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Silva S, Hayden JA, Mendes G, Verhagen AP, Pinto RZ, Silva A. Sleep as a prognostic factor in low back pain: a systematic review of prospective cohort studies and secondary analyses of randomized controlled trials. Sleep 2024; 47:zsae023. [PMID: 38300526 DOI: 10.1093/sleep/zsae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/12/2023] [Indexed: 02/02/2024] Open
Abstract
Sleep problems are common in individuals with low back pain (LBP) and sleep restriction seems to be associated with impaired pain processing. Our objective was to investigate whether sleep is associated with future LBP outcomes (i.e. pain intensity, disability, and recovery) in adults. We conducted a systematic review of prospective cohort studies and secondary analyses of randomized controlled trials (registration-PROSPERO CRD42022370781). In December 2022, we searched the MEDLINE, Embase, CINAHL, and PsycINFO databases. Fourteen studies, totaling 19 170 participants were included. Thirteen studies were rated as having high risk of bias (QUIPS tool). We used vote-counting and meta-analysis approaches to synthesize the data. We found associations between baseline sleep with future pain intensity, recovery, and between changes in sleep with changes in pain intensity, changes in disability, and recovery. We further synthesized outcomes as "overall LBP improvement" outcomes. Baseline poor sleep was moderately associated with non-improvement in LBP in the long-very long term (OR 1.55, 95% CI: 1.39 to 1.73; three studies providing unadjusted effect sizes), and non-improvement in sleep was largely associated with non-improvement in LBP in the short-moderate term (OR 3.45, 95% CI: 2.54 to 4.69; four studies providing unadjusted effect sizes). We found no association between baseline sleep with future disability and overall LBP improvement in the short-moderate term. Therefore, sleep may be a prognostic factor for pain intensity and recovery from LBP. All findings were supported by low to very low-quality evidence. Better-conducted studies are needed to strengthen our certainty about the evidence.
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Affiliation(s)
- Samuel Silva
- School of Physical Education, Physical Therapy, and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Jill A Hayden
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Gabriel Mendes
- School of Physical Education, Physical Therapy, and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Arianne P Verhagen
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Rafael Z Pinto
- School of Physical Education, Physical Therapy, and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Andressa Silva
- School of Physical Education, Physical Therapy, and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Hachul H, Hachul de Campos B, Lucena L, Tufik S. Sleep During Menopause. Sleep Med Clin 2023; 18:423-433. [PMID: 38501515 DOI: 10.1016/j.jsmc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Postmenopause is defined retrospectively after 12 consecutive months of amenorrhea. It represents the end of the reproductive period and ovarian failure. A decrease in estrogen leads to several changes in the short and long term. Among the early changes, vasomotor symptoms (hot flashes) are particularly common, occurring in about 70% of women. In addition, there are changes in mood, anxiety, depression, and insomnia. Insomnia occurs in almost 60% of postmenopausal women. Psychosocial aspects may also affect sleep. Proper diagnosis may lead to adequate treatment of sleep disturbances during menopause. Hormonal or other complementary therapies can improve sleep quality.
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Affiliation(s)
- Helena Hachul
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Department of Ginecology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
| | | | - Leandro Lucena
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
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Lima MG, Barros MBDA, Malta DC, Medina LDPB, Szwarcwald CL. Association of self-reported sleep problems with morbidities and multimorbidities according to sex: National Health Survey 2019. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2021386. [PMID: 35730889 PMCID: PMC9897816 DOI: 10.1590/ss2237-9622202200007.especial] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the association between self-reported sleep problems and the presence of non-communicable diseases (NCDs) and multimorbidity, and whether these associations differ by sex. METHODS This is a cross sectional study performed with data from the Brazilian National Health Survey, 2019. Prevalence ratios between morbidities, the number of NCDs, and the self-report of sleep problems were estimated by Poisson regression with robust variance, according to sex. RESULTS This study analysed data from 85,531 Brazilians age ≥ 18 years. The self-reported sleep problems were associated with all the herein studied morbidities and multimorbidities. The prevalence of sleep problems was higher in those who stated one or two (PR = 2.37; 95%CI 2.22;2.54) and three or more NCDs (PR = 4.73; 95%CI 4.37;5.11). Prevalence ratios of the association with diabetes, lung disease, mental disease, renal disease and multimorbidities were higher among males. CONCLUSION NCDs significantly impacted sleep quality, with a particularly stronger association in both, males and females.
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Affiliation(s)
| | | | | | | | - Célia Landmann Szwarcwald
- Fundação Instituto Oswaldo Cruz, Instituto de Comunicação e
Informação Científica e Tecnológica em Saúde, Rio de Janeiro, RJ, Brazil
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Mateos-Salgado EL, Domínguez-Trejo B, Guevara-López UM, Ayala-Guerrero F. Sleep architecture and the absence of trapezius muscle atonia in women with chronic whiplash-associated disorder: a pilot study. Sleep Biol Rhythms 2022; 20:165-171. [PMID: 38469253 PMCID: PMC10900046 DOI: 10.1007/s41105-021-00350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
Sleep disturbances frequently occur in people with whiplash-associated disorder (WAD) and have been evaluated using questionnaires or actigraphy. It is not clear whether sleep architecture, as assessed by polysomnography (PSG), is altered in individuals with WAD. Additionally, in people with WAD, muscle dysfunction is observed during tasks performed during wakefulness. Thus, this study aimed to analyze the sleep architecture of patients with chronic WAD as well as to evaluate trapezius muscle activity during sleep. Nine women with chronic WAD and nine healthy age-matched women participated in the study. Two PSG recordings were conducted for each participant. Surface electromyography signal samples of the right and left trapezius, and mentonian muscles were obtained from N2, N3, and REM sleep stages for analysis. Significant differences were found in the percentages of total sleep time in the N1 and N2 stages between the two groups. While the muscle tone of the three muscles analyzed decreased progressively across the sleep stages in the healthy group, in the chronic WAD group, this decrement was observed only in the mentonian muscle, and the trapezius muscle continued to exhibit the same muscle tone throughout the sleep stages without atonia during REM sleep. The absence of trapezius muscle atonia during REM sleep in the WAD patients may be related to dysfunction of the mechanisms that regulate motor activity.
