizabeth J. Halstead
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London, United Kingdom
| | | | - Stephen Mangar
- Department of Clinical Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London, United Kingdom
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Yang MM, Riva-Cambrin J, Cunningham J, Casha S. Impact of preoperative insomnia on poor postoperative pain control after elective spine surgery and the modified Calgary postoperative pain after spine surgery (MCAPPS) score. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100261. [PMID: 37753373 PMCID: PMC10518606 DOI: 10.1016/j.xnsj.2023.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 09/28/2023]
Abstract
Background Approximately 30% to 64% of patients experience inadequate pain control following spine surgery. The Calgary postoperative pain after spine surgery (CAPPS) score was developed to identify this subset of patients. The impact of preoperative insomnia on postoperative pain control is unknown. This study aimed to investigate the relationship between preoperative insomnia and poor pain control after spine surgery, as well as improve the predictive accuracy of the CAPPS score. Methods A prospective cohort study was conducted in patients undergoing elective spine surgery. Poor pain control was defined as a mean numeric rating scale pain score >4 at rest within the first 24-hours after surgery. Patients were evaluated using the CAPPS score, which included 7 prognostic factors. A multivariable logistic regression model was used to examine the association between preoperative insomnia severity index (ISI) and poor pain control, adjusting for the CAPPS score. The Modified CAPPS score was derived from this model. Results Of 219 patients, 49.7% experienced poorly controlled pain. Prevalence of clinical insomnia (ISI≥15) was 26.9%. Preoperative ISI was independently associated with poor pain control (odds ratio [OR] 1.09, [95%CI=1.03-1.16], p=.004), after adjusting for the CAPPS score (OR 1.61, [95%CI=1.38-1.89], p<.001). The model exhibited good discrimination (c-statistics 0.80, [95%CI=0.74-0.86]) and calibration (Hosmer-Lemeshow chi-square=8.95, p=.35). The Modified CAPPS score also demonstrated good discrimination (c-statistic 0.78, [95%CI=0.72-0.84]) and calibration (Hosmer-Lemeshow chi-square=2.92, p=.57). Low-, high-, and extreme-risk groups stratified by the Modified CAPPS score had 17.3%, 49.1%, and 80.7% predicted probability of experiencing inadequate pain control compared to 32.0%, 64.0%, and 85.1% in the CAPPS score. Conclusions Preoperative insomnia is prevalent and is a modifiable risk factor for poor pain control following spine surgery. Early identification and management of preoperative insomnia may lead to improved postoperative pain outcomes. Future external validation is needed to confirm the accuracy of the Modified CAPPS score.
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Affiliation(s)
- Michael M.H. Yang
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, 1403 29 St NW, Calgary, Alberta, T2N 2T9, Canada
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta, T2N 4Z6, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada
| | - Jay Riva-Cambrin
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, 1403 29 St NW, Calgary, Alberta, T2N 2T9, Canada
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Jonathan Cunningham
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, 1403 29 St NW, Calgary, Alberta, T2N 2T9, Canada
| | - Steven Casha
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, 1403 29 St NW, Calgary, Alberta, T2N 2T9, Canada
- Hotchkiss Brain Institute, University of Calgary, 3300 Hospital Dr, Calgary, Alberta, T2N 4N1, Canada
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3
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DuPont CM, Olmstead R, Reid MJ, Hamilton KR, Campbell CM, Finan PH, Sadeghi N, Castillo D, Irwin MR, Smith MT. A randomized, placebo-controlled, double-blinded mechanistic clinical trial using endotoxin to evaluate the relationship between insomnia, inflammation, and affective disturbance on pain in older adults: A protocol for the sleep and Healthy Aging Research for pain (SHARE-P) study. Brain Behav Immun Health 2023; 30:100642. [PMID: 37256193 PMCID: PMC10225887 DOI: 10.1016/j.bbih.2023.100642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 06/01/2023] Open
Abstract
Chronic pain is prevalent in older adults. Treatment, especially with opioids, is often ineffective and poses considerable negative consequences in this population. To improve treatment, it is important to understand why older adults are at a heightened risk for developing chronic pain. Insomnia is a major modifiable risk factor for chronic pain that is ubiquitous among older adults. Insomnia can also lead to heightened systemic inflammation and affective disturbance, both of which may further exacerbate pain conditions in older adults. Endotoxin exposure can be used as an experimental model of systemic inflammation and affective disturbance. The current study aims to understand how insomnia status and endotoxin-induced changes in inflammation and affect (increased negative affect and decreased positive affect) may interact to impact pain facilitatory and inhibitory processes in older adults. Longitudinal data will also assess how pain processing, affective, and inflammatory responses to endotoxin may predict the development of pain and/or depressive symptoms. The current study is a randomized, double-blinded, placebo-controlled, mechanistic clinical trial in men and women, with and without insomnia, aged 50 years and older. Participants were randomized to either 0.8ng/kg endotoxin injection or saline placebo injection. Daily diaries were used to collect variables related to sleep, mood, and pain at two-week intervals during baseline and 3-, 6-, 9-, and 12-months post-injection. Primary outcomes during the experimental phase include conditioned pain modulation, temporal summation, and affective pain modulation ∼5.5 hours after injection. Primary outcomes for longitudinal assessments are self-reported pain intensity and depressive symptoms. The current study uses endotoxin as an experimental model for pain. In doing so, it aims to extend the current literature by: (1) including older adults, (2) investigating insomnia as a potential risk factor for chronic pain, (3) evaluating the role of endotoxin-induced affective disturbances on pain sensitivity, and (4) assessing sex differences in endotoxin-induced hyperalgesia. Clinicaltrialsgov NCT03256760. Trial sponsor NIH R01AG057750-01.
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Affiliation(s)
- Caitlin M. DuPont
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Richard Olmstead
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Matthew J. Reid
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Katrina R. Hamilton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Claudia M. Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Patrick H. Finan
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Nina Sadeghi
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Daisy Castillo
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michael R. Irwin
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michael T. Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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4
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The Effect of Shiatsu Therapy on Sleep Quality in Patients With Low Back Pain: A Secondary Analysis. Holist Nurs Pract 2023; 37:71-77. [PMID: 36790421 DOI: 10.1097/hnp.0000000000000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The aim of this study is to investigate the efficacy of shiatsu therapy for chronic low back pain and sleep disturbance. We conducted a secondary analysis of the randomized trial at a large academic hospital in Tokyo. Patients with chronic low back pain were included. Patients were randomly assigned to either shiatsu therapy in addition to standard care or standard care only by computer randomization. Our primary outcome was improvement of the global Pittsburgh Sleep Quality Index (PSQI) score, and the secondary outcomes were improvement in each component of the PSQI at weeks 4 and 8. We included a total of 59 patients. The mean age was 67.8 (SD: 13.5) years, and 21 patients (35.6%) were male. The global PSQI scores improved in the intervention group at week 4 (adjusted β coefficient: 1.16, 95% confidence interval: 0.10-2.21) and week 8 (adjusted β coefficient: 1.82, 95% confidence interval: 0.74-2.90). In terms of each component of the PSQI, sleep efficiency (component 4) and sleep disturbance (component 5) were improved, but use of sleep medication (component 5) worsened in the intervention group compared with the control group in several models. Shiatsu therapy in addition to standard therapy for chronic low back pain may improve sleep quality after intervention.
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5
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Selvanathan J, Tang NKY, Peng PWH, Chung F. Sleep and pain: relationship, mechanisms, and managing sleep disturbance in the chronic pain population. Int Anesthesiol Clin 2022; 60:27-34. [PMID: 35261343 DOI: 10.1097/aia.0000000000000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Janannii Selvanathan
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - Philip W H Peng
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ghafouri M, Teymourzadeh A, Nakhostin-Ansari A, Sepanlou SG, Dalvand S, Moradpour F, Bavarsad AH, Boogar SS, Dehghan M, Ostadrahimi A, Aghazadeh-Attari J, Kahnooji M, Hosseinipour A, Gohari A, Hosseini SV, Mirzaei M, Khorram A, Shahmoradi M, Pourfarzi F, Moosazadeh M, Mansour-Ghanaei F, Marioryad H, Najafi F, Genevay S, Moghadam N, Kordi R. Prevalence and predictors of low back pain among the Iranian population: Results from the Persian cohort study. Ann Med Surg (Lond) 2022; 74:103243. [PMID: 35145656 PMCID: PMC8801351 DOI: 10.1016/j.amsu.2022.103243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 12/19/2022] Open
Abstract
Background and objectives Low back pain (LBP) is a common health condition in populations. Limited large-scale population-based studies evaluated the prevalence and predictors of LBP in developing countries. This study aimed to evaluate the prevalence and factors associated with LBP among the Iranian population. Methods We used baseline information from the Prospective Epidemiological Research Studies in Iran (PERSIAN), including individuals from 16 provinces of Iran. LBP was defined as the history of back pain interfering with daily activities for more than one week during an individual's lifetime. Various factors hypothesized to affect LBP, such as age, sex, marital status, educational status, ethnicity, living area, employment status, history of smoking, body mass index (BMI), physical activity, sleep duration, wealth score, history of joint pain, and history of morning stiffness in the joints were evaluated. Results In total, 163770 Iranians with a mean age of 49.37 (SD = 9.15) were included in this study, 44.8% of whom were male. The prevalence of LBP was 25.2% among participants. After adjusting for confounders, the female gender [OR:1.244(1.02–1.50)], middle and older ages [OR:1.23(1.10–1.33) and OR:1.13(1.07–1.42), respectively], being overweight or obese [OR:1.13(1.07–1.19) and OR:1.21(1.16–1.27), respectively], former and current smokers (OR:1.25(1.16–1.36) and OR:1.28(1.17–1.39), respectively], low physical activity [OR:1.07(1.01–1.14)], and short sleep duration [OR: 1.09(1.02–1.17)] were significantly associated with LBP. Conclusion In this large-scale study, we found the lifetime prevalence of LBP to be lower among the Iranian population in comparison to the global prevalence of LBP; further studies are warranted to evaluate the causality of risk factors on LBP. The lifetime prevalence of low back pain in the Iranian population is 25.2%. Our survey includes 163770 people from 16 Iranian provinces. We used PERSIAN Cohort data which is the largest study conducted in Iran population. For analysis, we used both unadjusted and adjusted logistic regression models.
