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Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization. Pain 2019; 159:33-40. [PMID: 28891869 DOI: 10.1097/j.pain.0000000000001053] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Chronic pain conditions are highly comorbid with insufficient sleep. While the mechanistic relationships between the 2 are not understood, chronic insufficient sleep may be 1 pathway through which central pain-modulatory circuits deteriorate, thereby contributing to chronic pain vulnerability over time. To test this hypothesis, an in-laboratory model of 3 weeks of restricted sleep with limited recovery (5 nights of 4-hour sleep per night followed by 2 nights of 8-hour sleep per night) was compared with 3 weeks of 8-hour sleep per night (control protocol). Seventeen healthy adults participated, with 14 completing both 3-week protocols. Measures of spontaneous pain, heat-pain thresholds, cold-pain tolerance (measuring habituation to cold over several weeks), and temporal summation of pain (examining the slope of pain ratings during cold water immersion) were assessed at multiple points during each protocol. Compared with the control protocol, participants in the sleep-restriction protocol experienced mild increases in spontaneous pain (P < 0.05). Heat-pain thresholds decreased after the first week of sleep restriction (P < 0.05) but normalized with longer exposure to sleep restriction. By contrast, chronic exposure to restricted sleep was associated with decreased habituation to, and increased temporal summation in response to cold pain (both P < 0.05), although only in the past 2 weeks of the sleep-restriction protocol. These changes may reflect abnormalities in central pain-modulatory processes. Limited recovery sleep did not completely resolve these alterations in pain-modulatory processes, indicating that more extensive recovery sleep is required. Results suggest that exposure to chronic insufficient sleep may increase vulnerability to chronic pain by altering processes of pain habituation and sensitization.
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102
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Christensen J, Noel M, Mychasiuk R. Neurobiological mechanisms underlying the sleep-pain relationship in adolescence: A review. Neurosci Biobehav Rev 2019; 96:401-413. [PMID: 30621863 DOI: 10.1016/j.neubiorev.2018.11.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 12/20/2022]
Abstract
Adolescence characterizes a period of significant change in brain structure and function, causing the neural circuitry to be particularly susceptible to the environment and various other experiences. Chronic pain and sleep deprivation represent major health issues that plague adolescence. A bidirectional relationship exists between sleep and pain; however, emerging evidence suggests that sleep disturbances have a stronger influence on subsequent pain than vice versa. The neurobiological underpinnings of this relationship, particularly during adolescence, are poorly understood. This review examines the current literature regarding sleep and pain in adolescence, with a particular focus on the neurobiological mechanisms underlying pain, sleep problems, and the neural circuitry that potentially links the two. Finally, a research agenda is outlined to stimulate future research on this topic. Given the high prevalence of these health issues during adolescence and the debilitating effects they inflict on nearly every domain of development, it is crucial that we determine the neurobiological mechanisms fundamental to this relationship and identify potential therapeutic strategies.
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Affiliation(s)
- Jennaya Christensen
- Department of Psychology, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, Canada; Hotchkiss Brain Institute, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, Canada; Hotchkiss Brain Institute, Canada
| | - Richelle Mychasiuk
- Department of Psychology, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, Canada; Hotchkiss Brain Institute, Canada.
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103
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The Pain of Sleep Loss: A Brain Characterization in Humans. J Neurosci 2019; 39:2291-2300. [PMID: 30692228 DOI: 10.1523/jneurosci.2408-18.2018] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 12/24/2022] Open
Abstract
Sleep loss increases the experience of pain. However, the brain mechanisms underlying altered pain processing following sleep deprivation are unknown. Moreover, it remains unclear whether ecologically modest night-to-night changes in sleep, within an individual, confer consequential day-to-day changes in experienced pain. Here, we demonstrate that acute sleep deprivation amplifies pain reactivity within human (male and female) primary somatosensory cortex yet blunts pain reactivity in higher-order valuation and decision-making regions of the striatum and insula cortex. Consistent with this altered neural signature, we further show that sleep deprivation expands the temperature range for classifying a stimulus as painful, specifically through a lowering of pain thresholds. Moreover, the degree of amplified reactivity within somatosensory cortex following sleep deprivation significantly predicts this expansion of experienced pain across individuals. Finally, outside of the laboratory setting, we similarly show that even modest nightly changes in sleep quality (increases and decreases) within an individual determine consequential day-to-day changes in experienced pain (decreases and increases, respectively). Together, these data provide a novel framework underlying the impact of sleep loss on pain and, furthermore, establish that the association between sleep and pain is expressed in a night-to-day, bidirectional relationship within a sample of the general population. More broadly, our findings highlight sleep as a novel therapeutic target for pain management within and outside the clinic, including circumstances where sleep is frequently short yet pain is abundant (e.g., the hospital setting).SIGNIFICANCE STATEMENT Are you experiencing pain? Did you have a bad night of sleep? This study provides underlying brain and behavioral mechanisms explaining this common co-occurrence. We show that sleep deprivation enhances pain responsivity within the primary sensing regions of the brain's cortex yet blunts activity in other regions that modulate pain processing, the striatum and insula. We further establish that even subtle night-to-night changes in sleep in a sample of the general population predict consequential day-to-day changes in pain (bidirectionally). Considering the societal rise in chronic pain conditions in lock-step with the decline in sleep time through the industrial world, our data support the hypothesis that these two trends may not simply be co-occurring but are significantly interrelated.
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104
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Kamiyama H, Iida T, Nishimori H, Kubo H, Uchiyama M, De Laat A, Lavigne G, Komiyama O. Effect of sleep restriction on somatosensory sensitivity in the oro-facial area: An experimental controlled study. J Oral Rehabil 2019; 46:303-309. [DOI: 10.1111/joor.12758] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Hirona Kamiyama
- Division of Oral Function and Rehabilitation, Department of Oral Health Science; Nihon University School of Dentistry at Matsudo; Matsudo Japan
| | - Takashi Iida
- Division of Oral Function and Rehabilitation, Department of Oral Health Science; Nihon University School of Dentistry at Matsudo; Matsudo Japan
| | - Hideta Nishimori
- Division of Oral Function and Rehabilitation, Department of Oral Health Science; Nihon University School of Dentistry at Matsudo; Matsudo Japan
| | - Hideyuki Kubo
- Department of Psychiatry; Nihon University School of Medicine; Tokyo Japan
| | - Makoto Uchiyama
- Department of Psychiatry; Nihon University School of Medicine; Tokyo Japan
| | - Antoon De Laat
- Department of Oral Health Sciences; KU Leuven; Leuven Belgium
- Department of Dentistry; University Hospital Leuven; Leuven Belgium
| | - Gilles Lavigne
- Faculty of Dental Medicine; Université de Montréal; Montreal Québec Canada
| | - Osamu Komiyama
- Division of Oral Function and Rehabilitation, Department of Oral Health Science; Nihon University School of Dentistry at Matsudo; Matsudo Japan
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105
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Rampes S, Ma K, Divecha YA, Alam A, Ma D. Postoperative sleep disorders and their potential impacts on surgical outcomes. J Biomed Res 2019; 34:271-280. [PMID: 32519977 PMCID: PMC7386412 DOI: 10.7555/jbr.33.20190054] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Postoperative sleep disturbance is a common occurrence with significant adverse effects on patients including delayed recovery, impairment of cognitive function, pain sensitivity and cardiovascular events. The development of postoperative sleep disturbance is multifactorial and involves the surgical inflammatory response, the severity of surgical trauma, pain, anxiety, the use of anesthetics and environmental factors such as nocturnal noise and light levels. Many of these factors can be managed perioperatively to minimize the deleterious impact on sleep. Pharmacological and non-pharmacological treatment strategies for postoperative sleep disturbance include dexmedetomidine, zolpidem, melatonin, enhanced recovery after surgery (ERAS) protocol and controlling of environmental noise and light levels. It is likely that a combination of pharmacological and non-pharmacological therapies will have the greatest impact; however, further research is required before their use can be routinely recommended.
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Affiliation(s)
- Sanketh Rampes
- Faculty of Life Sciences & Medicine, King's College London, London SE1 1UL, UK
| | - Katie Ma
- Faculty of Life Sciences & Medicine, King's College London, London SE1 1UL, UK
| | - Yasmin Amy Divecha
- Faculty of Life Sciences & Medicine, King's College London, London SE1 1UL, UK
| | - Azeem Alam
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London SW10 9NH, UK
| | - Daqing Ma
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London SW10 9NH, UK
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106
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Effect of sleep restriction on somatosensory sensitivity including occlusal sensation in the orofacial area. J Prosthodont Res 2018; 63:193-198. [PMID: 30559085 DOI: 10.1016/j.jpor.2018.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/05/2018] [Accepted: 11/13/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate the effect of sleep restriction on somatosensory sensitivity related to occlusion. METHODS Twelve healthy participants participated in an experimental voluntary total sleep restriction (SR) study. In a study design, they were invited to sleep as usual, normal sleep (NS) or to restrict their sleep for four nights. Following the SR night, participants were followed for 3 consecutive days including the 2 sleep nights. In NS experiment, all participants were instructed to maintain NS both nights. During all nights, actigraphy data were collected and total sleep time was estimated. On days before and after sleep conditions, all participants underwent measurements of tactile detection threshold (TDT), interocclusal detection threshold (IDT), perception of unpleasantness (POU), and the Epworth sleepiness scale (ESS). RESULTS As expected, total sleep time on the first night in SR experiment was significantly shorter than on the second night in SR experiment and on the first night in NS experiment (P<0.05). ESS values on Day-2 following SR experiment were significantly higher than on Day-1 and Day-3 in SR experiment and Day-2 in NS experiment (P<0.05). There were no significant differences in TDT and IDT between each day at each measurement point in both experiments. POU was significantly lower on Day-2 in SR experiment than on Day-1 and Day-3 in SR experiment and on Day-2 in NS experiment (P<0.05). CONCLUSIONS The present results suggest that SR affects to occlusal sensation related to POU.