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Affiliation(s)
- Erik L. Mateos-Salgado
- School of Psychology, National Autonomous University of Mexico, Av. Universidad 3004, Coyoacán, 04510 Mexico City, Mexico
| | - Benjamín Domínguez-Trejo
- School of Psychology, National Autonomous University of Mexico, Av. Universidad 3004, Coyoacán, 04510 Mexico City, Mexico
| | - Uría M. Guevara-López
- School of Medicine and Surgery, Benito Juárez Autonomous University of Oaxaca, Ex Hacienda de Aguilera S/N, Calz. San Felipe del Agua, 68120 Oaxaca de Juárez, Oaxaca Mexico
| | - Fructuoso Ayala-Guerrero
- School of Psychology, National Autonomous University of Mexico, Av. Universidad 3004, Coyoacán, 04510 Mexico City, Mexico
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Tuncer A, Atay F, Guzel HC, Tuncer AH. Comparison of factors affecting patients with a myofascial temporomandibular disorder with and without sleep bruxism. Niger J Clin Pract 2022; 25:273-280. [PMID: 35295048 DOI: 10.4103/njcp.njcp_1420_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims and Background The aim of the present study was to evaluate the relationship between jaw function, neck disability, sleep quality, fatigue, and headache in patients with myofascial temporomandibular disorder (TMD) with sleep Bruxism (SB) and without it (non-SB). Subjects and Methods This case-control study was conducted with a total of 200 myofascial TMD patients, comprising 91 identified as SB and 109 as non-SB. The Jaw Function Limitations Scale (JFLS), Neck Disability Index (NDI), Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), and Headache Impact Test-6 (HIT-6) scales and indexes were used. Results In the group with SB compared to the non-SB group, JFLS, NDI, PUKI, and FSS scores were statistically significantly higher (P < 0.001). No statistically significant difference was found between the groups in terms of visual analog scale (VAS) (P = 0.127) and HIT-6 scores (P = 0.365). The probability of having JFLS in patients with SB compared to those without was folded 3.551 times (P = 0.002), and the probability of having NDI increased 3.473 times (P = 0.002). In addition, SB was observed to trigger poor sleep quality (P < 0.001). There was no statistically significant determinant of bruxism on FSS (P = 0.196), and on HIT-6 (P = 0.488). Conclusion It can be concluded that SB causes limitation of the jaw's functional activities, neck problems, and decreased sleep quality in myofascial TMD. These findings emphasize the importance of considering SB when evaluating and treating patients with myofascial TMD problems.
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Affiliation(s)
- A Tuncer
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hasan Kalyoncu University, Gaziantep, Turkey
| | - F Atay
- Abdulkadir Konukoğlu, Healthy Life Center, Gaziantep, Turkey
| | - H C Guzel
- Umut Rehabilitation Center, Sanliurfa, Turkey
| | - A H Tuncer
- Department of Pediatric Dentistry, Henry M. Goldman School of Dental Medicine, Boston University, Boston, USA
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Iuzbashian PG, Lvov AN, Tereshenko AV, Volel BA, Satrudinova RR, Romanov DV. [Pain syndromes and insomnia: the role of association with comorbid mental disorders (on the model of glossalgia)]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:13-18. [PMID: 34874649 DOI: 10.17116/jnevro202112110113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To test the association between pain severity and anxiety, depression, and somatoform symptoms in burning sleep syndrome (BMS). MATERIAL AND METHODS The study included 36 patients (33 women, 3 men), mean age 58.0±14.8 years. Psychopathological, clinical-dermatological, parametric, statistical methods were used. Psychometric examination included the Visual Analogue Scale (VAS) for assessment of pain (severity of glossalgia), PHQ-4 for self-assessment of severity of anxiety (GAD-2) and depression (PHQ-2), the Hospital Anxiety and Depression Scale (HADS), the Screening for Somatoform Symptoms-2 (SOMS-2), the Pittsburgh Sleep Quality Index (PSQI), the EQ-5D-5L quality of life assessment scale. RESULTS AND CONCLUSION Insomnia in chronic pain is very common. On the one hand, studies show that sleep deprivation can enhance pain perception. On the other hand, chronic pain can trigger a variety of sleep disorders. One of the localizations of chronic pain syndrome is the oral mucosa. Somatoform pain disorder related to oral mucosa called «glossalgia» or «burning mouth syndrome» (BMS). The prevalence of insomnia in the study sample was 61.1%. The statistically significant positive correlation was found between the severity of insomnia (PSQI) and the severity of anxiety on both GAD-2 and HADS, while insomnia showed no correlation with depression and pain severity. At the same time, the severity of anxiety showed statistically significant positive correlation with the severity of pain assessed by VAS.