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Affiliation(s)
- Mohammad Ghafouri
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Teymourzadeh
- Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Nakhostin-Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadaf G. Sepanlou
- Digestive Disease Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Dalvand
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Moradpour
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | | | - Morteza Dehghan
- Department of Orthopedics, School of Medicine, And Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Alireza Ostadrahimi
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Aghazadeh-Attari
- Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Mahmood Kahnooji
- Department of Internal Medicine, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ali Hosseinipour
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Ali Gohari
- Department of Clinical Biochemistry and Nutrition, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Masoud Mirzaei
- Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Alireza Khorram
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mehdi Shahmoradi
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Farhad Pourfarzi
- Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Farid Najafi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Stephane Genevay
- Division of Rheumatology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Navid Moghadam
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author.
| | - Ramin Kordi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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7
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The role of mindfulness and relaxation in improved sleep quality following a mind-body and activity program for chronic pain. Mindfulness (N Y) 2021; 12:2672-2680. [PMID: 34900019 DOI: 10.1007/s12671-021-01729-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives Poor sleep quality is prevalent among individuals with chronic pain and contributes to increased physical and emotional dysfunction. However, treatments that improve sleep quality among individuals with chronic pain are scant. A previously developed mind-body activity program for chronic pain has been shown to be feasible and associated with improvements in pain and physical and emotional function. Using secondary data-analysis, the purpose of this study was to understand whether participants also experienced significant and sustained improvements in sleep quality over time and whether these improvements were explained by change in two core treatment targets, relaxation and mindfulness. Methods Participants with heterogenous chronic pain (N = 82) were randomized to a mind-body activity intervention with (GetActive-Fitbit; n=41) or without (GetActive; n=41) a Fitbit device. Sleep quality was measured with the PSQI, mindfulness with the CAMS-R, and relaxation with the relaxation subscale of the MOCS-A. Mediation was tested via mixed-models analysis. Results Both intervention groups experienced significant and comparable improvements in sleep quality from baseline to post-treatment, which were sustained through a 3-month follow-up. Mindfulness and relaxation also improved significantly over time and these improvements were associated with improved sleep quality. Mindfulness and relaxation fully mediated improvement in sleep quality (medium to large effect sizes). Conclusions Results suggest that, despite not targeting sleep explicitly, the two mind-body activity programs hold promise for sustainably improving sleep quality among patients with chronic pain. Targeting mindfulness and relaxation may facilitate these improvements.
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8
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Bean DJ, Horne J, Lee AC, Johnson MH. Pre-sleep cognitive arousal exacerbates sleep disturbance in chronic pain: an exploratory daily diary and actigraphy study. Scand J Pain 2021; 21:724-731. [PMID: 34116586 DOI: 10.1515/sjpain-2020-0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/17/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Insomnia is commonly comorbid with chronic pain, and typically leads to worse outcomes. Two factors that could contribute to a cycle of pain and sleeplessness are pre-sleep cognitive arousal (repetitive thought processes) and low mood. This study aimed to examine how pain, sleep disturbance, mood, and pre-sleep cognitive arousal inter-relate, to determine whether low mood or pre-sleep cognitive arousal contribute to a vicious cycle of pain and insomnia. METHODS Forty seven chronic pain patients completed twice daily diary measures and actigraphy for one week. Analyses investigated the temporal and directional relationships between pain intensity, sleep quality, time awake after sleep onset, anhedonic and dysphoric mood, and pre-sleep cognitive arousal. Fluctuations in predictor variables were used to predict outcome variables the following morning using mixed-effects modelling. RESULTS For people with chronic pain, an evening with greater pre-sleep cognitive arousal (relative to normal) led to a night of poorer sleep (measured objectively and subjectively), lower mood in the morning, and a greater misperception of sleep (underestimating sleep). A night of poorer sleep quality led to greater pain the following morning. Fluctuations in pain intensity and depression did not have a significant influence on subsequent sleep. CONCLUSIONS For people with chronic pain, cognitive arousal may be a key variable exacerbating insomnia, which in turn heightens pain. Future studies could target cognitive arousal to assess effects on sleep and pain outcomes.
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Affiliation(s)
- Debbie J Bean
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Juliette Horne
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand.,The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand
| | - Arier C Lee
- Department of Epidemiology & Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Malcolm H Johnson
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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9
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Zambelli Z, Halstead EJ, Fidalgo AR, Dimitriou D. Good Sleep Quality Improves the Relationship Between Pain and Depression Among Individuals With Chronic Pain. Front Psychol 2021; 12:668930. [PMID: 34025533 PMCID: PMC8138032 DOI: 10.3389/fpsyg.2021.668930] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022] Open
Abstract
Individuals with chronic pain often experience co-existing sleep problems and depression-related states. Chronic pain, sleep problems, and depression interrelate, and have been shown to exacerbate one another, which negatively impacts quality of life. This study explored the relationships between pain severity, pain interference, sleep quality, and depression among individuals with chronic pain. Secondly, we tested whether sleep quality may moderate the relationship between pain and depression. A cross-sectional survey was completed by 1,059 adults with non-malignant chronic pain conditions (M age 43 years, 88% identified as women) and collected measures related to pain severity, pain interference, sleep quality, and depression. Multiple regression analyses found that pain severity, pain interference, and sleep quality are all significantly associated with depression. Secondly, moderated regression analyses revealed that sleep quality moderates the relationship between pain interference and depression among individuals with chronic pain such that good sleep quality attenuates the effect of pain interference on depression, and poor sleep quality amplifies the effect of pain interference on depression. These findings suggest that sleep quality may be a relevant therapeutic target for individuals with chronic pain and co-existing depression.
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Affiliation(s)
- Zoe Zambelli
- Sleep Education and Research Laboratory, Psychology and Human Development, University College London-Institute of Education, London, United Kingdom
| | - Elizabeth J. Halstead
- Sleep Education and Research Laboratory, Psychology and Human Development, University College London-Institute of Education, London, United Kingdom
| | - Antonio R. Fidalgo
- Department of Psychology, University of East London, London, United Kingdom
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, Psychology and Human Development, University College London-Institute of Education, London, United Kingdom
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10
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Association between back pain and subjective health, wellbeing and sleep problems among older adults in six middle-income countries: a cross-sectional study. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01474-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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11
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Koffel E, Amundson E, Wisdom JP. Exploring the Meaning of Cognitive Behavioral Therapy for Insomnia for Patients with Chronic Pain. PAIN MEDICINE 2021; 21:67-75. [PMID: 31271434 DOI: 10.1093/pm/pnz144] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Insomnia is one of the most common, persistent, and distressing symptoms associated with chronic pain. Cognitive behavioral therapy for insomnia (CBT-I) is the firstline treatment for insomnia, but patient preferences and perspectives about CBT-I within the context of chronic pain are unknown. The current qualitative study sought to understand the experience of CBT-I among patients with chronic pain, including aspects of CBT-I that were found to be difficult (e.g., pain as a specific barrier to adherence/dropout), changes in sleep and pain functioning after CBT-I, and aspects of CBT-I that were appreciated. DESIGN Qualitative semistructured interviews. METHODS We conducted individual semistructured interviews with 17 veterans with chronic pain and insomnia who had recently participated in CBT-I, as well as their CBT-I therapists, and used thematic analysis to identify conceptual themes. RESULTS Results revealed that patients and CBT-I therapists found changing sleep habits during CBT-I challenging due to anxiety and temporary increases in fatigue, but did not identify major pain-related barriers to adhering to CBT-I recommendations; patients experienced better sleep, mood, energy, and socialization after CBT-I despite minimal changes in pain intensity; and patients highly valued CBT-I as a personalized treatment for sleep and strongly recommended it for other patients with chronic pain. CONCLUSIONS Findings of improved sleep and functional outcomes support efforts to incorporate CBT-I into chronic pain treatment, including educating patients and providers about the strong feasibility of improving sleep and quality of life despite ongoing pain.