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107
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DiMarco LA, Ramger BC, Howell GP, Serrani AM, Givens DL, Rhon DI, Cook CE. Differences in Characteristics and Downstream Drug Use Among Opioid-Naïve and Prior Opioid Users with Low Back Pain. Pain Pract 2018; 19:149-157. [PMID: 30269416 DOI: 10.1111/papr.12728] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/30/2018] [Accepted: 09/15/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Recent clinical practice guidelines have suggested conservative treatment approaches, including physical therapy, are indicated as first-line treatment for patients with low back pain (LBP); however, LBP continues to be managed with opioids, despite decreases in function, morbidity, and insignificant improvements in pain. OBJECTIVE The primary purpose was to compare characteristics and downstream medication use between patients with LBP with prior opioid exposure vs. those who were opioid-naïve. The secondary purpose was to explore the role of prior opioid use by LBP disability. METHODS Seven hundred and nine participants in a LBP self-management class were evaluated utilizing self-report data at baseline and longitudinal claims data from the Military Health System Data Repository. Participants were dichotomized into opioid-naïve and prior opioid use groups and then further divided into low and high disability groups based on Oswestry Disability Index (ODI) scores. Patient characteristics, comorbidities, and medication use were compared between groups. RESULTS Prior opioid users had significantly higher baseline ODI and Fear Avoidance Beliefs Questionnaire physical activity subscale and work subscale scores as well as pre-index instances of mental health disorders, chronic pain, and insomnia than opioid-naïve individuals. Prior opioid users filled significantly more pain medication prescriptions in the year after the index date than did opioid-naïve individuals. Prior opioid users were significantly more likely to be taking opioids at 1 year after the index date, regardless of disability level. CONCLUSION In patients presenting with LBP, prior opioid exposure appears to be related to increased analgesic use (opioid and non-opioid) and longitudinal analgesic utilization at 1 year after the index date.
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Affiliation(s)
- Lindsay A DiMarco
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina, U.S.A
| | - Benjamin C Ramger
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina, U.S.A
| | - Gregory P Howell
- Doctor of Physical Therapy Division, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Ali M Serrani
- Doctor of Physical Therapy Division, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Deborah L Givens
- Doctor of Physical Therapy Division, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Daniel I Rhon
- Doctoral Programs in Physical Therapy, Baylor University, San Antonio, Texas, U.S.A
| | - Chad E Cook
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina, U.S.A
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108
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Dissanayaka TD, Farrell M, Zoghi M, Egan GF, Jaberzadeh S. Test–retest reliability of subjective supra-threshold scaling of multiple pressure-pain sensations among healthy individuals: a study using hydraulic pressure algometry. Somatosens Mot Res 2018; 35:153-161. [DOI: 10.1080/08990220.2018.1505608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- T. D. Dissanayaka
- Non-Invasive Brain Stimulation & Neuroplasticity Laboratory, Department of Physiotherapy, School of Primary Healthcare, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - M. Farrell
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
- Biomedicine Discovery Institute and Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Australia
| | - M. Zoghi
- Department of Rehabilitation, Nutrition and Sport, School of Allied health, La Trobe University, Melbourne, Australia
| | - G. F. Egan
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - S. Jaberzadeh
- Non-Invasive Brain Stimulation & Neuroplasticity Laboratory, Department of Physiotherapy, School of Primary Healthcare, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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109
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Santos JS, Giacheti CM, Dornelas LS, Silva NC, Souza ALDM, Guissoni Campos LM, Pinato L. Day/night melatonin content in cerebral palsy. Neurosci Lett 2018; 686:23-27. [PMID: 30176339 DOI: 10.1016/j.neulet.2018.08.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/30/2018] [Accepted: 08/28/2018] [Indexed: 11/26/2022]
Abstract
Changes in the sleep-wake cycle are frequent and may impair quality of life in individuals with cerebral palsy (CP). To investigate if a lack of a day/night variation of melatonin content could be related with sleep disorders (SD), the SD were evaluated with a Sleep Questionnaire and the melatonin content using ELISA in 33 individuals with CP and 24 controls. The indicative of SD were present in 47% of CP group, and the most frequent was the indicative of sleep breathing disorder. The CP group showed higher diurnal and lower nocturnal melatonin content than controls. Individuals with CP that had indicative of SD showed lower nocturnal content of melatonin than those without SD. These results showed that the lack of the day/night variation of melatonin was related to SD in individuals with CP.
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Affiliation(s)
- Janaina S Santos
- Specialized Center for Rehabilitation, Sorri - Bauru-SP, Brazil; São Paulo State University-UNESP, Marília, SP, Brazil
| | | | - Lilian S Dornelas
- Specialized Center for Rehabilitation, Sorri - Bauru-SP, Brazil; São Paulo State University-UNESP, Marília, SP, Brazil
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110
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The Role of Sex in Sleep Deprivation Related Changes of Nociception and Conditioned Pain Modulation. Neuroscience 2018; 387:191-200. [DOI: 10.1016/j.neuroscience.2017.09.044] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/11/2017] [Accepted: 09/24/2017] [Indexed: 11/19/2022]
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111
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Schuh-Hofer S, Eichhorn N, Grinevich V, Treede RD. Sleep Deprivation Related Changes of Plasma Oxytocin in Males and Female Contraceptive Users Depend on Sex and Correlate Differentially With Anxiety and Pain Hypersensitivity. Front Behav Neurosci 2018; 12:161. [PMID: 30116181 PMCID: PMC6082934 DOI: 10.3389/fnbeh.2018.00161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/09/2018] [Indexed: 02/05/2023] Open
Abstract
Disturbed sleep is known to substantially aggravate both the pain condition and the affective state of pain patients. The neurobiological mechanisms underlying these adverse effects are unknown. Oxytocin (OT), being largely involved in social and emotional behavior, is considered to also play a modulatory role in nociception. We hypothesized a pathophysiological role of OT for the hyperalgesic and anxiogenic effects of sleep loss. An established human model of one night of total sleep deprivation (TSD) was used to test this hypothesis. Twenty young healthy students (n = 10 male and n = 10 female) were investigated in a balanced cross-over design, contrasting TSD with a night of habitual sleep (HS). All females took monophasic oral contraceptives (OC) and were investigated during their ‘pill-free’ phase. Plasma OT concentrations were correlated with (1) pain thresholds, (2) descending pain inhibition, and (3) state-anxiety scores. Compared to the HS condition, the plasma OT concentration was significantly increased in sleep deprived females (p = 0.02) but not males (p = 0.69). TSD resulted in pain hypersensitivity to noxious cold (p = 0.05), noxious heat (p = 0.023), and pricking stimuli (p = 0.013) and significantly increased state-anxiety (p = 0.021). While, independent of sex, lower heat pain thresholds correlated with higher plasma OT (p = 0.036), no such associations were found for cold/mechanical pain. In sleep-deprived females, higher plasma OT showed a mild (but insignificant) association with lower pain inhibition (p = 0.093). We found a positive correlation between anxiety-scores and OT (p = 0.021), which was enhanced when respecting “sex” (p = 0.008) and “sleep” (p = 0.001) in a hierarchical regression analysis. Altogether, our study revealed a complex and partially sex-dependent correlation between plasma OT and TSD-induced changes of experimental pain and anxiety. The minor role of OT for TSD-induced changes of evoked pain, and its major involvement in anxiety, argues against a specific role of OT for linking the adverse effects of TSD on pain sensitivity and anxiety with each other. Future investigations are needed in order to dissect out the effect of OC on the sex-dependent effects of TSD observed in our study.
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Affiliation(s)
- Sigrid Schuh-Hofer
- Department of Neurophysiology, Centre of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Clinic for Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicole Eichhorn
- Department of Neurophysiology, Centre of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Valery Grinevich
- Schaller Research Group on Neuropeptides, German Cancer Research Center, Heidelberg and Central Institute of Mental Health, Mannheim, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Centre of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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112
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Akodu AK, Akindutire OM. The effect of stabilization exercise on pain-related disability, sleep disturbance, and psychological status of patients with non-specific chronic low back pain. Korean J Pain 2018; 31:199-205. [PMID: 30013734 PMCID: PMC6037811 DOI: 10.3344/kjp.2018.31.3.199] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/02/2018] [Accepted: 06/04/2018] [Indexed: 11/23/2022] Open
Abstract
Background Sleep disturbance and depression are becoming more recognized as important symptoms among individuals with chronic low back pain. This study evaluated the effect of stabilization exercise on pain-related disability, sleep disturbance and the psychological status of patients with non-specific chronic low back pain (NSCLBP). Methods A total of 26 patients (M/F = 17/9) with NSCLBP with a mean age of 50.0 ± 15.5 took part in this study. Participants were recruited from selected hospitals in Lagos state. Ethical approval was sought and obtained from the health research and ethics committee of Lagos University Teaching Hospital Idi-araba, Lagos, Nigeria. Participants performed stabilization exercise for eight weeks consecutively and were assessed for pain-related disability, anxiety, depression, and sleep disturbance using the pain-disability index, hospital anxiety and depression scale, and the insomnia severity index at baseline, the 4th week, and the 8th week, post-intervention. Results The participants studied recorded significant reduction in pain-related disability (P = 0.001). There was also improvement in the sleep quality (P = 0.001), depression level (P = 0.001), and anxiety level (P = 0.001), post intervention. Conclusions This study revealed that stabilization exercise is very useful in the management of sleep disturbance, pain-related disability, depression, and anxiety in NSCLBP patients.