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Affiliation(s)
- P G Iuzbashian
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A N Lvov
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia.,Lomonosov Moscow State University, Moscow, Russia
| | - A V Tereshenko
- Moscow Scientific and Practical Center of Dermatology, Venereology and Cosmetology, Moscow, Russia
| | - B A Volel
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Mental Health Research Center, Moscow, Russia
| | - R R Satrudinova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - D V Romanov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Mental Health Research Center, Moscow, Russia
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Schwertner DS, Oliveira RANS, Koerich MHAL, Motta AF, Pimenta AL, Gioda FR. Prevalence of low back pain in young Brazilians and associated factors: Sex, physical activity, sedentary behavior, sleep and body mass index. J Back Musculoskelet Rehabil 2020; 33:233-244. [PMID: 31356188 DOI: 10.3233/bmr-170821] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Low back pain (LBP) has become increasingly common, but the prevalence of this complaint and associated factors in young people remains controversial. OBJECTIVE This study aimed to identify the prevalence of LBP and to explore the existence of associated factors (sex, physical activity, sedentary lifestyle, sleep, body mass index and waist circumference). METHODS This study considered all complaints of the lumbar region (acute or chronic) as LBP, which can irradiate to the backside and legs, lasting a minimum of 24 hours. Youngsters aged 15 to 18 years from a school in the south of Brazil were evaluated. Descriptive statistics was used, in particular Chi-square, Mann-Whitney U tests and binary logistic regression. A significance level of p< 0.05 was adopted. RESULTS A total of 330 youngsters answered a questionnaire and had their anthropometric measurements measured (response rate 84%). The prevalence of LBP in the present was 30%, quarterly 63% and throughout life 77%. There was a significant association between LBP and sex: girls have an increased risk of LBP in the last three-month period (PR = 1.3, 95% CI 1.06-1.56) and throughout life (PR = 1.2, 95% CI 1.04-1.43). The practice of physical activities was also associated with LBP, but as a protection factor in the present and in the last three-month period (PR = 0.7, 95% CI 0.47-0.90). Physical education at school has demonstrated a protective factor regarding LBP throughout life (PR = 0.9, 95% CI 0.77-0.97). Most of the students did not comply with recommendations related to sleep and time spent doing activities in front of a screen, and no association of these factors with LBP was detected. This exposure (physical activity, sleep time, sedentarism) did not present significant association with LBP when adjusted by the confusion factors (sex, age, BMI). CONCLUSIONS Youngsters reported a high prevalence of LBP. Girls were at greater risk of LBP than boys. It is recommended that prevention strategies focus on the practices of physical activities and scholar physical education. No association of LBP with sedentary lifestyle (TV and computer use time, sleep time), anthropometric measures and sleeping duration was observed.
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Affiliation(s)
- Debora Soccal Schwertner
- Universidade do Estado de Santa Catarina - UDESC, Santa Catarina State University, Florianópolis, Brazil.,Laboratory of Motor Behaviour, Postgraduate Program of Human Kinetics Faculty, University of Lisbon, UL, Lisbon, Portugal
| | - Raul A N S Oliveira
- Laboratory of Motor Behaviour, Postgraduate Program of Human Kinetics Faculty, University of Lisbon, UL, Lisbon, Portugal
| | - Micheline H A L Koerich
- Universidade do Estado de Santa Catarina - UDESC, Santa Catarina State University, Florianópolis, Brazil
| | - Andréa Fontoura Motta
- Universidade do Estado de Santa Catarina - UDESC, Santa Catarina State University, Florianópolis, Brazil
| | | | - Fabiane Rosa Gioda
- Universidade Regional de Blumenau - FURB, Regional University of Blumenau, Blumenau, Brazil
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Lobbezoo F, Lavigne GJ, Kato T, de Almeida FR, Aarab G. The face of Dental Sleep Medicine in the 21st century. J Oral Rehabil 2020; 47:1579-1589. [PMID: 32799330 PMCID: PMC7754359 DOI: 10.1111/joor.13075] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/31/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022]
Abstract
It becomes increasingly clear that some sleep disorders have important diagnostic and/or management links to the dental domain, hence the emergence of the discipline ‘Dental Sleep Medicine’. In this review, the following topics are discussed: 1. the reciprocal associations between oro‐facial pain and sleep; 2. the associations between sleep bruxism and other sleep‐related disorders; 3. the role of the dentist in the assessment and management of sleep bruxism; and 4. the dental management of obstructive sleep apnoea. From these topics' descriptions, it becomes clear that the role of the dentist in the recognition and management of sleep‐related oro‐facial pain, sleep bruxism and obstructive sleep apnoea is large and important. Since many dental sleep disorders can have severe consequences for the individual's general health and well‐being, it is imperative that dentists are not only willing to take on that role, but are also able to do so. This requires more attention for Dental Sleep Medicine in the dental curricula worldwide, as well as better postgraduate training of dentists who are interested in specialising in this intriguing domain. This review contributes to increasing the dental researcher's, teacher's and care professional's insight into the discipline ‘Dental Sleep Medicine’ as it has taken shape in the 21st century, to the benefit of all patients suffering from dental sleep disorders.