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Affiliation(s)
- Erin Koffel
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Departments of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Erin Amundson
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Departments of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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12
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Climent-Sanz C, Morera-Amenós G, Bellon F, Pastells-Peiró R, Blanco-Blanco J, Valenzuela-Pascual F, Gea-Sánchez M. Poor Sleep Quality Experience and Self-Management Strategies in Fibromyalgia: A Qualitative Metasynthesis. J Clin Med 2020; 9:jcm9124000. [PMID: 33321937 PMCID: PMC7763602 DOI: 10.3390/jcm9124000] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/26/2020] [Accepted: 12/09/2020] [Indexed: 12/17/2022] Open
Abstract
Poor sleep quality is a major concern and a highly prevalent symptom in fibromyalgia. We aimed to develop a metasynthesis of qualitative studies to assess how people diagnosed with fibromyalgia experience and manage poor sleep quality following the concepts of the Symptom Management Theory. The principles of metasynthesis established by Sandelowski and Barroso were utilized. A pre-planned comprehensive search was implemented in PubMed, Scopus, ISI WebofScience, and Cinahl Plus databases. The methodological quality was assessed following the CASP Qualitative Checklist. The findings of the studies were subjected to a metasummary and a metasynthesis. Seventeen studies were included in the metasynthesis. Two overarching themes were pre-established: (1) experience of poor sleep quality in Fibromyalgia and (2) poor sleep quality management strategies in Fibromyalgia. Four sub-themes emerged from the results: (1) evaluation of poor sleep quality, (2) response to poor sleep quality, (3) management strategies to favor sleep, and (4) managing the consequences of a sleepless night. Poor sleep quality is a severe and disabling symptom that negatively impacts the general health status of people diagnosed with FM. Prescribed treatments are commonly seen as ineffective and self-management strategies are a last resort and do not show beneficial effects.
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Affiliation(s)
- Carolina Climent-Sanz
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (C.C.-S.); (G.M.-A.); (R.P.-P.); (J.B.-B.); (F.V.-P.); (M.G.-S.)
- Grup de Recerca de Cures en Salut, GRECS, Institut de Recerca Biomèdica de Lleida, Fundació Dr. Pifarré, 25198 Lleida, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain
| | - Genís Morera-Amenós
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (C.C.-S.); (G.M.-A.); (R.P.-P.); (J.B.-B.); (F.V.-P.); (M.G.-S.)
| | - Filip Bellon
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (C.C.-S.); (G.M.-A.); (R.P.-P.); (J.B.-B.); (F.V.-P.); (M.G.-S.)
- Grup de Recerca de Cures en Salut, GRECS, Institut de Recerca Biomèdica de Lleida, Fundació Dr. Pifarré, 25198 Lleida, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain
- Correspondence: ; Tel.: +34-973-70-24-68
| | - Roland Pastells-Peiró
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (C.C.-S.); (G.M.-A.); (R.P.-P.); (J.B.-B.); (F.V.-P.); (M.G.-S.)
- Grup de Recerca de Cures en Salut, GRECS, Institut de Recerca Biomèdica de Lleida, Fundació Dr. Pifarré, 25198 Lleida, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain
| | - Joan Blanco-Blanco
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (C.C.-S.); (G.M.-A.); (R.P.-P.); (J.B.-B.); (F.V.-P.); (M.G.-S.)
- Grup de Recerca de Cures en Salut, GRECS, Institut de Recerca Biomèdica de Lleida, Fundació Dr. Pifarré, 25198 Lleida, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain
| | - Fran Valenzuela-Pascual
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (C.C.-S.); (G.M.-A.); (R.P.-P.); (J.B.-B.); (F.V.-P.); (M.G.-S.)
- Grup de Recerca de Cures en Salut, GRECS, Institut de Recerca Biomèdica de Lleida, Fundació Dr. Pifarré, 25198 Lleida, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain
| | - Montserrat Gea-Sánchez
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (C.C.-S.); (G.M.-A.); (R.P.-P.); (J.B.-B.); (F.V.-P.); (M.G.-S.)
- Grup de Recerca de Cures en Salut, GRECS, Institut de Recerca Biomèdica de Lleida, Fundació Dr. Pifarré, 25198 Lleida, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain
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de Rooij A, van der Leeden M, Roorda LD, Rinkema M, Beuving W, Dekker J. Factors Associated With Sleep Quality in Patients With Chronic Widespread Pain Attending Multidisciplinary Treatment. Pain Pract 2020; 20:471-479. [PMID: 31999892 DOI: 10.1111/papr.12873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/20/2019] [Accepted: 01/12/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE (1) To investigate the prevalence of poor sleep quality and (2) to explore the associations between clinical, cognitive, and emotional factors and quality of sleep in patients with chronic widespread pain (CWP) receiving multidisciplinary treatment. METHOD Baseline data were used from 163 patients with CWP referred for multidisciplinary treatment. Linear regression models were used to assess the relationship of clinical (pain, fatigue, pain interference, and disability), emotional (anxiety, depression, and psychological distress), and cognitive factors (catastrophizing, acceptance, self-efficacy, kinesiophobia and illness beliefs) with sleep quality, as measured using the Pittsburgh Sleep Quality Index. RESULTS Poor sleep quality was found in 92% of the patients. The multivariable model showed that a higher level of fatigue (b = 1.77, standard error [SE] = 0.62, β = 0.21, t = 2.87, P < 0.01), psychological distress (b = 0.02, SE = 0.01, β = 0.27, t = 3.50, P < 0.01), and more concerns about the illness (b = 0.46, SE = 0.18, β = 0.20, t = 2.57, P = 0.01) were independently associated with poorer quality of sleep. The overall linear regression model explains 27.9% of sleep quality. CONCLUSIONS The high prevalence of poor sleep quality in patients with CWP referred for multidisciplinary treatment emphasizes the need to target sleep during treatment. Further research is needed to disentangle the cause-effect relationship between fatigue, psychological distress, and concerns about the illness and poor sleep (note: this abstract has been published before [Ann Rheum Dis. 2018;77:A1788]).
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Affiliation(s)
- Aleid de Rooij
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands
| | - Marieke Rinkema
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands
| | - Willemine Beuving
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
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14
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Mannes ZL, Ferguson EG, Perlstein WM, Waxenberg LB, Cottler LB, Ennis N. Negative health consequences of pain catastrophizing among retired National Football League athletes. Health Psychol 2020; 39:452-462. [PMID: 31999177 DOI: 10.1037/hea0000847] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study examined the association between pain catastrophizing with pain interference, depressive symptoms, and health-related quality of life (HRQoL) among National Football League (NFL) retirees. METHOD Former NFL athletes from the Retired NFL Players Association (N = 90) were recruited from 2018 to 2019 via telephone and were administered measures of pain, substance use, depressive symptoms, and HRQoL. Multiple linear and binomial regression analyses examined the association of pain catastrophizing with pain interference, depressive symptoms, and HRQoL while controlling for covariates (i.e., pain intensity, concussions, opioid use, binge alcohol use, years since NFL retirement, and marital status). RESULTS Many retired NFL athletes reported moderate-severe depressive symptoms as well as poorer perceived physical health compared with general medical patients. Greater pain catastrophizing was associated with more severe pain interference, greater odds of reporting moderate-severe depressive symptoms, and lower odds of reporting average and above physical and mental HRQoL after adjusting for relevant covariates. Concussions were not associated with any of the study outcomes. CONCLUSIONS Given the findings from this study, health care professionals should monitor symptoms of catastrophizing among current and retired NFL athletes. Assessment and requisite treatment of pain catastrophizing may assist these elite athletes in reducing depressive symptoms, while improving pain interference and HRQoL in this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Nicole Ennis
- Department of Behavioral Sciences and Social Medicine
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15
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Relationships Between Psychological, Social, Physical Activity, and Sleep Measures and Somatosensory Function in Individuals With Spinal Pain: A Systematic Review and Meta-analysis. Clin J Pain 2019; 36:124-134. [PMID: 31764166 DOI: 10.1097/ajp.0000000000000775] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Somatosensory abnormalities are linked to clinical pain outcomes in individuals with spinal pain. However, a range of factors might confound the relationship between altered somatosensory function and clinical pain outcomes. This systematic review aimed to evaluate the literature to assess the level of evidence of associations between psychological, social, physical activity, and sleep measures and somatosensory function (assessed via sensory psychophysical testing) among individuals with spinal pain. METHODS A comprehensive literature search was performed in 6 electronic databases from their inception to June 2018. Two reviewers independently assessed the methodological quality using a modified Quality in Prognostic Studies (QUIPS) tool and supplemented with recommendations from the Critical Appraisal and Data Extraction for the Systematic Review of Prediction Modelling Studies (CHARMS) checklist and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The level of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Data were pooled to evaluate the strength of the relationships of interest. RESULTS Among the 17 factors identified in the included studies, pain catastrophizing, depression, and pain-related fear have significant negative (small to fair) associations with pain thresholds. A "very low" to "moderate" quality of evidence was found for all the investigated factors. Subgroup analysis showed a smaller effect size for pain catastrophizing/fear of movement and pain thresholds in individuals with low back pain. CONCLUSIONS Psychological factors are associated negatively with pain thresholds and they need to be adjusted when establishing predictive relationships between somatosensory function and pain outcomes in individuals with spinal pain.