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Affiliation(s)
- Ashiyat Kehinde Akodu
- Department of Physiotherapy, College of Medicine, University of Lagos, Lagos, Nigeria
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113
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Sardi NF, Lazzarim MK, Guilhen VA, Marcílio RS, Natume PS, Watanabe TC, Lima MMS, Tobaldini G, Fischer L. Chronic sleep restriction increases pain sensitivity over time in a periaqueductal gray and nucleus accumbens dependent manner. Neuropharmacology 2018; 139:52-60. [PMID: 29928886 DOI: 10.1016/j.neuropharm.2018.06.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/29/2018] [Accepted: 06/16/2018] [Indexed: 11/29/2022]
Abstract
Painful conditions and sleep disturbances are major public health problems worldwide and one directly affects the other. Sleep loss increases pain prevalence and severity; while pain disturbs sleep. However, the underlying mechanisms are largely unknown. Here we asked whether chronic sleep restriction for 6 h daily progressively increases pain sensitivity and if this increase is reversed after two days of free sleep. Also, whether the pronociceptive effect of chronic sleep restriction depends on the periaqueductal grey and on the nucleus accumbens, two key regions involved in the modulation of pain and sleep-wake cycle. We showed that sleep restriction induces a pronociceptive effect characterized by a significant decrease in the mechanical paw withdrawal threshold in rats. Such effect increases progressively from day 3 to day 12 remaining stable thereafter until day 26. Two consecutive days of free sleep were not enough to reverse the effect, not even to attenuate it. This pronociceptive effect depends on the periaqueductal grey and on the nucleus accumbens, since it was prevented by their excitotoxic lesion. Complementarily, chronic sleep restriction significantly increased c-Fos protein expression within the periaqueductal grey and the nucleus accumbens and this correlates with the intensity of the pronociceptive effect, suggesting that the greater the neural activity in this regions, the greater the effect. These findings may contribute not only to understand why painful conditions are more prevalent and severe among people who sleep poorly, but also to develop therapeutic strategies to prevent this, increasing the effectiveness of pain management in this population.
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Affiliation(s)
- Natalia F Sardi
- Neurophysiology Laboratory, Department of Physiology, Division of Biological Sciences, Federal University of Parana, Curitiba, Parana, Brazil
| | - Mayla K Lazzarim
- Neurophysiology Laboratory, Department of Physiology, Division of Biological Sciences, Federal University of Parana, Curitiba, Parana, Brazil
| | - Vinicius A Guilhen
- Neurophysiology Laboratory, Department of Physiology, Division of Biological Sciences, Federal University of Parana, Curitiba, Parana, Brazil
| | - Renata S Marcílio
- Neurophysiology Laboratory, Department of Physiology, Division of Biological Sciences, Federal University of Parana, Curitiba, Parana, Brazil
| | - Priscila S Natume
- Neurophysiology Laboratory, Department of Physiology, Division of Biological Sciences, Federal University of Parana, Curitiba, Parana, Brazil
| | - Thainá C Watanabe
- Neurophysiology Laboratory, Department of Physiology, Division of Biological Sciences, Federal University of Parana, Curitiba, Parana, Brazil
| | - Marcelo M S Lima
- Neurophysiology Laboratory, Department of Physiology, Division of Biological Sciences, Federal University of Parana, Curitiba, Parana, Brazil
| | - Glaucia Tobaldini
- Neurophysiology Laboratory, Department of Physiology, Division of Biological Sciences, Federal University of Parana, Curitiba, Parana, Brazil
| | - Luana Fischer
- Neurophysiology Laboratory, Department of Physiology, Division of Biological Sciences, Federal University of Parana, Curitiba, Parana, Brazil.
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114
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Lin WC, Shen CC, Tsai SJ, Yang AC. Increased Risk of Myofascial Pain Syndrome Among Patients with Insomnia. PAIN MEDICINE 2018; 18:1557-1565. [PMID: 28339643 DOI: 10.1093/pm/pnw300] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objective The aim of this study is to evaluate the risk of developing myofascial pain syndrome among patients diagnosed with insomnia. Methods We conducted a population-based longitudinal study of a matched cohort with 7,895 participants (1,579 patients with insomnia and 6,316 controls) who were selected from the Taiwan National Health Insurance Research Database. The patients were observed for a maximum of 10 years to determine the incidence of newly diagnosed myofascial pain syndrome. A Cox regression analysis was performed to identify the risk factors associated with myofascial pain syndrome in patients with insomnia. Results During the 10-year follow-up period, 182 insomnia patients (14.9 per 1,000 person-years) and 379 controls (7.5 per 1,000 person-years) were diagnosed with myofascial pain syndrome. The incidence risk ratio of myofascial pain syndrome between the insomnia and control patients was 2.00 (95% confidence interval [CI] = 1.67-2.38, P < 0.001). After adjusting for age, sex, monthly income, urbanization, and comorbidities, the insomnia patients were 1.93 times more likely to develop myofascial pain syndrome (95% CI = 1.62-2.31, P < .001) than the control patients. Malignant neoplasm (hazard ratio = 3.08) and living in urban areas (hazard ratio = 3.05) were identified as independent risk factors for myofascial pain syndrome in patients with insomnia. Conclusions Patients with insomnia had a higher risk of developing myofascial pain syndrome than controls. This study adds to the understanding of the complex relationship between sleep disturbance and pain.
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Affiliation(s)
- Wei-Chen Lin
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Psychiatry, Faculty of Medicine.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Che Shen
- Division of Psychiatry, Faculty of Medicine.,Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.,Department of Information Management, National Chung-Cheng University, Chiayi, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Psychiatry, Faculty of Medicine
| | - Albert C Yang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Psychiatry, Faculty of Medicine.,Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan
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Nijs J, Mairesse O, Neu D, Leysen L, Danneels L, Cagnie B, Meeus M, Moens M, Ickmans K, Goubert D. Sleep Disturbances in Chronic Pain: Neurobiology, Assessment, and Treatment in Physical Therapist Practice. Phys Ther 2018; 98:325-335. [PMID: 29425327 DOI: 10.1093/ptj/pzy020] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 02/05/2018] [Indexed: 02/09/2023]
Abstract
Among people with chronic pain, insomnia is highly prevalent, closely related to the mechanism of central sensitization, characterized by low-grade neuroinflammation, and commonly associated with stress or anxiety; in addition, it often does not respond effectively to drug treatments. This review article applies the current understanding of insomnia to clinical practice, including assessment and conservative treatment of insomnia in people with chronic pain. Cognitive-behavioral therapy for insomnia can be efficacious for improvements in sleep initiation, sleep maintenance, perceived sleep quality, and pain interference with daily functioning in people with chronic pain. A recent systematic review concluded that with additional training, physical therapist-led cognitive-behavioral interventions are efficacious for low back pain, allowing their implementation within the field. Cognitive-behavioral therapy for insomnia, as provided to people with chronic pain, typically includes education, sleep restriction measures, stimulus control instructions, sleep hygiene, and cognitive therapy.
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Affiliation(s)
- Jo Nijs
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, the Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium, and Vrije Universiteit Brussel, Building F-Kima, Laarbeeklaan 103, BE-1090 Brussels, Belgium
| | - Olivier Mairesse
- Brugmann University Hospital, Sleep Laboratory and Unit for Chronobiology U78, Université Libre de Bruxelles - Vrije Universiteit Brussel, Brussels, Belgium, and the Department of Experimental and Applied Psychology (EXTO), Vrije Universiteit Brussel
| | - Daniel Neu
- Brugmann University Hospital, Sleep Laboratory and Unit for Chronobiology U78, Université Libre de Bruxelles - Vrije Universiteit Brussel, and UNI Neuroscience Institute, ULB312 Faculty of Medicine, and ULB388 Faculty of Motor Sciences, Université Libre de Bruxelles
| | - Laurence Leysen
- Pain in Motion International Research Group, and the Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine, Ghent University
| | - Mira Meeus
- Pain in Motion International Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine, Ghent University
| | - Maarten Moens
- Department of Neurosurgery and Radiology, University Hospital, and the Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel
| | - Kelly Ickmans
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, and the Department of Physical Medicine and Physiotherapy, University Hospital Brussels
| | - Dorien Goubert
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, and Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine, Ghent University
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116
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Pieh C, Jank R, Waiß C, Pfeifer C, Probst T, Lahmann C, Oberndorfer S. Night-shift work increases cold pain perception. Sleep Med 2018; 45:74-79. [DOI: 10.1016/j.sleep.2017.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/01/2017] [Accepted: 12/05/2017] [Indexed: 02/07/2023]
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Individual Variation in Pain Sensitivity and Conditioned Pain Modulation in Acute Low Back Pain: Effect of Stimulus Type, Sleep, and Psychological and Lifestyle Factors. THE JOURNAL OF PAIN 2018; 19:942.e1-942.e18. [PMID: 29597080 DOI: 10.1016/j.jpain.2018.02.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/18/2018] [Accepted: 02/22/2018] [Indexed: 02/08/2023]
Abstract
Generalized hyperalgesia and impaired pain modulation are reported in chronic low back pain (LBP). Few studies have tested whether these features are present in the acute phase. This study aimed to test for differences in pain presentation in early-acute LBP and evaluate the potential contribution of other factors to variation in sensitivity. Individuals within 2 weeks of onset of acute LBP (n = 126) and pain-free controls (n = 74) completed questionnaires related to their pain, disability, behavior, and psychological status before undergoing conditioned pain modulation (CPM) and pain threshold (heat, cold, and pressure) testing at the back and forearm/thumb. LBP participants were more sensitive to heat and cold at both sites and pressure at the back than controls, without differences in CPM. Only those with high-pain (numeric rating scale ≥4) were more sensitive to heat at the forearm and pressure at the back. Four subgroups with distinct features were identified: "high sensitivity," "low CPM efficacy," "high sensitivity/low CPM efficacy," and "low sensitivity/high CPM efficacy." Various factors such as sleep and alcohol were associated with each pain measure. Results provide evidence for generalized hyperalgesia in many, but not all, individuals during acute LBP, with variation accounted for by several factors. Specific pain phenotypes provide candidate features to test in longitudinal studies of LBP outcome. PERSPECTIVE Sensory changes indicative of increased/decreased central processing of pain and nociceptive input presented differently between individuals with acute LBP and were related to factors such as sleep and alcohol. This may underlie variation in outcome and suggest potential for early identification of individuals with poor long-term outcome.