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Affiliation(s)
- Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gilles J Lavigne
- Faculty of Dental Medicine, Centre d'étude du sommeil, Université de Montréal and Hôpital du Sacré Coeur, Montréal, QC, Canada
| | - Takafumi Kato
- Department of Oral Physiology, Sleep Medicine Center, Osaka University Hospital, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Fernanda R de Almeida
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Predictors of sleep quality among university students: the use of advanced machine learning techniques. Sleep Breath 2020; 25:1119-1126. [PMID: 32700289 DOI: 10.1007/s11325-020-02150-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/01/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the prevalence of sleep disturbances among university students and investigate potential correlated factors and their relative importance in quantifying sleep quality using advanced machine learning techniques. METHODS A total of 1600 university students participated in this cross-sectional study. Sociodemographic information was collected, and the Pittsburgh Sleep Quality Index (PSQI) was administered to assess sleep quality among university students. Study variables were evaluated using logistic regression and advanced machine learning techniques. Study variables that were significant in the logistic regression and had high mean decrease in model accuracy in the machine learning technique were considered important predictors of sleep quality. RESULTS The mean (SD) age of the sample was 26.65 (6.38) and 57% of them were females. The prevalence of poor sleep quality in our sample was 70%. The most accurate and balanced predictive model was the random forest model with a 74% accuracy and a 95% specificity. Age and number of cups of tea per day were identified as protective factors for a better sleep quality, while electronics usage hours, headache, other systematic diseases, and neck pain were found risk factors for poor sleep quality. CONCLUSIONS Six predictors of poor sleep quality were identified in university students in which 2 of them were protective and 3 were risk factors. The results of this study can be used to promote health and well-being in university students, improve their academic performance, and assist in developing appropriate interventions.
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Hannerz H, Holtermann A, Madsen IEH. Musculoskeletal pain as a predictor for depression in the general working population of Denmark. Scand J Public Health 2020; 49:589-597. [PMID: 31969068 PMCID: PMC8512271 DOI: 10.1177/1403494819875337] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Aim: This study examines the association between musculoskeletal
complaints and subsequent use of antidepressants and/or psychiatric hospital
treatment for depressive mood disorders in the Danish labour force.
Methods: The study is based on two cohorts. The first
cohort is the total labour force in 21 Danish municipalities
(n=693,860), where the risk of depression (psychiatric
diagnosis or antidepressant treatment) during 2010–2015 was compared between
individuals on long-term sickness absence due to musculoskeletal disorders (MSD)
and non-sick-listed gainfully employed individuals. The second cohort is a
random sample of the Danish labour force (n=9248) who were
followed during 2011–2015 to estimate the association between self-rated
musculoskeletal pain and depression. All analyses were controlled for age, sex,
calendar period and socio-economic status. Results: Compared to
non-sick-listed gainfully employed individuals, there was an increased risk of
depression in individuals sick-listed with MSD, with rate ratios of 2.39 (99%
confidence interval (CI) 2.22–2.58) for individuals with less severe MSD and
4.27 (99% CI 3.98–4.59) for individuals with more severe MSD. There was also an
increased risk of depression associated with self-rated pain (yes vs. no), with
a rate ratio of 2.17 (99% CI 1.69–2.78). The population attributable fraction of
depression from musculoskeletal pain was 0.35 (99% CI 0.24–0.45).
Conclusions: The results of the present study
indicate that musculoskeletal pain is an important predictor of indicators
of depression in the general working population of Denmark.
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Affiliation(s)
- Harald Hannerz
- National Research Centre for the Working Environment, Denmark
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Camps T, Amat M, Manteca X. A Review of Medical Conditions and Behavioral Problems in Dogs and Cats. Animals (Basel) 2019; 9:E1133. [PMID: 31842492 PMCID: PMC6941081 DOI: 10.3390/ani9121133] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/06/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
Not all animals behave identically when faced with the same situation. These individual differences in the expression of their behavior could be due to many factors, including medical conditions. These medical problems can change behavior directly or indirectly. The aims of this review are to describe the state of the art of the relationship among some medical and behavioral problems, and to propose new lines of investigation. The revision is focused on the relation between behavioral problems and pain, endocrine diseases, neurological problems, vomeronasal organ alterations, and cardiac disorders. These problems represent a diagnostic challenge from a practical point of view. The most common sign of pain in animals is a change in behavior. Although the relation of pain to behavioral problems has been widely studied, it is not absolutely clear. As an example, the relation between sleep disorders and pain is poorly known in veterinary medicine. New studies in humans and laboratory animals show that a reciprocal relationship does, in fact, exist. More specifically, the literature suggests that the temporal effect of sleep deprivation on pain may be stronger than that of pain on sleep. Some behavioral problems could modify the sleep-awake cycle (e.g., cognitive dysfunction). The impact of these behavioral problems on pain perception is completely unknown in dogs and cats. Thyroid hormones play an important role, regarding behavioral control. Both hypothyroidism and hyperthyroidism have been related to behavioral changes. Concerning hypothyroidism, this relationship remains controversial. Nonetheless, new neuro-imaging studies provide objective evidence that brain structure and function are altered in hypothyroid patients, both in laboratory animals and in humans. There are many neurological problems that could potentially change behavior. This paper reviews those neurological problems that could lead to behavioral changes without modifying neurological examination. The most common problems are tumors that affect central nervous system silent zones, mild traumatic brain injury, ischemic attacks, and epilepsy. Most of these diseases and their relationship to behavior are poorly studied in dogs and cats. To better understand the pathophysiology of all of these problems, and their relation to behavioral problems, may change the diagnostic protocol of behavioral problems.