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16
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Kim HK, Kim ME. Phenotyping 1488 patients with painful temporomandibular disorders and its relevance to subjective sleep quality: A key step for stratified medicine. Cranio 2019; 39:491-501. [DOI: 10.1080/08869634.2019.1682750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Hye-Kyoung Kim
- Department of Orofacial Pain and Oral Medicine, College of Dentistry, Dankook University, Cheonan, South Korea
| | - Mee-Eun Kim
- Department of Orofacial Pain and Oral Medicine, College of Dentistry, Dankook University, Cheonan, South Korea
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17
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Vega RDL, Miró J, Esteve R, Ramírez-Maestre C, López-Martínez AE, Jensen MP. Sleep disturbance in individuals with physical disabilities and chronic pain: The role of physical, emotional and cognitive factors. Disabil Health J 2019; 12:588-593. [PMID: 31076226 DOI: 10.1016/j.dhjo.2019.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 04/15/2019] [Accepted: 04/23/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sleep problems are common for individuals living with physical disabilities and chronic pain. However, the factors that influence the relationship between pain and sleep problems in these populations remain unknown. OBJECTIVE The aim of this study was to increase our understanding of the physical, emotional and cognitive factors associated with sleep disturbance in individuals with chronic health conditions often associated with physical disabilities. METHODS Participants were recruited from a database of individuals with a variety of chronic health conditions, including multiple sclerosis, spinal cord injury, back pain, osteoarthritis, and amputations. To participate in the study, they needed to report having a chronic pain problem. Participants completed an online survey using REDCap assessing average pain intensity (Numerical Rating Scale-11), pain extent (number of painful body areas), sleep disturbance (PROMIS Sleep Disturbance), depression (PROMIS Emotional Distress-Depression) and catastrophizing (Coping Strategies Questionnaire). A total of 455 participants (Mage = 58.9; SD = 11.4), of which 292 (64%) were women, provided complete data. We performed a series of four regression analyses. RESULTS After controlling for age and sex, the predictors explained an additional 7-16% of the variance in sleep disturbance. The final model with all of the predictors explained 22%. CONCLUSIONS Consistent with the study hypothesis, all the variables examined made significant and independent contributions to the variance in sleep disturbance. The findings provide additional evidence that physical, emotional and cognitive factors all play a role in the sleep quality of individuals with chronic health conditions often associated with physical disabilities.
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Affiliation(s)
- Rocío de la Vega
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Jordi Miró
- Unit for the Study and Treatment of Pain-ALGOS and Research Center for Behavior Assessment (CRAMC), Department of Psychology and Institut d'Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Rosa Esteve
- Universidad de Málaga, Andalucía Tech, Facultad de Psicología, Málaga, Spain
| | | | | | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
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18
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Puzino K, Frye SS, LaGrotte CA, Vgontzas AN, Fernandez-Mendoza J. Am I (hyper)aroused or anxious? Clinical significance of pre-sleep somatic arousal in young adults. J Sleep Res 2019; 28:e12829. [PMID: 30714242 DOI: 10.1111/jsr.12829] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/10/2018] [Accepted: 12/27/2018] [Indexed: 11/30/2022]
Abstract
Self-reported somatic arousal remains a challenging clinical construct, particularly because only a subset of patients report symptoms such as racing heart, palpitations or increased body temperature interfering with their sleep. It is unclear whether self-reported somatic arousal is a marker of hyperarousal or co-morbid clinical anxiety in individuals with insomnia. Participants included 196 young adults aged 20.2 ± 1.0 years old who were predominantly females (75%). About 39% of the sample reported subthreshold insomnia, and about 8% reported clinically significant insomnia, based on their Insomnia Severity Index. Participants completed the Pre-Sleep Arousal Scale, Beck Anxiety Inventory, Beck Depression Inventory, Arousal Predisposition Scale, and Ford Insomnia Response to Stress Test. Multivariable stepwise regression assessed which factors were independently associated with pre-sleep cognitive (Pre-Sleep Arousal Scale-Cognitive) and somatic (Pre-Sleep Arousal Scale-Somatic) arousal. Receiver-operating characteristic analysis assessed the predictive value to identify clinically significant anxiety (Beck Anxiety Inventory ≥ 20), insomnia (Insomnia Severity Index ≥ 15) and arousability (Arousal Predisposition Scale ≥ 32). Beck Anxiety Inventory (β = 0.42) was the best single correlate of Pre-Sleep Arousal Scale-Somatic, while Insomnia Severity Index (β = 0.33) was of Pre-Sleep Arousal Scale-Cognitive. A Pre-Sleep Arousal Scale-Somatic score of 12 or more identified those with clinically significant anxiety with 65% specificity and 65% sensitivity, while a cut-off score of 14 increased its sensitivity (86%). Self-reported pre-sleep somatic arousal may be an index of co-morbid clinical anxiety in individuals with insomnia. These findings aid clinicians with assessment and treatment, particularly in the absence of clinical guidelines indicating when somatically focused relaxation techniques should be included as part of multicomponent cognitive behavioural treatment of insomnia.
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Affiliation(s)
- Kristina Puzino
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Sara S Frye
- College of Education, University of Arizona, Tucson, Arizona, USA
| | - Caitlin A LaGrotte
- College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Alexandros N Vgontzas
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Julio Fernandez-Mendoza
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
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Owen-Smith AA, Ahmedani BK, Peterson E, Simon GE, Rossom RC, Lynch FL, Lu CY, Waitzfelder BE, Beck A, DeBar LL, Sanon V, Maaz Y, Khan S, Miller-Matero LR, Prabhakar D, Frank C, Drake CL, Braciszewski JM. The Mediating Effect of Sleep Disturbance on the Relationship Between Nonmalignant Chronic Pain and Suicide Death. Pain Pract 2019; 19:382-389. [PMID: 30462885 DOI: 10.1111/papr.12750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/08/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022]
Abstract
IMPORTANCE Few studies have examined the relationship between nonmalignant chronic pain (NMCP) and suicide death, and even fewer have specifically explored what role sleep disturbance might play in the association between NMCP and suicide death. OBJECTIVE To assess whether sleep disturbance mediates the relationship between NMCP and suicide death. DESIGN This case-control study included 2,674 individuals who died by suicide between 2000 and 2013 (cases) and 267,400 matched individuals (controls). SETTING Eight Mental Health Research Network (MHRN)-affiliated healthcare systems. PARTICIPANTS All cases and matched controls were health plan members for at least 10 months during the year prior to the index date. MAIN OUTCOMES AND MEASURES Sociodemographic data and diagnosis codes for NMCP and sleep disorders were extracted from the MHRN's Virtual Data Warehouse. Suicide mortality was identified using International Statistical Classification of Diseases and Related Health Problems (ICD)-10 codes from official government mortality records matched to health system records. RESULTS After accounting for covariates, there was a significant relationship between NMCP and sleep disturbance; those who were diagnosed with NMCP were more likely to develop subsequent sleep disturbance. Similarly, sleep disturbance was significantly associated with suicide death. Finally, a significant indirect effect of NMCP on suicide death, through sleep disturbance, and a nonsignificant direct effect of NMCP on suicide death provide support for a fully mediated model. CONCLUSIONS AND RELEVANCE There is a need for clinicians to screen for both sleep disturbance and suicidal ideation in NMCP patients and for health systems to implement more widespread behavioral treatments that address comorbid sleep problems and NMCP.
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Affiliation(s)
- Ashli A Owen-Smith
- School of Public Health, Georgia State University, Atlanta, Georgia, U.S.A.,Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, Georgia
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, U.S.A.,Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Ed Peterson
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Gregory E Simon
- Kaiser Permanente Washington, Health Research Institute, Seattle, Washington, U.S.A
| | | | - Frances L Lynch
- Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, U.S.A
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, U.S.A
| | - Beth E Waitzfelder
- Kaiser Permanente Hawaii, Center for Health Research, Honolulu, Hawaii, U.S.A
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, Colorado, U.S.A
| | - Lynn L DeBar
- Kaiser Permanente Washington, Health Research Institute, Seattle, Washington, U.S.A
| | - Victoria Sanon
- School of Public Health, Georgia State University, Atlanta, Georgia, U.S.A
| | - Yousef Maaz
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Shehryar Khan
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Lisa R Miller-Matero
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, U.S.A.,Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Deepak Prabhakar
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Cathy Frank
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Christopher L Drake
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, U.S.A
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20
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Sleep disturbances and sleep disorders in adults living with chronic pain: a meta-analysis. Sleep Med 2018; 52:198-210. [DOI: 10.1016/j.sleep.2018.05.023] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/01/2018] [Accepted: 05/24/2018] [Indexed: 11/23/2022]
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21
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Glette M, Landmark T, Jensen MP, Woodhouse A, Butler S, Borchgrevink PC, Stiles TC. Catastrophizing, Solicitous Responses From Significant Others, and Function in Individuals With Neuropathic Pain, Osteoarthritis, or Spinal Pain in the General Population. THE JOURNAL OF PAIN 2018; 19:983-995. [DOI: 10.1016/j.jpain.2018.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 02/28/2018] [Accepted: 03/26/2018] [Indexed: 01/22/2023]
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22
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Lerman SF, Campbell CM, Buenaver LF, Medak M, Phillips J, Polley M, Smith MT, Haythornthwaite JA. Exploring the Role of Negative Cognitions in the Relationship Between Ethnicity, Sleep, and Pain in Women With Temporomandibular Joint Disorder. THE JOURNAL OF PAIN 2018; 19:1342-1351. [PMID: 29890298 DOI: 10.1016/j.jpain.2018.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/16/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022]
Abstract
Negative cognitions are central to the perpetuation of chronic pain and sleep disturbances. Patients with temporomandibular joint disorder (TMJD), a chronic pain condition characterized by pain and limitation in the jaw area, have a high comorbidity of sleep disturbances that possibly exacerbate their condition. Ethnic group differences are documented in pain, sleep, and coping, yet the mechanisms driving these differences are still unclear, especially in clinical pain populations. We recruited 156 women (79% white, 21% African American) diagnosed with TMJD as part of a randomized, controlled trial evaluating the effectiveness of interventions targeting sleep and pain catastrophizing on pain in TMJD. Analysis of baseline data demonstrated that, relative to white participants, African Americans exhibited higher levels of clinical pain, insomnia severity, and pain catastrophizing, yet there was no ethnic group difference in negative sleep-related cognitions. Mediation models revealed pain catastrophizing, but not sleep-related cognitions or insomnia severity, to be a significant single mediator of the relationship between ethnicity and clinical pain. Only the helplessness component of catastrophizing together with insomnia severity sequentially mediated the ethnicity-pain relationship. These findings identify pain catastrophizing as a potentially important link between ethnicity and clinical pain and suggest that interventions targeting pain-related helplessness could improve both sleep and pain, especially for African American patients. Perspective:Pain-related helplessness and insomnia severity contribute to ethnic differences found in clinical pain among woman with TMJD. Findings can potentially inform interventions that target insomnia and catastrophizing to assist in reducing ethnic disparities in clinical pain.