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118
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Tick H, Nielsen A, Pelletier KR, Bonakdar R, Simmons S, Glick R, Ratner E, Lemmon RL, Wayne P, Zador V. Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White Paper. Explore (NY) 2018; 14:177-211. [PMID: 29735382 DOI: 10.1016/j.explore.2018.02.001] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/08/2018] [Indexed: 02/06/2023]
Abstract
Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths. The rising costs of pain care and managing adverse effects of that care have prompted action from state and federal agencies including the DOD, VHA, NIH, FDA and CDC. There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options. This White Paper details the historical context and magnitude of the current pain problem including individual, social and economic impacts as well as the challenges of pain management for patients and a healthcare workforce engaging prevalent strategies not entirely based in current evidence. Detailed here is the evidence-base for nonpharmacologic therapies effective in postsurgical pain with opioid sparing, acute non-surgical pain, cancer pain and chronic pain. Therapies reviewed include acupuncture therapy, massage therapy, osteopathic and chiropractic manipulation, meditative movement therapies Tai chi and yoga, mind body behavioral interventions, dietary components and self-care/self-efficacy strategies. Transforming the system of pain care to a responsive comprehensive model necessitates that options for treatment and collaborative care must be evidence-based and include effective nonpharmacologic strategies that have the advantage of reduced risks of adverse events and addiction liability. The evidence demands a call to action to increase awareness of effective nonpharmacologic treatments for pain, to train healthcare practitioners and administrators in the evidence base of effective nonpharmacologic practice, to advocate for policy initiatives that remedy system and reimbursement barriers to evidence-informed comprehensive pain care, and to promote ongoing research and dissemination of the role of effective nonpharmacologic treatments in pain, focused on the short- and long-term therapeutic and economic impact of comprehensive care practices.
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Affiliation(s)
- Heather Tick
- Departments of Family Medicine, Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Arya Nielsen
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Kenneth R Pelletier
- Department of Medicine, University of California School of Medicine, San Francisco, CA
| | - Robert Bonakdar
- Department of Pain Management, Scripps Center for Integrative Medicine, La Jolla, CA
| | | | - Ronald Glick
- Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Emily Ratner
- MedStar Health, Institute for Innovation, Integrative Medicine Initiatives, MedStar Montgomery Medical Center, Washington, DC
| | - Russell L Lemmon
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Peter Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Veronica Zador
- Beaumont Hospital Integrative Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI
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119
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Vitkova M, Gdovinova Z, Rosenberger J, Szilasiova J, Mikula P, Stewart RE, Groothoff JW, van Dijk JP. Is Poor Sleep Quality Associated With Greater Disability in Patients With Multiple Sclerosis? Behav Sleep Med 2018; 16:106-116. [PMID: 27191379 DOI: 10.1080/15402002.2016.1173555] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Poor sleep is a serious burden for patients with multiple sclerosis (MS). The aim of this study is to assess whether the association between sleep quality and disability in MS patients is direct or mediated by depression, pain, and fatigue. We collected data from 152 patients with MS who filled out the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, the Multidimensional Fatigue Inventory and one item of the Short Form-36 regarding pain. The relationship between poor sleep and disability was found to be indirect, mediated by depression (p < 0.05), pain (p < 0.001) and physical fatigue (p < 0.01). Treatment of sleep disturbances may have beneficial effects beyond improving sleep. It may reduce depression, pain, and physical fatigue, which in turn may lessen disability.
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Affiliation(s)
- Marianna Vitkova
- a Department of Neurology, Faculty of Medicine , Safarik University , Kosice , Slovakia.,b Graduate School Kosice Institute for Society and Health, Safarik University , Kosice , Slovakia
| | - Zuzana Gdovinova
- a Department of Neurology, Faculty of Medicine , Safarik University , Kosice , Slovakia
| | - Jaroslav Rosenberger
- b Graduate School Kosice Institute for Society and Health, Safarik University , Kosice , Slovakia
| | - Jarmila Szilasiova
- a Department of Neurology, Faculty of Medicine , Safarik University , Kosice , Slovakia
| | - Pavol Mikula
- b Graduate School Kosice Institute for Society and Health, Safarik University , Kosice , Slovakia
| | - Roy E Stewart
- c Department of Community & Occupational Health , University Medical Center Groningen, University of Groningen , Groningen , the Netherlands
| | - Johan W Groothoff
- c Department of Community & Occupational Health , University Medical Center Groningen, University of Groningen , Groningen , the Netherlands
| | - Jitse P van Dijk
- b Graduate School Kosice Institute for Society and Health, Safarik University , Kosice , Slovakia.,c Department of Community & Occupational Health , University Medical Center Groningen, University of Groningen , Groningen , the Netherlands
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120
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Rhon DI, Clewley D, Young JL, Sissel CD, Cook CE. Leveraging healthcare utilization to explore outcomes from musculoskeletal disorders: methodology for defining relevant variables from a health services data repository. BMC Med Inform Decis Mak 2018; 18:10. [PMID: 29386010 PMCID: PMC5793373 DOI: 10.1186/s12911-018-0588-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 01/17/2018] [Indexed: 12/29/2022] Open
Abstract
Background Large healthcare databases, with their ability to collect many variables from daily medical practice, greatly enable health services research. These longitudinal databases provide large cohorts and longitudinal time frames, allowing for highly pragmatic assessment of healthcare delivery. The purpose of this paper is to discuss the methodology related to the use of the United States Military Health System Data Repository (MDR) for longitudinal assessment of musculoskeletal clinical outcomes, as well as address challenges of using this data for outcomes research. Methods The Military Health System manages care for approximately 10 million beneficiaries worldwide. Multiple data sources pour into the MDR from multiple levels of care (inpatient, outpatient, military or civilian facility, combat theater, etc.) at the individual patient level. To provide meaningful and descriptive coding for longitudinal analysis, specific coding for timing and type of care, procedures, medications, and provider type must be performed. Assumptions often made in clinical trials do not apply to these cohorts, requiring additional steps in data preparation to reduce risk of bias. The MDR has a robust system in place to validate the quality and accuracy of its data, reducing risk of analytic error. Details for making this data suitable for analysis of longitudinal orthopaedic outcomes are provided. Results Although some limitations exist, proper preparation and understanding of the data can limit bias, and allow for robust and meaningful analyses. There is the potential for strong precision, as well as the ability to collect a wide range of variables in very large groups of patients otherwise not captured in traditional clinical trials. This approach contributes to the improved understanding of the accessibility, quality, and cost of care for those with orthopaedic conditions. Conclusion The MDR provides a robust pool of longitudinal healthcare data at the person-level. The benefits of using the MDR database appear to outweigh the limitations.
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Affiliation(s)
- Daniel I Rhon
- Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA.
| | - Derek Clewley
- Baylor University, 3630 Stanley Road, Bldg 2841, Suite 1301; Joint Base San Antonio - Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Jodi L Young
- Division of Physical Therapy, Department of Orthopedics, Duke University, 2200 W. Main Street, Durham, NC, 27701, USA
| | - Charles D Sissel
- Department of Physical Therapy, Arizona School of Health Sciences, 5850 E. Still Circle, Mesa, AZ, 85206, USA
| | - Chad E Cook
- Headquarters, U.S. Army Medical Command, Analysis & Evaluation Division, 3630 Stanley Road; Joint Base San Antonio - Fort Sam Houston, San Antonio, TX, 78234, USA
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121
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The Role of Sleep in Learning Placebo Effects. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 139:321-355. [DOI: 10.1016/bs.irn.2018.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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122
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Vinstrup J, Jakobsen MD, Calatayud J, Jay K, Andersen LL. Association of Stress and Musculoskeletal Pain With Poor Sleep: Cross-Sectional Study Among 3,600 Hospital Workers. Front Neurol 2018; 9:968. [PMID: 30519210 PMCID: PMC6258880 DOI: 10.3389/fneur.2018.00968] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/29/2018] [Indexed: 01/15/2023] Open
Abstract
Background: While acute stress and pain are part of our inherent survival mechanisms, persistent stress and pain can negatively impact health and well-being. This may also lead to poor sleep and thus a lack of recovery. This study investigated the influence of stress and musculoskeletal pain on sleep quality. Methods: A total of 3,593 Danish hospital workers replied to a questionnaire about work and health. Pain intensity was evaluated using subjective values as an average of 9 body parts. Stress was assessed using the full version of Cohen's Perceived Stress scale. Sleep quality was rated using 3 questions on sleep characteristics. Associations between stress and pain (mutually adjusted predictors) and sleep (outcome) were modeled using binary logistic regression controlling for gender, age, education, BMI and smoking. Results: The risk ratio of moderate stress (compared to no/low stress) on poor sleep was 1.27 (CI 1.26-1.29), whereas the risk ratio of high stress on poor sleep was 1.87 (CI 1.83-1.91). Similarly, for pain, the risk ratio of moderate pain (compared to no/low pain) on poor sleep was 1.18 (95% CI 1.16-1.19), whereas the risk ratio of a high pain score on poor sleep was 1.48 (95% CI 1.44-1.52). Conclusion: This study demonstrates that both stress and musculoskeletal pain are associated with poor sleep among hospital workers. Hospital management should consider implementing strategies for preventing stress and musculoskeletal pain to improve the overall health and workability among hospital workers.
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Affiliation(s)
- Jonas Vinstrup
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Joaquin Calatayud
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Exercise Intervention for Health Research Group, Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Kenneth Jay
- The Carrick Institute for Graduate studies, Institute of Clinical Neuroscience and Rehabilitation, Cape Canaveral, FL, United States
| | - Lars Louis Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Abstract
Despite decades of intense study, the functions of sleep are still shrouded in mystery. The difficulty in understanding these functions can be at least partly attributed to the varied manifestations of sleep in different animals. Daily sleep duration can range from 4-20 hrs among mammals, and sleep can manifest throughout the brain, or it can alternate over time between cerebral hemispheres, depending on the species. Ecological factors are likely to have shaped these and other sleep behaviors during evolution by altering the properties of conserved arousal circuits in the brain. Nonetheless, core functions of sleep are likely to have arisen early and to have persisted to the present day in diverse organisms. This review will discuss the evolutionary forces that may be responsible for phylogenetic differences in sleep and the potential core functions that sleep fulfills.