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Affiliation(s)
- Tomàs Camps
- Etovets: Behavioral Medicine and Animal Welfare, 07010 Palma, Spain
| | - Marta Amat
- School of Veterinary Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; (M.A.); (X.M.)
| | - Xavier Manteca
- School of Veterinary Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; (M.A.); (X.M.)
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Marshansky S, Mayer P, Rizzo D, Baltzan M, Denis R, Lavigne GJ. Sleep, chronic pain, and opioid risk for apnea. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:234-244. [PMID: 28734941 DOI: 10.1016/j.pnpbp.2017.07.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/15/2017] [Accepted: 07/15/2017] [Indexed: 01/21/2023]
Abstract
Pain is an unwelcome sleep partner. Pain tends to erode sleep quality and alter the sleep restorative process in vulnerable patients. It can contribute to next-day sleepiness and fatigue, affecting cognitive function. Chronic pain and the use of opioid medications can also complicate the management of sleep disorders such as insomnia (difficulty falling and/or staying asleep) and sleep-disordered breathing (sleep apnea). Sleep problems can be related to various types of pain, including sleep headache (hypnic headache, cluster headache, migraine) and morning headache (transient tension type secondary to sleep apnea or to sleep bruxism or tooth grinding) as well as periodic limb movements (leg and arm dysesthesia with pain). Pain and sleep management strategies should be personalized to reflect the patient's history and ongoing complaints. Understanding the pain-sleep interaction requires assessments of: i) sleep quality, ii) potential contributions to fatigue, mood, and/or wake time functioning; iii) potential concomitant sleep-disordered breathing (SDB); and more importantly; iv) opioid use, as central apnea may occur in at-risk patients. Treatments include sleep hygiene advice, cognitive behavioral therapy, physical therapy, breathing devices (continuous positive airway pressure - CPAP, or oral appliance) and medications (sleep facilitators, e.g., zolpidem; or antidepressants, e.g., trazodone, duloxetine, or neuroleptics, e.g., pregabalin). In the presence of opioid-exacerbated SDB, if the dose cannot be reduced and normal breathing restored, servo-ventilation is a promising avenue that nevertheless requires close medical supervision.
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Affiliation(s)
- Serguei Marshansky
- CIUSSS du Nord de l'Île de Montréal, Hôpital Sacré-Cœur, Québec, Canada; Hôpital Hôtel-Dieu du Centre Hospitalier de l'Université de Montréal (CHUM), Faculté de Médecine, Université de Montréal, Québec, Canada
| | - Pierre Mayer
- Hôpital Hôtel-Dieu du Centre Hospitalier de l'Université de Montréal (CHUM), Faculté de Médecine, Université de Montréal, Québec, Canada
| | - Dorrie Rizzo
- Jewish General, Université de Montréal, Montréal, Québec, Canada
| | - Marc Baltzan
- Faculty of Medicine, McGill University, Mount Sinai Hospital, Montréal, Canada
| | - Ronald Denis
- CIUSSS du Nord de l'Île de Montréal, Hôpital Sacré-Cœur, Québec, Canada
| | - Gilles J Lavigne
- CIUSSS du Nord de l'Île de Montréal, Hôpital Sacré-Cœur, Québec, Canada; Faculty of Dental Medicine, Université de Montréal, Department of Stomatology, CHUM, Montréal, Québec, Canada.
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Substance-related disorders: A review of prevalence and correlates among patients with chronic pain. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:245-254. [PMID: 28669582 DOI: 10.1016/j.pnpbp.2017.06.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 01/25/2023]
Abstract
Over the past few decades, research has revealed high rates of substance-related disorders among patients with chronic pain. In addition to their potentially deleterious health consequences, substance-related disorders have consistently been associated with negative pain-related outcomes among patients with chronic pain. The goal of this narrative review was to provide an overview of studies that have examined the prevalence and correlates of substance-related disorders among patients with chronic pain. A particular focus was placed on opioids, sedatives/hypnotics, cannabis, tobacco, and alcohol given that these substances have received the bulk of research attention among patients with pain. Research conducted to date suggests that a host of biological and psychological factors are likely to contribute to the elevated rates of substance-related disorders among patients with chronic pain. In this review, in addition to reviewing the prevalence and correlates of substance-related disorders among patients with pain, we briefly discussed the changes that were recently made from the DSM-4 to the DSM-5 in the diagnostic criteria for substance-related disorders, and the implications of these changes for the assessment of patients with chronic pain. We also provided a brief overview of instruments that can be used for the assessment of these disorders in clinical and research settings.
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Abstract
Sleep and pain share a bidirectional relationship. Therefore, it is important for practitioners managing patients experiencing either sleep and/or pain issues to recognize and understand this complex association from a neurobiological perspective involving neuroanatomic and neurochemical processes. Accounting for the influence of pain on the various aspects of sleep and understanding its impact on various orofacial pain disorders assists in developing a prudent management approach. Screening for sleep disorders benefits practitioners in identifying these individuals. Instituting evidence-based multidisciplinary management strategies using both behavioral and pharmacologic strategies enhances the delivery of appropriate care.