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Affiliation(s)
- Sheera F Lerman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine. Baltimore, Maryland..
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine. Baltimore, Maryland
| | - Luis F Buenaver
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine. Baltimore, Maryland
| | - Mary Medak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine. Baltimore, Maryland
| | - Jane Phillips
- Department of Neural and Pain Sciences, Brotman Facial Pain Center, University of Maryland School of Dentistry, Baltimore, Maryland
| | - Michelle Polley
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine. Baltimore, Maryland
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine. Baltimore, Maryland
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23
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Lerman SF, Finan PH, Smith MT, Haythornthwaite JA. Psychological interventions that target sleep reduce pain catastrophizing in knee osteoarthritis. Pain 2017; 158:2189-2195. [PMID: 28767510 PMCID: PMC5640483 DOI: 10.1097/j.pain.0000000000001023] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pain catastrophizing is a significant risk factor for patients with knee osteoarthritis (KOA) and thus is a target for many psychological interventions for pain. This study examined if interventions targeting sleep found to be effective in improving sleep in KOA also reduce pain catastrophizing measured as a trait through the pain catastrophizing scale and measured as a daytime and nocturnal state through daily diaries. Secondary analyses were conducted on data collected as part of a randomized controlled trial assessing the effectiveness of cognitive behavioral therapy for insomnia in patients with KOA at 5 different time points: pretreatment, midtreatment and posttreatment and at 3- and 6-month follow-up. One hundred patients diagnosed with KOA and insomnia were randomized to receive either 8 sessions of cognitive behavioral therapy for insomnia or a placebo intervention of behavioral desensitization. Multilevel modeling revealed that both intervention groups showed a significant reduction pretreatment to posttreatment in all 3 measures of pain catastrophizing and maintained stable levels through the 6-month follow-up. Increased sleep continuity early in treatment (pretreatment to midtreatment), but not reductions in pain, was associated with a reduction in trait and nocturnal catastrophizing later in treatment (midtreatment to posttreatment). These results suggest that short interventions focusing on sleep can significantly reduce pain catastrophizing even in a clinical population with low baseline levels of catastrophizing, possibly through improving sleep continuity.
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Affiliation(s)
- Sheera F Lerman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Dragioti E, Levin LÅ, Bernfort L, Larsson B, Gerdle B. Insomnia severity and its relationship with demographics, pain features, anxiety, and depression in older adults with and without pain: cross-sectional population-based results from the PainS65+ cohort. Ann Gen Psychiatry 2017; 16:15. [PMID: 28250802 PMCID: PMC5324239 DOI: 10.1186/s12991-017-0137-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/16/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Insomnia is a major cause of concern in the elderly with and without pain. This study set out to examine the insomnia and its correlates in a large sample of community adults aged ≥65 years. METHODS A cross-sectional postal survey was completed by 6205 older individuals (53.8% women; mean age = 76.2 years; SD = 7.5). The participants also completed the Insomnia Severity Index (ISI) and questionnaires assessing pain intensity, pain spreading, anxiety, depression, and basic demographic information. The sample was divided into three groups based on the presence and duration of pain: chronic pain (CP; n = 2790), subacute pain (SP; n = 510), and no pain (NP; n = 2905). RESULTS A proportion of each of the groups had an ISI score of 15 or greater (i.e., clinical insomnia): CP = 24.6%; SP = 21.3%; and NP = 13.0%. The average scores of ISI differed significantly among CP, SP, and NP groups (p < 0.001). Stratified regression analyses showed that pain intensity, pain spreading, anxiety, and depression were independently related to insomnia in the CP group. Anxiety and depression were independently related to insomnia in the SP group, but only anxiety was significantly associated with insomnia in the NP group. Age and sex were not associated with insomnia. CONCLUSIONS This study confirms that insomnia is not associated with chronological aging per se within the elderly population. Although the possible associations of insomnia with pain are complex, ensuing from pain intensity, pain spreading, anxiety, and depression, our results highlighted that anxiety was more strongly associated with insomnia in all groups than the depression and pain characteristics. Therapeutic plans should consider these relations during the course of pain, and a comprehensive assessment including both pain and psychological features is essential when older people are seeking primary health care for insomnia complaints.
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Affiliation(s)
- Elena Dragioti
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences (IMH), Linköping University, 581 85 Linköping, Sweden
| | - Lars-Åke Levin
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, 581 85 Linköping, Sweden
| | - Lars Bernfort
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, 581 85 Linköping, Sweden
| | - Britt Larsson
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences (IMH), Linköping University, 581 85 Linköping, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences (IMH), Linköping University, 581 85 Linköping, Sweden
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Lindholm P, Lamusuo S, Taiminen T, Virtanen A, Pertovaara A, Forssell H, Hagelberg N, Jääskeläinen S. The analgesic effect of therapeutic rTMS is not mediated or predicted by comorbid psychiatric or sleep disorders. Medicine (Baltimore) 2016; 95:e5231. [PMID: 27858874 PMCID: PMC5591122 DOI: 10.1097/md.0000000000005231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Mechanisms underlying alleviation of neuropathic pain by repetitive transcranial magnetic stimulation (rTMS) of primary motor cortex (M1) and right secondary somatosensory cortex (S2) are only partly known. Patients with chronic neuropathic pain often have comorbidities like depression and sleep problems. Through functional connectivity, rTMS of M1 and S2 may activate dorsolateral prefrontal cortex, the target for treating depression with rTMS. Thus, the analgesic effect of rTMS could be mediated indirectly via improvement of psychiatric comorbidities or sleep. We examined whether rTMS has an independent analgesic effect or whether its clinical benefits depend on effects on mood or sleep. We also evaluated if comorbid psychiatric or sleep disorders predict the treatment outcome. METHODS Sixteen patients with chronic drug-resistant neuropathic orofacial pain participated in this randomized controlled crossover rTMS study. Patients' psychiatric history was evaluated by a specialist in psychiatry. Intensity and interference of pain, mood, and the quality of sleep and life were evaluated at baseline and after 2 active (primary somatosensory cortex [S1]/M1 and S2) and placebo rTMS treatments. A logistic regression analysis was done to investigate predictors of treatment outcome. RESULTS The analgesic effect of the right S2 stimulation was not associated with improvement of psychiatric conditions or sleep, whereas S1/M1 stimulation improved sleep without significant analgesic effect (P = 0.013-0.046 in sleep scores). Psychiatric and sleep disorders were more common in patients than in the general population (P = 0.000-0.001 in sleep scores), but these comorbidities did not predict the rTMS treatment outcome. CONCLUSION We conclude that rTMS to the right S2 does not exert its beneficial analgesic effects in chronic neuropathic orofacial pain via indirect improvement of comorbid psychiatric or sleep disorders.
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Affiliation(s)
- Pauliina Lindholm
- Division of Clinical Neuroscience Department of Clinical Neurophysiology Department of Psychiatry, Turku University Hospital, University of Turku, Turku Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki Institute of Dentistry Pain Clinic, Turku University Hospital, University of Turku, Turku, Finland
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Afolalu EF, Moore C, Ramlee F, Goodchild CE, Tang NKY. Development of the Pain-Related Beliefs and Attitudes about Sleep (PBAS) Scale for the Assessment and Treatment of Insomnia Comorbid with Chronic Pain. J Clin Sleep Med 2016; 12:1269-77. [PMID: 27448428 DOI: 10.5664/jcsm.6130] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/16/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Dysfunctional beliefs and attitudes about sleep is a cognitive-behavioral factor central to the development and perpetuation of insomnia. Previous works to unravel the complex interrelationship between pain and insomnia have not explored the role of inflexible beliefs about the sleep-pain interaction, possibly due to a lack of a valid instrument for doing so. The current study evaluated the psychometric and functional properties of a 10-item Pain-Related Beliefs and Attitudes about Sleep (PBAS) scale. METHODS The PBAS scale was administered to four clinical samples of chronic pain patients with comorbid insomnia: to examine the scale's psychometric properties (n = 137), test-retest reliability (n = 26), sensitivity to treatment (n = 20), and generalizability (n = 62). All participants completed the PBAS together with validated measures of pain interference, insomnia severity, and cognitive-behavioral processes hypothesized to underpin insomnia. RESULTS The PBAS scale was found to be reliable, with adequate internal consistency and temporal stability. Factor analysis suggested a 2-factor solution representing beliefs about "pain as the primary cause of insomnia" and the "inevitable consequences of insomnia on pain and coping." The PBAS total score was positively correlated with scores from the Insomnia Severity Index (ISI) scale, Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scale, and the Anxiety and Preoccupation about Sleep Questionnaire (APSQ). It was a significant predictor of insomnia severity and pain interference. A significant reduction in PBAS was also observed in patients after receiving a hybrid cognitive-behavioral intervention for both pain and insomnia. CONCLUSIONS Pain-related sleep beliefs appear to be an integral part of chronic pain patients' insomnia experience. The PBAS is a valid and reliable instrument for evaluating the role of these beliefs in chronic pain patients.