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Affiliation(s)
- William J Joiner
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92093-0636, USA; Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, CA 92093-0636, USA; Neurosciences Graduate Program, University of California San Diego, La Jolla, CA 92093-0636, USA; Center for Circadian Biology, University of California San Diego, La Jolla, CA 92093-0636, USA.
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124
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Dharmajaya R, Sari DK, Ganie RA. A Comparison of the Quality of Sleep between Pre and Post-Surgery Cervical Herniated Nucleus Pulposus Patients Utilizing the Anterior Discectomy Method. Open Access Maced J Med Sci 2017; 5:948-954. [PMID: 29362625 PMCID: PMC5771301 DOI: 10.3889/oamjms.2017.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/24/2017] [Accepted: 09/29/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Herniated Nucleus Pulposus (HNP) is the prolapse of the intervertebral disk through a tear in the annulus fibrosus. This causes nerve root compression with clinical pain manifestation and affects the quality of sleep. AIM The aim of this study was find out the comparison in the quality of sleep between before (pre) and after (post) surgery cervical HNP patients. METHODS This study was a retrospective cohort study. Ninety patients were asked to complete the Pittsburgh Sleep Quality Index (PSQI) questionnaire. All data which has been computed were analysed with the McNemar test. RESULT The outcome reveals that from 90 patient`s cervical HNP, 81 (90%) were 40 years old age group and 66 (73.3%) of them were women. The result showed that 66 (73.3%) patients have a bad sleep quality before surgery. Surgery has increased the quality of sleep after surgery 66 (73.3%) patients had good sleep quality. There was a significant difference in the quality of sleep pre and post operation (p = 0.001). CONCLUSION There was a significant difference in the quality of sleep between pre and post operation cervical HNP patient utilising anterior discectomy methods.
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125
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Tousignant-Laflamme Y, Martel MO, Joshi AB, Cook CE. Rehabilitation management of low back pain - it's time to pull it all together! J Pain Res 2017; 10:2373-2385. [PMID: 29042813 PMCID: PMC5633330 DOI: 10.2147/jpr.s146485] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In the past, rehabilitation research initiatives for low back pain (LBP) have targeted outcome enhancement through personalized treatment approaches, namely through classification systems (CS). Although the use of CS has enhanced outcomes, common management practices have not changed, the prevalence of LBP is still high, and only selected patients meet the CS profile, namely those with a nociceptive context. Similarly, although practice guidelines propose some level of organization and occasionally a timeline of care provision, each mainly provides best practice for isolated treatment approaches. Moreover, there is no theoretical framework that has been proposed that guides the rehabilitation management process of mechanical LBP. In this commentary, we propose a model constituted of five domains (nociceptive drivers, nervous system dysfunction drivers, comorbidities drivers, cognitive–emotional drivers, and contextual drivers) grounded as mechanisms driving pain and/or disability in LBP. Each domain is linked to the International Classification of Functioning, Disability and Health, where once a patient is deemed suitable for rehabilitation, the clinician assesses elements of each domain in order to identify where the relative treatment efforts should be focused. This theoretical model is designed to provide a more comprehensive management overview, by appreciating the relative contribution of each domain driving pain and disability. Considering that the multiple domains driving pain and disability, and their interaction, requires a model that is comprehensive enough to identify and address each related issue, we consider that the proposed model has several positive implications for rehabilitation of this painful and highly prevalent musculoskeletal disorder.
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Affiliation(s)
- Yannick Tousignant-Laflamme
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Clinicial Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Anand B Joshi
- Duke Health, Department of Orthopaedic Surgery, Duke University Medical Center
| | - Chad E Cook
- Doctor of Physical Therapy Division, Duke University, Durham, NC, USA
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126
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Nucleus accumbens mediates the pronociceptive effect of sleep deprivation: the role of adenosine A2A and dopamine D2 receptors. Pain 2017; 159:75-84. [DOI: 10.1097/j.pain.0000000000001066] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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127
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Affiliation(s)
- David R Hillman
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Centre for Sleep Science, University of Western Australia, Perth, Australia.
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128
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Abstract
Provoked vestibulodynia (PVD) refers to vulvar pain of at least 3 months duration, localized to the vestibule, provoked by touch and sexual activity and occurring in the absence of a clear identifiable cause. The clinical spectrum ranges from mild with distressing discomfort through to severe and disabling pain. Current understanding is that PVD is one of many chronic pain conditions characterized by sensitization of peripheral and central nociceptive pathways, with pain arising due to dysfunctional neuronal activity in the absence of painful stimuli. Pathophysiology is not well understood but is likely a complex interplay of environmental, genetic, psychological and immune factors. Care is multidisciplinary and follows general principles of chronic pain management with the addition of specific therapy tailored to address pelvic floor overactivity, and sexual and relationship difficulties. More recently, the therapeutic use of placebo is gaining traction in chronic pain research and is a very promising adjunctive therapy. The majority of women with PVD are managed outside of tertiary clinic settings, and care depends on availability and affordability of specialized services; however, much can be done by the primary health provider. PVD is common, and highly treatable, especially with early intervention, but unfortunately, many clinicians are unaware of this condition, and the biggest hurdle for women accessing treatment is obtaining a diagnosis. With treatment, most women can expect significant improvement, often with fairly simple interventions, although some women will benefit from referral to specialized centers. The aims of this article are twofold: firstly, to summarize current literature concerning PVD pathophysiology and management; secondly, to provide a framework for clinicians unfamiliar with vulvar medicine to understand and manage PVD.
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Affiliation(s)
- Helen Henzell
- Melbourne Sexual Health Centre, Carlton.,Action Centre, Family Planning Victoria, Melbourne
| | - Karen Berzins
- Melbourne Sexual Health Centre, Carlton.,Dermatology/Vulval Conditions Clinic, Mercy Hospital for Women, Heidelberg
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129
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Nijs J, Loggia ML, Polli A, Moens M, Huysmans E, Goudman L, Meeus M, Vanderweeën L, Ickmans K, Clauw D. Sleep disturbances and severe stress as glial activators: key targets for treating central sensitization in chronic pain patients? Expert Opin Ther Targets 2017; 21:817-826. [DOI: 10.1080/14728222.2017.1353603] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Jo Nijs
- Department of physiotherapy, human physiology and anatomy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Marco L. Loggia
- MGH/HST A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Andrea Polli
- Department of physiotherapy, human physiology and anatomy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maarten Moens
- Department of Neurosurgery and Radiology, University Hospital Brussels, Brussels, Belgium
- Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Huysmans
- Department of physiotherapy, human physiology and anatomy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lisa Goudman
- Department of physiotherapy, human physiology and anatomy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neurosurgery and Radiology, University Hospital Brussels, Brussels, Belgium
| | - Mira Meeus
- Department of physiotherapy, human physiology and anatomy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Luc Vanderweeën
- Department of physiotherapy, human physiology and anatomy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Private Practice for Spinal Manual Therapy, Schepdaal-Dilbeek, Belgium
| | - Kelly Ickmans
- Department of physiotherapy, human physiology and anatomy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Daniel Clauw
- Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, USA
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Harvey MP, Lorrain D, Martel M, Bergeron-Vezina K, Houde F, Séguin M, Léonard G. Can we improve pain and sleep in elderly individuals with transcranial direct current stimulation? - Results from a randomized controlled pilot study. Clin Interv Aging 2017; 12:937-947. [PMID: 28652716 PMCID: PMC5472413 DOI: 10.2147/cia.s133423] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The prevalence of chronic pain and sleep disturbances substantially increases with age. Pharmacotherapy remains the primary treatment option for these health issues. However, side effects and drug interactions are difficult to control in elderly individuals. Aims The objective of this study was to assess the feasibility of conducting a randomized sham-controlled trial and to collect preliminary data on the efficacy of transcranial direct current stimulation (tDCS) to reduce pain and improve sleep in older adults suffering from chronic pain. Methods Fourteen elderly individuals (mean age 71±7 years) suffering from chronic pain and sleep complaints were randomized to receive either anodal tDCS, applied over the primary motor cortex (2 mA, 20 minutes), or sham tDCS, for 5 consecutive days. Pain was measured with visual analog scales, pain logbooks and questionnaires, while sleep was assessed with actigraphy, sleep diaries and questionnaires. Results There were no missing data for pain and sleep measures, except for actigraphy, that generated several missing data. Blinding was maintained throughout the study, for both the evaluator and participants. Active but not sham tDCS significantly reduced pain (P<0.05). No change was observed in sleep parameters, in both the active and sham tDCS groups (all P≥0.18). Conclusion The present study provides guidelines for the implementation of future tDCS studies in larger populations of elderly individuals. M1 anodal tDCS in this population appears to be effective to reduce pain, but not to improve sleep.
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Affiliation(s)
- Marie-Philippe Harvey
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Faculty of Medicine and Health Sciences, Université de Sherbrooke
| | - Dominique Lorrain
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Department of Psychology, Université de Sherbrooke
| | - Marylie Martel
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Faculty of Medicine and Health Sciences, Université de Sherbrooke
| | | | - Francis Houde
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Faculty of Medicine and Health Sciences, Université de Sherbrooke
| | - Mario Séguin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke.,Department of Neurosurgery, Centre Hospitalier Universitaire de Sherbrooke
| | - Guillaume Léonard
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Faculty of Medicine and Health Sciences, Université de Sherbrooke.,School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada
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131
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Sribastav SS, Peiheng H, Jun L, Zemin L, Fuxin W, Jianru W, Hui L, Hua W, Zhaomin Z. Interplay among pain intensity, sleep disturbance and emotion in patients with non-specific low back pain. PeerJ 2017; 5:e3282. [PMID: 28533953 PMCID: PMC5436560 DOI: 10.7717/peerj.3282] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 04/07/2017] [Indexed: 11/23/2022] Open
Abstract
Background Low back pain (LBP) is the most common problem worldwide. There are several negative consequences of LBP, such as sleep disorders, work leave, disability, depression, anxiety, and poor quality of life. In this study, we designed to evaluate the prevalence of sleep disturbance in patients with non-specific LBP(NSLBP), and cross-correlation among sleep disorder, anxiety, depression and pain intensity in patients with NSLBP. Aim In this study, we designed to evaluate the prevalence of sleep disturbance in patients with NSLBP, and cross-correlation among sleep disorder, anxiety, depression and pain intensity in patients with NSLBP. Methods A cross-sectional self-assessment questionnaire survey was carried out in an outpatient clinic. Anonymous assessments were used to characterize the presence of NSLBP, PSQI, VAS, SF-36 form, ODI, BAI and BDI. Cross-correlation among the severity of NSLBP and sleep disturbance, anxiety, depression and life quality were evaluated. Results Patients with NSLBP have a higher incidence of sleep disorder, anxiety and depression, and higher ODI scores than healthy people without LPB (P < 0.01). NSLBP patients with sleep disorders have more severe anxiety, depression, an increased VAS score and poor daily living (P < 0.05). NSLBP patients with anxiety have declined sleep quality, poor daily living, decreased work and social skills, and increased LBP severity (P < 0.05). NSLBP patients with depression have declined sleep quality, poor daily living, decreased work and social skills (P < 0.05). Significant associations were found between the severity of NSLBP and sleep disorders, anxiety and ODI scores. Conclusion Psychological and social factors play an important role in the development of NSLBP. NSLBP leads to sleep disorders, which decrease the sleep quality and increase the unpleasant emotions and memories in return; these can exacerbate the severity of LBP, with the cycle repeating to form a vicious circle.