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Affiliation(s)
- Gary D Klasser
- Department of Diagnostic Sciences, Louisiana State University Health Sciences Center, School of Dentistry, 1100 Florida Avenue, Box 140, New Orleans, LA 70119, USA.
| | - Galit Almoznino
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Orofacial Sensory Clinic, Hebrew University-Hadassah School of Dental Medicine, PO Box 91120, Jerusalem, Israel; Division of Big Data, Department of Community Dentistry, Orofacial Sensory Clinic, Hebrew University-Hadassah School of Dental Medicine, PO Box 91120, Jerusalem, Israel
| | - Giulio Fortuna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Via Pansini, 5, Naples 80131, Italy
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Ojeda B, Salazar A, Calahorro MJ, Dueñas M, Mico JA, de Sola H, Failde I. Understanding the different relationships between mood and sleep disorders in several groups of non-oncological patients with chronic pain. Curr Med Res Opin 2018; 34:669-676. [PMID: 28945136 DOI: 10.1080/03007995.2017.1384372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare sleep dimensions in patients suffering from chronic pain of different origins, and with a group of pain-free subjects. To analyze the relationship between depression and/or anxiety and sleep disorders in musculoskeletal, neuropathic, and fibromyalgia patients. METHODS This cross-sectional study included patients diagnosed with neuropathic pain (NP) (n = 104), musculoskeletal pain (MSK) (n = 99), or fibromyalgia (FM) (n = 51), and pain free subjects (n = 72). Information about sleep dimensions (MOS-sleep), duration and intensity of pain (Visual Analog Scale), and anxiety and depression (Hospital Anxiety and Depression scale) was collected. RESULTS Of the 254 patients with chronic pain (PCP) studied, the mean pain intensity was 6.6 (SD = 1.9), with an average duration of 9 years. The scores in all sleep dimensions of the MOS-sleep were higher in CPP (more disturbances) compared to pain free patients, and differences were observed among the three groups of PCP, with FM most severely affected. Anxiety (β = 1.3), depression (β = 1.1), intensity (β = 1.7), and duration of pain (β = 0.04) were associated with more sleep problems in MSK patients. In contrast, anxiety (β = 2.5) and duration of pain (β = 0.05) were negatively related to sleep in the NP patients, and only depression (β = 1.3) affected FM patients. CONCLUSIONS The sleep pattern differs among groups of PCP in the presence or absence of mood disorders. Understanding these disorders in each specific group of PCP is fundamental, and it can contribute to improve the clinical situation of the patients and better orientating therapeutic strategies.
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Affiliation(s)
- B Ojeda
- a Preventive Medicine and Public Health Area , University of Cádiz , Spain
- b The Observatory of Pain (External Chair of Pain), University of Cádiz , Spain
- c Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA) , Spain
| | - A Salazar
- a Preventive Medicine and Public Health Area , University of Cádiz , Spain
- b The Observatory of Pain (External Chair of Pain), University of Cádiz , Spain
- c Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA) , Spain
| | - M J Calahorro
- d Medical Care Center, Andalusian Health Service , Spain
| | - M Dueñas
- b The Observatory of Pain (External Chair of Pain), University of Cádiz , Spain
- c Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA) , Spain
- e Faculty of Nursing 'Salus Infirmorum' , University of Cádiz , Spain
| | - J A Mico
- f Department of Neuroscience , Pharmacology and Psychiatry, CIBER of Mental Health (CIBERSAM), Institute of Health Carlos III, University of Cádiz , Spain
| | - H de Sola
- a Preventive Medicine and Public Health Area , University of Cádiz , Spain
- b The Observatory of Pain (External Chair of Pain), University of Cádiz , Spain
- c Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA) , Spain
| | - I Failde
- a Preventive Medicine and Public Health Area , University of Cádiz , Spain
- b The Observatory of Pain (External Chair of Pain), University of Cádiz , Spain
- c Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA) , Spain
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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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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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Svensson P, Kumar A. Assessment of risk factors for oro-facial pain and recent developments in classification: implications for management. J Oral Rehabil 2016; 43:977-989. [PMID: 27690281 DOI: 10.1111/joor.12447] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2016] [Indexed: 02/06/2023]
Abstract
Oro-facial pain research has during the last decades provided important novel insights into the basic underlying mechanisms, the need for standardised diagnostic procedures and classification systems, and multiple treatment options for successful rehabilitation of the patient in pain. Notwithstanding the significant progress in our knowledge spanning from molecules to chair, there may also be limitations in our ability to integrate and interpret the tremendous amount of new data and information, in particular in terms of the clinical implications and overriding conceptual models for oro-facial pain. The aim of the present narrative review is to briefly summarise some of the current thoughts on oro-facial pain mechanisms and recent attempts to identify biomarkers and risk factors leading to the proposal of a new risk assessment diagram for oro-facial pain (RADOP) and a provocative new concept based on stochastic variation between multiple risk factors. Finally, the implications for novel management strategies will briefly be discussed.