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Affiliation(s)
| | - Corran Moore
- Department of Psychology, University of Warwick, Coventry, UK
| | - Fatanah Ramlee
- Department of Psychology, University of Warwick, Coventry, UK
| | | | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
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Sleep Problems are Associated With Chronic Pain Over and Above Mutual Associations With Depression and Catastrophizing. Clin J Pain 2016; 32:792-9. [DOI: 10.1097/ajp.0000000000000329] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
Insomnia most commonly presents comorbidly in association with medical and psychiatric disorders. Comorbid insomnia, however, remains under treated in the majority of patients. Concerns about drug interactions, adverse events, and dependence as well as the assumption that treating the insomnia as a secondary presentation that will resolve when the primary condition improves are all factors that contribute to the under treatment of comorbid insomnia. This article presents the growing research evidence that highlights the benefits and importance of targeting the insomnia that presents comorbidly with medical and psychiatric conditions utilizing the nonpharmacological and effective treatment of cognitive behavior therapy.
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Affiliation(s)
- Suma P Chand
- Department of Neurology and Psychiatry, Saint Louis University School of Medicine, Grand Blvd, St. Louis, MO, USA
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Byers HD, Lichstein KL, Thorn BE. Cognitive processes in comorbid poor sleep and chronic pain. J Behav Med 2015; 39:233-40. [PMID: 26458949 DOI: 10.1007/s10865-015-9687-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 09/30/2015] [Indexed: 10/23/2022]
Abstract
We examined the unique and shared contributions of pain catastrophizing, cognitive pre-sleep arousal, and somatic pre-sleep arousal, to the prediction of insomnia severity in chronic pain. Forty-eight adults with chronic pain completed self-report measures of these study variables, health, and mood. Hierarchical regression showed that pain catastrophizing accounted for unique variance in insomnia severity, independent of pain intensity, depression, restless legs symptoms, and demographics. However, when cognitive and somatic pre-sleep arousal were also taken into account, the significance of cognitive pre-sleep arousal rendered pain catastrophizing non-significant. We identify research and clinical implications of this study.
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Affiliation(s)
- Haley D Byers
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL, 35487-0348, USA
| | - Kenneth L Lichstein
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL, 35487-0348, USA.
| | - Beverly E Thorn
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL, 35487-0348, USA
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Jeff Bryson W, Read JB, Bush JP, Edwards CL. The Need for an Integrated Cognitive-Behavioral Model for Co-occurring Chronic Pain and Insomnia. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2015. [DOI: 10.1007/s10942-015-0213-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Edwards MJ, Tang NK, Wright AM, Salkovskis PM, Timberlake CM. Thinking about thinking about pain: a qualitative investigation of rumination in chronic pain. Pain Manag 2014; 1:311-23. [PMID: 24645658 DOI: 10.2217/pmt.11.29] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED SUMMARY AIMS A thinking process central to the etiology of emotional disorders, rumination is commonly observed in chronic pain. However, very little is understood about the characteristics of pain-related rumination and the mechanisms through which rumination impacts on pain perception and disability. This study began investigating this cognitive phenomenon by qualitatively examining chronic pain patients' experience of rumination. METHODS Semistructured interviews were conducted with 20 chronic pain patients. Themes were extracted from interview transcripts using thematic analysis. RESULTS Six themes were extracted from interviews with frequent ruminators. These elucidated the pattern of rumination and suggested a reciprocal relationship of rumination with not only pain, but also negative emotions and sleeplessness. Frequent ruminators appeared to hold positive beliefs about rumination and negative beliefs about self in overcoming pain. Two themes were extracted from interviews with infrequent ruminators: implicating negative beliefs about rumination and the flexible use of disengagement strategies in these individuals. CONCLUSION Rumination occurs frequently and can be easily triggered by pain, negative emotions and sleeplessness in patients who lack alternative coping strategies and believe rumination is a way to problem-solve. A tentative model of pain-related rumination has been proposed, outlining interesting hypotheses for rigorous empirical investigations.
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Affiliation(s)
- Melanie J Edwards
- Department of Psychology, Institute of Psychiatry, King's College London, UK
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Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. THE JOURNAL OF PAIN 2013; 14:1539-52. [PMID: 24290442 PMCID: PMC4046588 DOI: 10.1016/j.jpain.2013.08.007] [Citation(s) in RCA: 823] [Impact Index Per Article: 74.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/29/2013] [Accepted: 08/09/2013] [Indexed: 12/11/2022]
Abstract
UNLABELLED Ample evidence suggests that sleep and pain are related. However, many questions remain about the direction of causality in their association, as well as mechanisms that may account for their association. The prevailing view has generally been that they are reciprocally related. The present review critically examines the recent prospective and experimental literature (2005-present) in an attempt to update the field on emergent themes pertaining to the directionality and mechanisms of the association of sleep and pain. A key trend emerging from population-based longitudinal studies is that sleep impairments reliably predict new incidents and exacerbations of chronic pain. Microlongitudinal studies employing deep subjective and objective assessments of pain and sleep support the notion that sleep impairments are a stronger, more reliable predictor of pain than pain is of sleep impairments. Recent experimental studies suggest that sleep disturbance may impair key processes that contribute to the development and maintenance of chronic pain, including endogenous pain inhibition and joint pain. Several biopsychosocial targets for future mechanistic research on sleep and pain are discussed, including dopamine and opioid systems, positive and negative affect, and sociodemographic factors. PERSPECTIVE This critical review examines the recent prospective and experimental research (2005-present) on the association of sleep and pain in an attempt to identify trends suggestive of directionality and potential mechanisms. An update on this literature is needed to guide future clinical efforts to develop and augment treatments for chronic sleep disturbance and chronic pain.
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Affiliation(s)
- Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Prefontaine K, Rochette A. A Literature Review on Chronic Pain: The Daily Overcoming of a Complex Problem. Br J Occup Ther 2013. [DOI: 10.4276/030802213x13706169932905] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: Chronic pain has an impact on the working life of those affected, but what about other areas of daily living? The objective in this research paper is to review the relationship between chronic pain and engagement in instrumental activities of daily living (IADLs), sleep and family life. Method: A search in the Medline (2006–2010) and the Cumulative Index to Nursing and Allied Health (CINAHL) (2004–2010) databases using the key terms ‘chronic pain’, ‘family’, ‘sleep disorders’ and ‘occupation’ was carried out. To be included, articles had to refer to the effects of chronic pain on IADLs, on sleep or on the family. Studies in which a specific diagnosis or condition was discussed were excluded to provide a more general view of the effects of chronic pain. Quality was assessed using the STROBE statement scale (for descriptive studies, from Strengthening the Reporting of Observational studies in Epidemiology), the Qualitative Research Guidelines Project (for qualitative studies) and the PRISMA statement scale (for systematic reviews, from Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Results: Of the 256 articles obtained from the search, 13 met the inclusion criteria. The articles show that chronic pain indeed has an impact on the lives of those affected in other areas besides work rehabilitation. Conclusion: Occupational therapists must consider levels of performance and engagement in all occupational domains of an individual, even when focusing on a single domain due to the work setting or commissioning process.
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Affiliation(s)
- Karine Prefontaine
- Occupational Therapist, Groupe Ergo Ressources, Montreal, Quebec, Canada
| | - Annie Rochette
- Associate Professor, University of Montreal - School of Rehabilitation and Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
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Artner J, Cakir B, Spiekermann JA, Kurz S, Leucht F, Reichel H, Lattig F. Prevalence of sleep deprivation in patients with chronic neck and back pain: a retrospective evaluation of 1016 patients. J Pain Res 2012; 6:1-6. [PMID: 23300350 PMCID: PMC3536352 DOI: 10.2147/jpr.s36386] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) and chronic neck pain (CNP) have become a serious medical and socioeconomic problem in recent decades. Patients suffering from chronic pain seem to have a higher prevalence of sleep disorders. PURPOSE To calculate the prevalence of sleep deprivation in patients with CLBP and CNP and to evaluate the factors that may contribute to sleep impairment. METHODS This study was a retrospective evaluation of 1016 patients with CNP and CLBP who consulted an orthopedic department at a university hospital. Factors assessed were gender, age, diagnosis, grade of sleep deprivation, pain intensity, chronification grade, and migrational background. Pearson's chi-squared test was performed to calculate the relationship between these factors and the grade of sleep deprivation. Regression analysis was performed to explore the correlation between the grade of sleep deprivation and age, pain intensity, and chronification grade. RESULTS A high prevalence of sleep deprivation (42.22%) was calculated in patients with CNP and CLBP, even when analgesics had been taken. About 19.88% of the patients reported serious sleep impairments (ie, <4 hours of sleep per night). The grade of sleep deprivation did not correlate with the gender or age distribution. A significant relationship was found between the grade of sleep deprivation and pain intensity, failed back surgery syndrome, and patients with a migrational background. There was a moderate relationship with intervertebral disc disease and no relationship with spinal stenosis. CONCLUSION Sleep disturbance should be assessed when treating patients with CNP or CLBP, especially in patients with higher pain intensity, failed back surgery syndrome, and a migrational background. Further research is needed to explore the complex relationship of sleep disturbance and chronic pain.