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Affiliation(s)
- Shilabant Sen Sribastav
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - He Peiheng
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Long Jun
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Li Zemin
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Wei Fuxin
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Wang Jianru
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Liu Hui
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Wang Hua
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Zheng Zhaomin
- Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China.,Pain Research Center and Department of Physiology, Zhongshan Medical School of Sun Yat-Sen University, Guangzhou, P.R. China
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132
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Decreased alertness due to sleep loss increases pain sensitivity in mice. Nat Med 2017; 23:768-774. [PMID: 28481358 DOI: 10.1038/nm.4329] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 03/17/2017] [Indexed: 12/11/2022]
Abstract
Extended daytime and nighttime activities are major contributors to the growing sleep deficiency epidemic, as is the high prevalence of sleep disorders like insomnia. The consequences of chronic insufficient sleep for health remain uncertain. Sleep quality and duration predict presence of pain the next day in healthy subjects, suggesting that sleep disturbances alone may worsen pain, and experimental sleep deprivation in humans supports this claim. We demonstrate that sleep loss, but not sleep fragmentation, in healthy mice increases sensitivity to noxious stimuli (referred to as 'pain') without general sensory hyper-responsiveness. Moderate daily repeated sleep loss leads to a progressive accumulation of sleep debt and also to exaggerated pain responses, both of which are rescued after restoration of normal sleep. Caffeine and modafinil, two wake-promoting agents that have no analgesic activity in rested mice, immediately normalize pain sensitivity in sleep-deprived animals, without affecting sleep debt. The reversibility of mild sleep-loss-induced pain by wake-promoting agents reveals an unsuspected role for alertness in setting pain sensitivity. Clinically, insufficient or poor-quality sleep may worsen pain and this enhanced pain may be reduced not by analgesics, whose effectiveness is reduced, but by increasing alertness or providing better sleep.
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133
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Kristiansen ES, Nielsen LS, Christensen SS, Botvid SHC, Nørgaard Poulsen J, Gazerani P. Sleep deprivation sensitizes human craniofacial muscles. Somatosens Mot Res 2017; 34:116-122. [DOI: 10.1080/08990220.2017.1317241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | - Louise Skou Nielsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | | | | | - Parisa Gazerani
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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134
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Frange C, Naufel MF, Andersen ML, Ribeiro EB, Girão MJBC, Tufik S, Hachul H. Impact of insomnia on pain in postmenopausal women. Climacteric 2017; 20:262-267. [PMID: 28391713 DOI: 10.1080/13697137.2017.1309381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sleep disturbances and pain are assumed to be reciprocally linked. Insomnia and pain are central symptoms of the postmenopausal period and are closely related. Insomnia affects quality of life, increases pain sensitivity, the risk of pain-related disability, and other health problems. OBJECTIVE To investigate whether insomnia influences aspects of pain (pain intensity and the effect of pain on daily function) in postmenopausal women, and to evaluate the objective sleep pattern of insomniacs with pain. METHODS Fifty-seven women completed questionnaires about insomnia, climacteric symptoms, and pain. Polysomnography data were collected as well as their medical history. Patients were allocated into three groups: control, subthreshold insomnia, and insomnia. Pain intensity, climacteric symptoms and objective sleep pattern were compared between groups. RESULTS Postmenopausal women with insomnia had statistically significant higher pain interference in their activities (e.g. relationships with other people, enjoyment of life and sleep) than controls, and had more severe climacteric symptoms. There were no statistically significant differences in pain intensity and objective sleep pattern between groups. CONCLUSIONS Insomnia status affected climacteric symptoms and pain interference, but not pain intensity in postmenopausal women. Women with insomnia had higher rates of climacteric symptoms than those without insomnia or those with subthreshold insomnia. No changes in objective sleep pattern were found.
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Affiliation(s)
- C Frange
- a Department of Psychobiology , Universidade Federal de São Paulo , São Paulo , Brazil
| | - M Fernanda Naufel
- b Department of Nutrition , Universidade Federal de São Paulo , São Paulo , Brazil
| | - M Levy Andersen
- a Department of Psychobiology , Universidade Federal de São Paulo , São Paulo , Brazil
| | - E Beraldi Ribeiro
- b Department of Nutrition , Universidade Federal de São Paulo , São Paulo , Brazil
| | - M J B Castelo Girão
- c Department of Gynecology , Universidade Federal de São Paulo , São Paulo , Brazil
| | - S Tufik
- a Department of Psychobiology , Universidade Federal de São Paulo , São Paulo , Brazil
| | - H Hachul
- a Department of Psychobiology , Universidade Federal de São Paulo , São Paulo , Brazil.,c Department of Gynecology , Universidade Federal de São Paulo , São Paulo , Brazil
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135
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Fontes F, Gonçalves M, Pereira S, Lunet N. Neuropathic pain after breast cancer treatment and its impact on sleep quality one year after cancer diagnosis. Breast 2017; 33:125-131. [PMID: 28384563 DOI: 10.1016/j.breast.2017.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/24/2017] [Accepted: 03/26/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Data regarding the impact of breast cancer treatment-related neuropathic pain (NP) on sleep quality are scarce. Therefore, we aimed to assess the impact of breast cancer treatment-related NP on patients' sleep quality, during the first year after cancer diagnosis. MATERIALS AND METHODS A total of 501 breast cancer patients were followed prospectively. Incident NP was identified through systematic evaluations after treatments and one year after enrolment. NP severity was quantified using the Brief Pain Inventory severity subscale and sleep quality was evaluated through the Pittsburgh Sleep Quality Index (PSQI), at baseline and after one year. Adjusted regression coefficients (β) and 95% confidence intervals (95%CI) were used to quantify the relation between NP and the variation in the PSQI z-scores. RESULTS The occurrence of NP was associated with a deterioration in sleep quality during the first year of follow-up, more pronounced among those with good sleep quality (PSQI≤5) than those with poor sleep quality at baseline (PSQI>5) (β = 0.44, 95%CI: 0.11 to 0.77 versus β = 0.33, 95%CI: 0.08 to 0.59). These differences were accentuated when only the cases of NP with greater severity were considered (β = 0.86, 95%CI: 0.37 to 1.35 versus β = 0.31, 95%CI: -0.08 to 0.64). Within the PSQI components, daytime dysfunction and sleep duration were the most impaired by NP. CONCLUSION Our findings highlight the importance of the promotion of sleep hygiene among breast cancer patients diagnosed with NP, especially among those with good sleep quality before treatments.
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Affiliation(s)
- Filipa Fontes
- ISPUP - EPIUnit, Universidade do Porto, Porto, Portugal
| | - Marta Gonçalves
- ISPUP - EPIUnit, Universidade do Porto, Porto, Portugal; Centro de Medicina do Sono - Hospital CUF Porto, Porto, Portugal
| | - Susana Pereira
- ISPUP - EPIUnit, Universidade do Porto, Porto, Portugal; Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Nuno Lunet
- ISPUP - EPIUnit, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
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136
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Abstract
The redefinition of neuropathic pain as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system,” which was suggested by the International Association for the Study of Pain (IASP) Special Interest Group on Neuropathic Pain (NeuPSIG) in 2008, has been widely accepted. In contrast, the proposed grading system of possible, probable, and definite neuropathic pain from 2008 has been used to a lesser extent. Here, we report a citation analysis of the original NeuPSIG grading paper of 2008, followed by an analysis of its use by an expert panel and recommendations for an improved grading system. As of February, 2015, 608 eligible articles in Scopus cited the paper, 414 of which cited the neuropathic pain definition. Of 220 clinical studies citing the paper, 56 had used the grading system. The percentage using the grading system increased from 5% in 2009 to 30% in 2014. Obstacles to a wider use of the grading system were identified, including (1) questions about the relative significance of confirmatory tests, (2) the role of screening tools, and (3) uncertainties about what is considered a neuroanatomically plausible pain distribution. Here, we present a revised grading system with an adjusted order, better reflecting clinical practice, improvements in the specifications, and a word of caution that even the “definite” level of neuropathic pain does not always indicate causality. In addition, we add a table illustrating the area of pain and sensory abnormalities in common neuropathic pain conditions and propose areas for further research.