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Affiliation(s)
- P Svensson
- Section of Orofacial Pain and Jaw Function, Institute of Odontology and Oral Health, Aarhus University, Aarhus, Denmark.,Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus University, Aarhus, Denmark
| | - A Kumar
- Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus University, Aarhus, Denmark
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Lavigne G, Sessle B. The Neurobiology of Orofacial Pain and Sleep and Their Interactions. J Dent Res 2016; 95:1109-16. [DOI: 10.1177/0022034516648264] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article provides an overview of the neurobiology of orofacial pain as well as the neural processes underlying sleep, with a particular focus on the mechanisms that underlie pain and sleep interactions including sleep disorders. Acute pain is part of a hypervigilance system that alerts the individual to injury or potential injury of tissues. It can also disturb sleep. Disrupted sleep is often associated with chronic pain states, including those that occur in the orofacial region. The article presents many insights that have been gained in the last few decades into the peripheral and central mechanisms involved in orofacial pain and its modulation, as well as the circuits and processes in the central nervous system that underlie sleep. Although it has become clear that sleep is essential to preserve and maintain health, it has also been found that pain, particularly chronic pain, is commonly associated with disturbed sleep. In the presence of chronic pain, a circular relationship may prevail, with mutual deleterious influences causing an increase in pain and a disruption of sleep. This article also reviews findings that indicate that reducing orofacial pain and improving sleep need to be targeted together in the management of acute to chronic orofacial pain states in order to improve an orofacial pain patient’s quality of life, to prevent mood alterations or exacerbation of sleep disorder (e.g., insomnia, sleep-disordered breathing) that can negatively affect their pain, and to promote healing and optimize their health.
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Affiliation(s)
- G.J. Lavigne
- Faculties of Dental Medicine and Medicine, University of Montréal, Montréal, Québec, Canada
- Centre for Advanced Research in Sleep Medicine and Trauma Unit, Surgery Department, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - B.J Sessle
- Faculties of Dentistry and Medicine, University of Toronto, Toronto, Ontario, Canada
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Wang HY, Fu TS, Hsu SC, Hung CI. Association of depression with sleep quality might be greater than that of pain intensity among outpatients with chronic low back pain. Neuropsychiatr Dis Treat 2016; 12:1993-8. [PMID: 27563244 PMCID: PMC4984826 DOI: 10.2147/ndt.s110162] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE No study to date has compared the associations of pain intensity, depression, and anxiety with insomnia among outpatients with chronic low back pain (CLBP). This study aimed to investigate this issue. PATIENTS AND METHODS A total of 225 outpatients with CLBP were enrolled from a general orthopedics clinic. The Insomnia Severity Index was used to evaluate sleep quality. Major depressive disorder (MDD) and anxiety disorders were diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision, Axis I Disorders. Two psychometric scales were used to evaluate depression and anxiety. The Visual Analog Scale was employed to assess pain intensity. Multiple linear regressions were performed to determine the association of insomnia with pain intensity, depression, and anxiety. RESULTS Among the 225 subjects, 58 (25.8%) had clinical insomnia; 83 (36.9%) had severe low back pain; 49 (21.8%) had MDD, including 21 (9.3%) with a current major depressive episode (MDE); and 52 (23.1%) had anxiety disorders. More than half (56.9%) of the subjects with CLBP and clinical insomnia had MDD and/or anxiety disorders. Subjects with a current MDE or anxiety disorders had greater severities of pain and insomnia as compared with subjects without these conditions. After controlling for demographic variables, MDE was more strongly associated with insomnia than severe low back pain; moreover, the severity of depression had a greater association with insomnia than pain intensity. CONCLUSION The association of depression with insomnia was not inferior to that of pain intensity with insomnia. Among patients with CLBP and insomnia, integration of depression and anxiety treatment into treatment of pain might help to improve sleep quality.
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Affiliation(s)
- Hsin-Yu Wang
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan; Chang Gung University College of Medicine, Taoyuan
| | - Tsai-Sheng Fu
- Chang Gung University College of Medicine, Taoyuan; Department of Orthopedics, Chang Gung Memorial Hospital at Keelung, Taiwan, Republic of China
| | - Shih-Chieh Hsu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan; Chang Gung University College of Medicine, Taoyuan
| | - Ching-I Hung
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan; Chang Gung University College of Medicine, Taoyuan
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Sleep-associated aspects of myofascial pain in the orofacial area among Temporomandibular Disorder patients and controls. Sleep Med 2015; 16:1056-61. [PMID: 26298779 DOI: 10.1016/j.sleep.2015.03.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/10/2015] [Accepted: 03/31/2015] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVES To assess sleep-associated aspects of temporomandibular disorder (TMD) with myofascial pain (MP) in the orofacial area of patients and controls. MEASUREMENTS Three hundred five female patients were screened to find 44 participants fulfilling the inclusion criteria, 22 suffering from MP and 22 in a control group. Sleep quality was assessed by use of the Pittsburgh Sleep-Quality-Index (PSQI) and a validated German sleep questionnaire (SF-AR). Tooth wear was assessed and anterior temporalis muscle activity was measured at home for several nights by use of a portable electromyography (EMG) device. RESULTS 22 patients (45.0 ± 13.6 years) and 22 controls (45.2 ± 9.0 years) were recruited. The PSQI sum-score was 7.5 ± 3.7 for patients and 4.4 ± 3.0 for controls (p = 0.006). The SF-AR showed that 23% of the controls and 14% of the patients were "long sleepers". The overall number of episodes in the two groups was not significantly different (4.10 ± 2.65 versus 4.57 ± 1.99 episodes per hour). However, more patients had temporalis muscle activity possibly related to SB during all four consecutive nights (p = 0.04). According to the International Classification of Sleep Disorders - Third Edition (ICSD-3) criteria, 13.6% of the controls and 71.4% of the patients (p < 0.001) showed SB. CONCLUSIONS Sleep-associated disturbances, including reduction of sleep quality and greater prevalence of SB and facial pain in the morning, occurred significantly more often among TMD patients. Additionally, SB fluctuated over the nights especially in controls. This should be taken into consideration when the prevalence of SB is assessed by use of EMG.