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Affiliation(s)
- Juraj Artner
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - Balkan Cakir
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - Jane-Anna Spiekermann
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany
| | - Stephan Kurz
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - Frank Leucht
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - Heiko Reichel
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
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Erratum to: Prevalence of sleep disturbance in patients with low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:554-60. [PMID: 21863463 DOI: 10.1007/s00586-011-1954-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Tang NKY, Goodchild CE, Hester J, Salkovskis PM. Pain-related insomnia versus primary insomnia: a comparison study of sleep pattern, psychological characteristics, and cognitive-behavioral processes. Clin J Pain 2012; 28:428-36. [PMID: 22179550 DOI: 10.1097/ajp.0b013e31823711bc] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent applications of cognitive-behavior therapy for primary insomnia in the management of pain-related insomnia are based on the implicit assumption that the 2 types of insomnia share the same presentation and maintaining mechanisms. The objectives of this study were to compare the characteristics of patients who have pain-related insomnia with those reporting primary insomnia and to identify psychological factors that predict pain-related insomnia. METHODS Chronic pain patients with concomitant insomnia (n=137; Pain-related Insomnia Group) completed a selection of questionnaires that measure sleep patterns, psychological attributes, and cognitive-behavioral processes associated with the persistence of insomnia. Their responses were compared with those of primary insomnia patients (n=33; Primary Insomnia Group), using 3 sets of multivariate analyses of covariance that took account of demographic differences. Hierarchical regression analyses were performed to identify predictors of insomnia severity among the chronic pain patients. RESULTS The Pain-related Insomnia Group did not differ from the Primary Insomnia Group in their pattern and severity of sleep disturbance. The 2 groups were largely comparable in terms of their psychological characteristics, except that the Primary Insomnia Group was distinguishable from the Pain-related Insomnia Group by their greater tendency to worry. Patients in the Pain-related Insomnia Group reported levels of sleep-related anxiety and presleep somatic arousal that matched with those reported by patients in the Primary Insomnia Group. However, relative to patients in the Pain-related Insomnia Group, those in the Primary Insomnia Group reported more dysfunctional sleep beliefs and presleep cognitive arousal. In addition to pain intensity, depression, and presleep cognitive arousal were significant predictors of insomnia severity within the Pain-related Insomnia Group. CONCLUSIONS There are more similarities than differences between the 2 types of insomnia. Besides pain, mood, and presleep, thought processes also seem to have a role in the manifestation of pain-related insomnia. It is suggested that hybrid treatments that seek to simultaneously address factors across these domains may represent more effective treatments than 1-dimensional interventions.
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Affiliation(s)
- Nicole K Y Tang
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK.
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Tang NKY, Goodchild CE, Sanborn AN, Howard J, Salkovskis PM. Deciphering the temporal link between pain and sleep in a heterogeneous chronic pain patient sample: a multilevel daily process study. Sleep 2012; 35:675-87A. [PMID: 22547894 PMCID: PMC3321427 DOI: 10.5665/sleep.1830] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Because insomnia is a common comorbidity of chronic pain, scientific and clinical interest in the relationship of pain and sleep has surged in recent years. Although experimental studies suggest a sleep-interfering property of pain and a pain-enhancing effect of sleep deprivation/fragmentation, the temporal association between pain and sleep as experienced by patients is less understood. The current study was conducted to examine the influence of presleep pain on subsequent sleep and sleep on pain reports the next day, taking into consideration other related psychophysiologic variables such as mood and arousal. DESIGN A daily process study, involving participants to monitor their pain, sleep, mood, and presleep arousal for 1 wk. Multilevel modeling was used to analyze the data. SETTING In the patients' natural living and sleeping environment. PATIENTS One hundred nineteen patients (73.9% female, mean age = 46 years) with chronic pain and concomitant insomnia. MEASUREMENT An electronic diary was used to record patients' self-reported sleep quality/efficiency and ratings of pain, mood, and arousal at different times of the day; actigraphy was also used to provide estimates of sleep efficiency. RESULTS Results indicated that presleep pain was not a reliable predictor of subsequent sleep. Instead, sleep was better predicted by presleep cognitive arousal. Although sleep quality was a consistent predictor of pain the next day, the pain-relieving effect of sleep was only evident during the first half of the day. CONCLUSIONS These findings challenge the often-assumed reciprocal relationship between pain and sleep and call for a diversification in thinking of the daily interaction of these 2 processes.
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Affiliation(s)
- Nicole K Y Tang
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire, United Kingdom.
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Buenaver LF, Quartana PJ, Grace EG, Sarlani E, Simango M, Edwards RR, Haythornthwaite JA, Smith MT. Evidence for indirect effects of pain catastrophizing on clinical pain among myofascial temporomandibular disorder participants: the mediating role of sleep disturbance. Pain 2012; 153:1159-1166. [PMID: 22417656 DOI: 10.1016/j.pain.2012.01.023] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 11/05/2011] [Accepted: 01/23/2012] [Indexed: 11/29/2022]
Abstract
Sleep disturbance and pain catastrophizing are important mediators of the chronic pain experience. To date, these factors have not been considered concurrently despite compelling theoretical rationale to do so. In the present study, we examined whether pain catastrophizing not only has direct effects on clinical pain and pain-related interference, but also indirect effects through its association with sleep disturbance. We evaluated this hypothesis using a cohort (n=214) of myofascial temporomandibular disorder participants using a statistical bootstrapping technique recommended for tests of indirect effects. Results suggested that pain catastrophizing was associated with greater sleep disturbance, and that a significant portion of variance in clinical pain severity and pain-related interference attributable to pain catastrophizing was mediated by sleep disturbance. Supplementary analyses revealed that the rumination component of catastrophizing seemed to be indirectly related to clinical outcomes through sleep disturbance. No evidence for indirect effects was observed for helplessness and magnification components. These results suggest that rumination about pain may contribute to clinical pain indirectly through alterations in sleep. Prospective studies are needed to examine lagged associations between these constructs. These findings have important theoretical and clinical implications. Critically, interventions that reduce pain catastrophizing may concurrently improve sleep and clinical pain.
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Affiliation(s)
- Luis F Buenaver
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA Department of Neural and Pain Sciences, University of Maryland Dental School, Baltimore, MD, USA Private Practice, Athens, Greece Department of Anesthesia, Harvard Medical School, Brigham and Women's Pain Management Center, Boston, MA, USA
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McCracken LM, Williams JL, Tang NKY. Psychological flexibility may reduce insomnia in persons with chronic pain: a preliminary retrospective study. PAIN MEDICINE 2011; 12:904-12. [PMID: 21539701 DOI: 10.1111/j.1526-4637.2011.01115.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Sleep disturbance is a common complaint in people with chronic pain, and is associated with a range of adverse outcomes including reports of greater pain and disability. Research into insomnia with chronic pain sufferers has not yet examined the role of psychological flexibility, a process from acceptance and commitment therapy. We examined this role. DESIGN Participants in this study were 159 adult patients attending an assessment at a specialist pain center. They were mostly women, 63%, and the mean age was 43.8 years. RESULTS In preliminary analyses 79% of participants met the criteria for significant insomnia based on their self-reported symptoms. As predicted, significant positive correlations were found between components of psychological flexibility, particularly acceptance of pain and values-based action, and all measures of sleep quality. In regression analyses, the components of psychological flexibility considered together accounted for between 11% and 19% of variance across a range of measures of sleep quality. CONCLUSION These results suggest the need to further develop treatment services for people with chronic pain and insomnia.
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Affiliation(s)
- Lance M McCracken
- Centre for Pain Services, Royal National Hospital for Rheumatic Diseases & Centre for Pain Research, University of Bath, Bath, UK.