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137
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Iacovides S, George K, Kamerman P, Baker FC. Sleep Fragmentation Hypersensitizes Healthy Young Women to Deep and Superficial Experimental Pain. THE JOURNAL OF PAIN 2017; 18:844-854. [PMID: 28300651 DOI: 10.1016/j.jpain.2017.02.436] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/24/2017] [Accepted: 02/26/2017] [Indexed: 12/11/2022]
Abstract
The effect of sleep deprivation on pain sensitivity has typically been studied using total and partial sleep deprivation protocols. These protocols do not mimic the fragmented pattern of sleep disruption usually observed in individuals with clinical pain conditions. Therefore, we conducted a controlled experiment to investigate the effect of sleep fragmentation on pain perception (deep pain: forearm muscle ischemia, and superficial pain: graded pin pricks applied to the skin) in 11 healthy young women after 2 consecutive nights of sleep fragmentation, compared with a normal night of sleep. Compared with normal sleep, sleep fragmentation resulted in significantly poorer sleep quality, morning vigilance, and global mood. Pin prick threshold decreased significantly (increased sensitivity), as did habituation to ischemic muscle pain (increased sensitivity), over the course of the 2 nights of sleep fragmentation compared with the night of normal sleep. Sleep fragmentation did not increase the maximum pain intensity reported during muscle ischemia (no increase in gain), and nor did it increase the number of spontaneous pains reported by participants. Our data show that sleep fragmentation in healthy, young, pain-free women increases pain sensitivity in superficial and deep tissues, indicating a role for sleep disruption, through sleep fragmentation, in modulating pain perception. PERSPECTIVE Our findings that pain-free, young women develop hyperalgesia to superficial and deep muscle pain after short-term sleep disruption highlight the need for effective sleep management strategies in patients with pain. Findings also suggest the possibility that short-term sleep disruption associated with recurrent acute pain could contribute to increased risk for future chronic pain conditions.
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Affiliation(s)
- Stella Iacovides
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Kezia George
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Kamerman
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Biomedical Sciences, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Fiona C Baker
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Human Sleep Research Program, SRI International, Menlo Park, California
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138
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Pain, opioids, and sleep: implications for restless legs syndrome treatment. Sleep Med 2017; 31:78-85. [DOI: 10.1016/j.sleep.2016.09.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 12/31/2022]
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139
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Glassford JAG. The Neuroinflammatory Etiopathology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Front Physiol 2017; 8:88. [PMID: 28261110 PMCID: PMC5314655 DOI: 10.3389/fphys.2017.00088] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/01/2017] [Indexed: 12/30/2022] Open
Abstract
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating multi-systemic chronic illness of unknown etiology, classified as a neurological disorder by the World Health Organization (WHO). The symptomatology of the condition appears to emanate from a variety of sources of chronic neurological disturbance and associated distortions, and chronicity, in noxious sensory signaling and neuroimmune activation. This article incorporates a summary review and discussion of biomedical research considered relevant to this essential conception perspective. It is intended to provide stakeholders with a concise, integrated outline disease model in order to help demystify this major public health problem. The primary etiopathological factors presented are: (A) Postural/biomechanical pain signaling, affecting adverse neuroexcitation, in the context of compression, constriction, strain, or damage of vertebral-regional bone and neuromuscular tissues; (B) Immune mediated inflammatory sequelae, in the context of prolonged immunotropic neurotrophic infection—with lymphotropic/gliotropic/glio-toxic varieties implicated in particular; (C) A combination of factors A and B. Sustained glial activation under such conditions is associated with oxidative and nitrosative stress, neuroinflammation, and neural sensitivity. These processes collectively enhance the potential for multi-systemic disarray involving endocrine pathway aberration, immune and mitochondrial dysfunction, and neurodegeneration, and tend toward still more intractable synergistic neuro-glial dysfunction (gliopathy), autoimmunity, and central neuronal sensitization.
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140
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Hagenauer MH, Crodelle JA, Piltz SH, Toporikova N, Ferguson P, Booth V. The Modulation of Pain by Circadian and Sleep-Dependent Processes: A Review of the Experimental Evidence. ASSOCIATION FOR WOMEN IN MATHEMATICS SERIES 2017. [DOI: 10.1007/978-3-319-60304-9_1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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141
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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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Nijs J, Leysen L, Pas R, Adriaenssens N, Meeus M, Hoelen W, Ickmans K, Moloney N. Treatment of pain following cancer: applying neuro-immunology in rehabilitation practice. Disabil Rehabil 2016; 40:714-721. [DOI: 10.1080/09638288.2016.1261418] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jo Nijs
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Laurence Leysen
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Roselien Pas
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nele Adriaenssens
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Oncology, University Hospital Brussels, Brussels, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine, Antwerp University, Antwerp, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Wouter Hoelen
- De Berekuyl, Private practice for physiotherapy in oncology & lymphology, Hierden, the Netherlands
| | - Kelly Ickmans
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Niamh Moloney
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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143
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Sleep restriction alters plasma endocannabinoids concentrations before but not after exercise in humans. Psychoneuroendocrinology 2016; 74:258-268. [PMID: 27689899 DOI: 10.1016/j.psyneuen.2016.09.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/22/2016] [Accepted: 09/21/2016] [Indexed: 01/19/2023]
Abstract
Following binding to cannabinoid receptors, endocannabinoids regulate a variety of central nervous system processes including appetite and mood. Recent evidence suggests that the systemic release of these lipid metabolites can be altered by acute exercise and that their levels also vary across the 24-h sleep-wake cycle. The present study utilized a within-subject design (involving 16 normal-weight men) to determine whether daytime circulating endocannabinoid concentrations differ following three nights of partial sleep deprivation (4.25-h sleep opportunity, 2:45-7a.m. each night) vs. normal sleep (8.5-h sleep opportunity, 10:30p.m.-7a.m. each night), before and after an acute bout of ergometer cycling in the morning. In addition, subjective hunger and stress were measured. Pre-exercise plasma concentrations of 2-arachidonoylglycerol (2AG) were 80% higher 1.5h after awakening (vs. normal sleep, p<0.05) when participants were sleep-deprived. This coincided with increased hunger ratings (+25% vs. normal sleep, p<0.05). Moreover, plasma 2AG was elevated 15min post-exercise (+44%, p<0.05). Sleep duration did not however modulate this exercise-induced rise. Finally, subjective stress was generally lower on the day after three nights of short sleep vs. normal sleep, especially after exercise (p<0.05). Given that activation of the endocannabinoid system has been previously shown to acutely increase appetite and mood, our results could suggest that behavioral effects of acute sleep loss, such as increased hunger and transiently improved psychological state, may partially result from activation of this signaling pathway. In contrast, more pronounced exercise-induced elevations of endocannabinoids appear to be less affected by short sleep duration.
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144
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Kumar A, Vandana, Aslami AN. Analgesics Self-Medication and its Association with Sleep Quality among Medical Undergraduates. J Clin Diagn Res 2016; 10:FC07-FC11. [PMID: 28208872 DOI: 10.7860/jcdr/2016/22504.8953] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 09/06/2016] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Self medication especially with analgesics is a common practice among undergraduate medical students. Variation in analgesic self medication prevalence and pattern is often seen due to geographical and target population differences. The mutual influence of pain and sleep quality might persuade students self medication behaviour. AIM To assess analgesic self medication and its association with sleep quality among the medical undergraduates. MATERIALS AND METHODS A cross-sectional questionnaire based study was conducted from December 2015 to February 2016 among 320 medical undergraduates. The information about socio-demographic profile, symptoms, types of analgesics, source of information and reason for analgesic self medication was collected. The sleep quality of students was assessed by Pittsburgh Sleep Quality Index (PSQI). The qualitative variables were expressed as percentages. Odds Ratio (OR) with 95% Confidence Interval (CI) was also calculated. Chi-square test was used. RESULTS Analgesic self medication prevalence was 49.7%, more prevalence seen among males, seniors, urban residents and students of working parents. Headache (48.4%) was the most common cause and paracetamol (79.7%) was most frequent drug used, based on knowledge obtained through textbook and internet (47.1%). Mildness of symptoms (49.1%) was the most important motivation behind self medication. Analgesic use was more (57.4%) among "poor sleepers" compared to "normal sleepers" (45.2%). CONCLUSION Despite having easy accessibility to expert consultations, high prevalence of analgesic self medication among medical students and its association with poor sleep quality is a distressing issue. This indicates an urgent need of awareness programmes about harmful effects of self medication and healthy sleep practices.
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Affiliation(s)
- Amit Kumar
- Assistant Professor, Department of Pharmacology, Narayan Medical College and Hospital , Sasaram, Bihar, India
| | - Vandana
- Assistant Professor, Department of Physiology, Narayan Medical College and Hospital , Sasaram, Bihar, India
| | - Ahmad Nadeem Aslami
- Assistant Professor, Department of Community Medicine, Narayan Medical College and Hospital , Sasaram, Bihar, India
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Kvistgaard Olsen J, Fener DK, Waehrens EE, Wulf Christensen A, Jespersen A, Danneskiold-Samsøe B, Bartels EM. Reliability of Pain Measurements Using Computerized Cuff Algometry: A DoloCuff Reliability and Agreement Study. Pain Pract 2016; 17:708-717. [DOI: 10.1111/papr.12514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/12/2016] [Accepted: 08/01/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Jack Kvistgaard Olsen
- Department of Rheumatology; The Parker Institute; Copenhagen University Hospital, Bispebjerg and Frederiksberg; Frederiksberg Denmark
| | - Dilay Kesgin Fener
- Department of Rheumatology; The Parker Institute; Copenhagen University Hospital, Bispebjerg and Frederiksberg; Frederiksberg Denmark
| | - Eva Elisabet Waehrens
- Department of Rheumatology; The Parker Institute; Copenhagen University Hospital, Bispebjerg and Frederiksberg; Frederiksberg Denmark
- The Research Initiative for Activity Studies and Occupational Therapy; General Practice; Department of Public Health; University of Southern Denmark; Odense Denmark
| | - Anton Wulf Christensen
- Department of Rheumatology; The Parker Institute; Copenhagen University Hospital, Bispebjerg and Frederiksberg; Frederiksberg Denmark
| | - Anders Jespersen
- Department of Rheumatology; The Parker Institute; Copenhagen University Hospital, Bispebjerg and Frederiksberg; Frederiksberg Denmark
| | - Bente Danneskiold-Samsøe
- Department of Rheumatology; The Parker Institute; Copenhagen University Hospital, Bispebjerg and Frederiksberg; Frederiksberg Denmark
- Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
| | - Else Marie Bartels
- Department of Rheumatology; The Parker Institute; Copenhagen University Hospital, Bispebjerg and Frederiksberg; Frederiksberg Denmark
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146
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Park SJ, Yoon DM, Yoon KB, Moon JA, Kim SH. Factors Associated with Higher Reported Pain Levels in Patients with Chronic Musculoskeletal Pain: A Cross-Sectional, Correlational Analysis. PLoS One 2016; 11:e0163132. [PMID: 27636367 PMCID: PMC5026346 DOI: 10.1371/journal.pone.0163132] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/03/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Chronic musculoskeletal pain is highly prevalent, disabling, and costly, and has many negative effects on quality of life. The aim of this study was to investigate factors associated with higher reported pain levels in patients with chronic musculoskeletal pain among demographic, clinical, and psychological factors, and to evaluate whether insomnia is independently associated with pain intensity in this population. METHODS A total of 357 patients with chronic musculoskeletal pain (pain duration ≥ six months) satisfied the study inclusion criteria and were included in the analyses. Patient demographics, clinical, and psychological factors were evaluated with hierarchical multivariate logistic analysis to identify factors associated with severe pain (NRS [numeric rating scale] ≥ 7). Hierarchical linear regression analysis also performed to identify factors associated with pain intensity (0 to 10 NRS). RESULTS Multivariate logistic analyses revealed older age (OR [odds ratio] = 1.017, 95% CI [confidence interval] 1.001-1.032, P = 0.034), high anxiety level (OR = 1.162, 95% CI 1.020-1.324, P = 0.024), high pain catastrophizing (OR = 1.043, 95% CI 1.007-1.081, P = 0.018), and severe insomnia (OR = 1.112, 95% CI 1.057-1.170, P<0.001) were significantly associated with severe pain. Hierarchical linear regression analysis showed age (β = 0.106, P = 0.041), pain catastrophizing (β = 0.249, P<0.001), and insomnia (β = 0.286, P<0.001) were significantly associated with pain intensity. The variance in pain intensity explained by the final model was 32.2%. CONCLUSIONS Older age, severe insomnia, and high pain catastrophizing were significantly associated with higher reported pain levels. Insomnia was independently associated with pain intensity, even after controlling for various demographic and clinical factors. These factors should be considered when devising pain management strategies for this population.
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Affiliation(s)
- Sang Jun Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Duck Mi Yoon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Bong Yoon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Ae Moon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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147
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Pires GN, Bezerra AG, Tufik S, Andersen ML. Effects of experimental sleep deprivation on anxiety-like behavior in animal research: Systematic review and meta-analysis. Neurosci Biobehav Rev 2016; 68:575-589. [DOI: 10.1016/j.neubiorev.2016.06.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 06/18/2016] [Accepted: 06/20/2016] [Indexed: 01/15/2023]
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148
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Abstract
Fibromyalgia is a disorder that is part of a spectrum of syndromes that lack precise classification. It is often considered as part of the global overview of functional somatic syndromes that are otherwise medically unexplained or part of a somatization disorder. Patients with fibromyalgia share symptoms with other functional somatic problems, including issues of myalgias, arthralgias, fatigue and sleep disturbances. Indeed, there is often diagnostic and classification overlap for the case definitions of a variety of somatization disorders. Fibromyalgia, however, is a critically important syndrome for physicians and scientists to be aware of. Patients should be taken very seriously and provided optimal care. Although inflammatory, infectious, and autoimmune disorders have all been ascribed to be etiological events in the development of fibromyalgia, there is very little data to support such a thesis. Many of these disorders are associated with depression and anxiety and may even be part of what has been sometimes called affected spectrum disorders. There is no evidence that physical trauma, i.e., automobile accidents, is associated with the development or exacerbation of fibromyalgia. Treatment should be placed on education, patient support, physical therapy, nutrition, and exercise, including the use of drugs that are approved for the treatment of fibromyalgia. Treatment should not include opiates and patients should not become poly pharmacies in which the treatment itself can lead to significant morbidities. Patients with fibromyalgia are living and not dying of this disorder and positive outlooks and family support are key elements in the management of patients.
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Affiliation(s)
- Andrea T Borchers
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA.
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Erlendson MJ, D'Arcy N, Encisco EM, Yu JJ, Rincon-Cruz L, Peltz G, Clark JD, Chu LF. Palonosetron and hydroxyzine pre-treatment reduces the objective signs of experimentally-induced acute opioid withdrawal in humans: a double-blinded, randomized, placebo-controlled crossover study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:78-86. [PMID: 27712113 DOI: 10.1080/00952990.2016.1210614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Treatments for reducing opioid withdrawal are limited and prone to problematic side effects. Laboratory studies, clinical observations, and limited human trial data suggest 5-HT3-receptor antagonists and antihistamines may be effective. OBJECTIVES This double-blind, crossover, placebo-controlled study employing an acute physical dependence model evaluated whether (i) treatment with a 5-HT3-receptor antagonist (palonosetron) would reduce opioid withdrawal symptoms, and (ii) co-administration of an antihistamine (hydroxyzine) would enhance any treatment effect. METHODS At timepoint T = 0, healthy (non-opioid dependent, non-substance abuser) male volunteers (N = 10) were pre-treated with either a) placebo, b) palonosetron IV (0.75 mg), or c) palonosetron IV (0.75 mg) and hydroxyzine PO (100 mg) in a crossover study design. This was followed at T = 30 by intravenous morphine (10 mg/70kg). At T = 165, 10 mg/70kg naloxone IV was given to precipitate opioid withdrawal. The objective opioid withdrawal score (OOWS) and subjective opioid withdrawal score (SOWS) were determined 5 and 15 minutes after naloxone administration (T = 170, 180, respectively). Baseline measurements were recorded at T = -30 and T = -15. RESULTS Comparison of average baseline OOWS scores with OOWS scores obtained 15 minutes after naloxone was significant (p = 0.0001). Scores from 15 minutes post-naloxone infusion showed significant differences in OOWS scores between treatment groups: placebo, 3.7 ± 2.4; palonosetron, 1.5 ± 0.97; and palonosetron with hydroxyzine, 0.2 ± 0.1333. CONCLUSIONS Pretreatment with palonosetron significantly reduced many signs of experimentally-induced opioid withdrawal. Co-administration with hydroxyzine further reduced opioid withdrawal severity. These results suggest that 5-HT3 receptor antagonists, alone or in combination with an antihistamine, may be useful in the treatment of opioid withdrawal.
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Affiliation(s)
- Matthew J Erlendson
- a Department of Anesthesia , Stanford University School of Medicine , Stanford , CA , USA
| | - Nicole D'Arcy
- a Department of Anesthesia , Stanford University School of Medicine , Stanford , CA , USA
| | - Ellen M Encisco
- a Department of Anesthesia , Stanford University School of Medicine , Stanford , CA , USA
| | - Jeffrey J Yu
- a Department of Anesthesia , Stanford University School of Medicine , Stanford , CA , USA
| | - Lorena Rincon-Cruz
- a Department of Anesthesia , Stanford University School of Medicine , Stanford , CA , USA
| | - Gary Peltz
- a Department of Anesthesia , Stanford University School of Medicine , Stanford , CA , USA
| | - J David Clark
- a Department of Anesthesia , Stanford University School of Medicine , Stanford , CA , USA
| | - Larry F Chu
- a Department of Anesthesia , Stanford University School of Medicine , Stanford , CA , USA
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150
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Patel A, Hasak S, Cassell B, Ciorba MA, Vivio EE, Kumar M, Gyawali CP, Sayuk GS. Effects of disturbed sleep on gastrointestinal and somatic pain symptoms in irritable bowel syndrome. Aliment Pharmacol Ther 2016; 44:246-58. [PMID: 27240555 PMCID: PMC5020700 DOI: 10.1111/apt.13677] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 01/08/2016] [Accepted: 05/06/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sleep disturbances are common, and perhaps are even more prevalent in irritable bowel syndrome (IBS). AIMS To determine the effect of measured sleep on IBS symptoms the following day, IBS-specific quality of life (IBS-QOL) and non-GI pain symptoms. METHODS IBS patients' sleep patterns were compared to healthy individuals via wrist-mounted actigraphy over 7 days. Daily bowel pain logs (severity, distress; 10-point Likert) stool pattern (Bristol scale) and supporting symptoms (e.g. bloating, urgency; 5-point Likert) were kept. Validated measures, including the GI Symptom Rating Scale-IBS, Visceral Sensitivity Index, Pittsburgh Sleep Quality Index and the IBS-Quality of Life were collected. Mediation analysis explored the relationship between sleep, mood and bowel symptoms. RESULTS Fifty subjects (38.6 ± 1.0 years old, 44 female; 24 IBS and 26 healthy controls) completed sleep monitoring. IBS patients slept more hours per day (7.7 ± 0.2 vs. 7.1 ± 0.1, P = 0.008), but felt less well-rested. IBS patients demonstrated more waking episodes during sleep (waking episodes; 12.1 vs. 9.3, P < 0.001). Waking episodes predicted worse abdominal pain (P ≤ 0.01) and GI distress (P < 0.001), but not bowel pattern or accessory IBS symptoms (P > 0.3 for each). Waking episodes negatively correlated with general- and IBS-specific QOL in IBS (r = -0.58 and -0.52, P < 0.001 for each). Disturbed sleep effects on abdominal pain were partially explained by mood as an intermediate. CONCLUSIONS Sleep disturbances are more common in irritable bowel syndrome, and correlate with IBS-related pain, distress and poorer irritable bowel syndrome-related quality of life. Disturbed sleep effects extend beyond the bowel, leading to worse mood and greater somatic pain in patients with the irritable bowel syndrome.
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Affiliation(s)
- Ami Patel
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephen Hasak
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Benjamin Cassell
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Matthew A. Ciorba
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Emily E. Vivio
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mrudula Kumar
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - C. Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gregory S. Sayuk
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA,Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA,Gastroenterology Section, John Cochran Veterans Affairs Medical Center, St. Louis, Missouri, USA
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