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Alsaadi SM, McAuley JH, Hush JM, Maher CG. Prevalence of sleep disturbance in patients with low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 20:737-43. [PMID: 21190045 DOI: 10.1007/s00586-010-1661-x] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 09/17/2010] [Accepted: 12/09/2010] [Indexed: 11/30/2022]
Abstract
Low back pain (LBP) is a common health condition that is often associated with disability, psychological distress and work loss. Worldwide, billions of dollars are expended each year trying to manage LBP, often with limited success. Recently, some researchers have reported that LBP patients also report sleep disturbance as a result of their LBP. However, as most of this evidence was obtained from highly selected groups of patients or from studies with small samples, high quality data on prevalence of sleep disturbance for patients with LBP are lacking. It is also unclear whether sleep disturbance is more likely to be reported by patients with recent-onset LBP than by patients with persistent LBP. Finally, it is not known whether high pain intensity, the most relevant condition-specific variable, is associated with higher rates of reported sleep disturbance. The present study aimed to determine the prevalence of reported sleep disturbance in patients with LBP. In addition, we aimed to determine whether sleep disturbance was associated with the duration of back pain symptoms and whether pain intensity was associated with reported sleep disturbance. Data from 1,941 patients obtained from 13 studies conducted by the authors or their colleagues between 2001 and 2009 were used to determine the prevalence of sleep disturbance. Logistic regression analyses explored associations between sleep disturbance, the duration of low back symptoms and pain intensity. The estimated prevalence of sleep disturbance was 58.7% (95% CI 56.4-60.7%). Sleep disturbance was found to be dependent on pain intensity, where each increase by one point on a ten-point visual analogue scale (VAS) was associated with a 10% increase in the likelihood of reporting sleep disturbance. Our findings indicate that sleep disturbance is common in patients with LBP. In addition, we found that the intensity of back pain was only weakly associated with sleep disturbance, suggesting that other factors contribute to sleep problems for LBP patients.
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Affiliation(s)
- Saad M Alsaadi
- Musculoskeletal Division, The George Institute for International Health, The University of Sydney, PO Box M201, Missenden Road, Sydney, NSW, 2050, Australia.
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MacDonald S, Linton SJ, Jansson-Fröjmark M. Cognitive vulnerability in the development of concomitant pain and sleep disturbances. Br J Health Psychol 2010; 15:417-34. [DOI: 10.1348/135910709x468089] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ashworth PCH, Davidson KM, Espie CA. Cognitive-behavioral factors associated with sleep quality in chronic pain patients. Behav Sleep Med 2010; 8:28-39. [PMID: 20043247 DOI: 10.1080/15402000903425587] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
People with chronic pain commonly complain of sleep disturbance. This study reports the characteristics of the pain and sleep of a large sample of patients with chronic pain (n = 160). This study compared subgroups of good sleepers with pain (n = 48) and poor sleepers with pain (n = 108). Poor sleepers with pain were younger and reported more pain, pain-related disability, depression, pain-related anxiety, and dysfunctional beliefs about sleep. Using simultaneous regression analysis, this study examined the roles of pain, dysfunctional beliefs about sleep, pain-related disability, depression, and pain-related anxiety in predicting concurrent sleep quality. The findings are relevant to the development of models of sleep disturbance comorbid with chronic pain.
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Affiliation(s)
- Polly C H Ashworth
- Health Psychology Department, Gloucestershire Hospitals NHS Foundation Trust, Great Western Rd., Gloucester, GL1 3NN, United Kingdom.
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Smith MT, Quartana PJ, Okonkwo RM, Nasir A. Mechanisms by which sleep disturbance contributes to osteoarthritis pain: a conceptual model. Curr Pain Headache Rep 2010; 13:447-54. [PMID: 19889286 DOI: 10.1007/s11916-009-0073-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Sleep disturbance is prevalent in aging and painful rheumatologic populations, but it has largely been a neglected dimension of the routine clinical care of arthritis patients. Pain associated with osteoarthritis (OA) is a leading cause of disability worldwide, and factors that contribute to pain in OA are poorly understood. Sleep disturbance is not only a consequence of pain, it is also likely to play an integral role in pain expression. Emerging research suggests that many patients with OA demonstrate signs of generalized hyperalgesia and faulty central pain modulatory processing similar to other idiopathic pain disorders, such as fibromyalgia. Sleep disruption is increasingly recognized as a direct contributor to both hyperalgesia and impaired endogenous pain modulation. This article reviews the extant literature on sleep disturbance and hyperalgesia in patients with OA. We propose a conceptual working model describing pathways by which sleep disturbance interacts directly with central pain processing mechanisms and inflammatory processes, and indirectly with mood and physical functioning to augment clinical OA pain. The clinical and research implications of the model are discussed.
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Affiliation(s)
- Michael T Smith
- Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 100, Baltimore, MD 21224, USA.
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Abstract
Chronic pain and insomnia often occur simultaneously, with the vast majority of chronic pain patients complaining of interrupted or poor quality sleep. The need to improve sleep in these patients is clear, given increasing evidence that sleep disturbance is associated with heightened pain sensitivity and elevated disability. This article evaluates the efficacy of pain management programs (PMPs) based on cognitive-behavioral therapy (CBT) principles and CBT for primary insomnia (CBT-I) in treating pain-related insomnia. Although PMPs effectively enhance pain management skills in patients, they do not adequately address insomnia. CBT-I has demonstrated strong efficacy in treating pain-related insomnia, but sleep improvement is not followed by pain reduction. As both CBT approaches involve strengths and limitations, a hybrid form of treatment is needed that simultaneously addresses pain and sleep.
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Fishbain DA, Cole B, Lewis JE, Gao J. What Is the Evidence for Chronic Pain Being Etiologically Associated with the DSM-IV Category of Sleep Disorder Due to a General Medical Condition? A Structured Evidence-Based Review. PAIN MEDICINE 2010; 11:158-79. [DOI: 10.1111/j.1526-4637.2009.00706.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Catastrophizing and depressive symptoms as prospective predictors of outcomes following total knee replacement. Pain Res Manag 2009; 14:307-11. [PMID: 19714271 DOI: 10.1155/2009/273783] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Several recent reports suggest that pain-related catastrophizing is a risk factor for poor acute pain outcomes following surgical interventions. However, it has been less clear whether levels of catastrophizing influence longer-term postoperative outcomes. Data were analyzed from a relatively small number (n=43) of patients who underwent total knee replacement and were followed for 12 months after their surgery. Previous research has suggested that high levels of both catastrophizing and depression are associated with elevated acute postoperative pain complaints among patients undergoing knee surgery. In this sample, catastrophizing and depression at each of the assessment points were studied as prospective predictors of pain (both global pain ratings and pain at night) at the subsequent assessment point over the course of one year. The predictive patterns differed somewhat across measures of pain reporting; depressive symptoms were unique predictors of greater global pain complaints, while catastrophizing was a specific and unique predictor of elevated nighttime pain. While surgical outcomes following total knee replacement are, on average, quite good, a significant minority of patients continue to experience long-term pain. The present findings suggest that high levels of catastrophizing and depression may promote enhanced pain levels, indicating that interventions designed to reduce catastrophizing and depressive symptoms may have the potential to further improve joint replacement outcomes.
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MacDonald S, Linton SJ, Jansson-Fröjmark M. Avoidant Safety Behaviors and Catastrophizing: Shared cognitive-behavioral processes and consequences in co-morbid pain and sleep disorders. Int J Behav Med 2008; 15:201-10. [DOI: 10.1080/10705500802222675] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tang NKY. Insomnia Co-Occurring with Chronic Pain: Clinical Features, Interaction, Assessments and Possible Interventions. Rev Pain 2008; 2:2-7. [PMID: 26525182 PMCID: PMC4589931 DOI: 10.1177/204946370800200102] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Insomnia is a major source of distress to people with chronic pain; many of whom presenting for treatment want tangible help with sleep.Compared to chronic pain patients who do not have trouble sleeping, those who do, report more severe pain, longer pain duration, greater levels of anxiety, depression and health anxiety, and worse impairment in physical and psychosocial functioning.Sleep disturbance experienced by patients with chronic pain can be characterised by longer sleep onset, more frequent and longer awakenings after sleep onset, shorter total sleep time, lower sleep efficiency and poorer sleep quality. Such pattern of disturbance is analogous to that of primary insomnia.The relationship between pain and sleep is likely to be bi-directional, although exactly how the two problems interact is little understood.The offer of sleep advice and the use of pharmacotherapy for pain-related insomnia have their respective limitations. Psychological and behavioural treatments demonstrated to be effective for both primary and comorbid insomnia may be a viable treatment alternative.
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Affiliation(s)
- Nicole K. Y. Tang
- Research Fellow in Clinical/Health Psychology, Department of Psychology, Institute of Psychiatry, King's College London
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Theadom A, Cropley M. Dysfunctional beliefs, stress and sleep disturbance in fibromyalgia. Sleep Med 2008; 9:376-81. [PMID: 17681881 DOI: 10.1016/j.sleep.2007.06.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 06/07/2007] [Accepted: 06/12/2007] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To explore sleep-related dysfunctional beliefs, stress levels and sleep quality in patients with fibromyalgia in comparison to healthy controls. METHODS One hundred sixty-six participants (83 patients with fibromyalgia and 83 healthy controls) completed self-report measures exploring beliefs and attitudes about sleep, perceived stress, sleep quality and levels of pain and fatigue. RESULTS Relative to healthy controls, patients with fibromyalgia revealed significantly higher levels of dysfunctional beliefs and attitudes about sleep and perceived stress. High dysfunctional beliefs were significantly associated with poorer sleep quality and high perceived stress was significantly related to higher sleep disturbances and daytime dysfunction. CONCLUSIONS Beliefs about sleep and perceived stress play a significant role in the sleep quality of patients with fibromyalgia. Interventions to improve sleep quality for people with fibromyalgia need to identify and address dysfunctional beliefs about sleep and incorporate stress management approaches.
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Affiliation(s)
- Alice Theadom
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK
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