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Sleep duration and sleep quality following acute mild traumatic brain injury: a propensity score analysis. Behav Neurol 2015; 2015:378726. [PMID: 25852234 PMCID: PMC4380095 DOI: 10.1155/2015/378726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/06/2015] [Indexed: 01/08/2023] Open
Abstract
Introduction. Mild traumatic brain injury (mTBI) has been widely studied and the effects of injury can be long term or even lifelong. This research aims to characterize the sleep problems of patients following acute mTBI. Methods. A total of 171 patients with mTBI within one month and 145 non-mTBI controls were recruited in this study. The questionnaire, Pittsburgh Sleep Quality Index (PSQI), was used to evaluate seven aspects of sleep problems. A propensity score method was used to generate a quasirandomized design to account for the background information, including gender, age, Beck's Anxiety Index, Beck's Depression Index, and Epworth Sleepiness Scale. The effect was evaluated via cumulative logit regression including propensity scores as a covariate. Results. Before adjustment, about 60% mTBI patients and over three quarters of control subjects had mild sleep disturbance while one third mTBI patients had moderate sleep disturbance. After adjusting by the propensity scores, the scores of sleep quality and duration were significant between mTBI and control groups. Conclusion. Our study supports that sleep problem is common in mTBI group. After adjusting the confounders by propensity score, sleep duration and subjective sleep quality are the most frequently reported problems in mTBI patients within one month after the injury.
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26
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Alsaadi SM, McAuley JH, Hush JM, Lo S, Lin CWC, Williams CM, Maher CG. Poor sleep quality is strongly associated with subsequent pain intensity in patients with acute low back pain. Arthritis Rheumatol 2014; 66:1388-94. [PMID: 24782195 DOI: 10.1002/art.38329] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 12/17/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Recent research suggests that sleep quality and pain intensity are intimately linked. Although sleep problems are common in patients with low back pain, the effect of sleep quality on the levels of pain intensity is currently unknown. The aim of this study was to investigate the effect of sleep quality on subsequent pain intensity in patients with recent-onset low back pain. METHODS Data on 1,246 patients with acute low back pain were included in the analysis. Sleep quality was assessed using the sleep quality item of the Pittsburgh Sleep Quality Index, scored on a 0-3-point scale, where 0 = very good sleep quality and 3 = very bad sleep quality. Pain intensity was assessed on a numerical rating scale (range 0-10). A generalized estimating equation (GEE) analysis modeled with an exchangeable correlation structure was used to examine the relationship between sleep quality and pain intensity. The model further controlled for symptoms of depression and prognostic factors for low back pain. RESULTS The GEE analysis demonstrated a large effect of poor sleep on subsequent pain intensity, such that for every 1-point decrease in sleep quality (based on a 0-3-point scale), pain intensity (based on a 0-10-point scale) increased by 2.08 points (95% confidence interval 1.99-2.16). This effect was independent of depression and common prognostic factors for low back pain. CONCLUSION Sleep quality is strongly related to subsequent pain intensity in patients with acute low back pain. Future research is needed to determine whether targeting sleep improvement contributes to pain reduction.
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Affiliation(s)
- Saad M Alsaadi
- King Fahd University Hospital and the University of Dammam, Khobar, Saudi Arabia
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27
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Agmon M, Armon G. Increased insomnia symptoms predict the onset of back pain among employed adults. PLoS One 2014; 9:e103591. [PMID: 25084165 PMCID: PMC4118902 DOI: 10.1371/journal.pone.0103591] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 07/03/2014] [Indexed: 01/25/2023] Open
Abstract
Background Back pain is among the most prevalent pain disorders causing chronic disability among adults, and insomnia is a common co-morbidity. However, whether insomnia precedes back pain or vice versa remains unclear. The current study tested the temporal association between insomnia and back pain. Methods A longitudinal design was used to investigate whether changes in insomnia over time predict the onset of back pain and vice versa. The study was conducted on a cohort of active healthy working adults (N = 2,131, 34% women) at three time points (T1, T2, and T3) over a period of 3.7 years (range = 2.2–5.12) years. Logistic regression analysis was used to test whether increased insomnia symptoms from T1 to T2 predicted the onset of new back pain. Ordinary least squares regression was used to test whether the existence of back pain at T2 predicted an increase in insomnia from T2 to T3. Results The results indicated that after controlling for socioeconomic variables, self-reported health, lifestyle behaviors, and anthropometrics, a T1–T2 increase in insomnia symptoms was associated with a 1.40-fold increased risk of back pain at T3 (OR = 1.40; 95% CI = 1.10–1.71). No support was found for reverse causation; i.e., that back pain predicts subsequent increase in insomnia. Conclusions Insomnia appears to be a risk factor in the development of back pain in healthy individuals. However, no evidence of reverse causation was found.
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Affiliation(s)
- Maayan Agmon
- School of Nursing, University of Haifa, Haifa, Israel
- * E-mail:
| | - Galit Armon
- Department of Psychology, University of Haifa, Haifa, Israel
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Hopton A, Eldred J, MacPherson H. Patients' experiences of acupuncture and counselling for depression and comorbid pain: a qualitative study nested within a randomised controlled trial. BMJ Open 2014; 4:e005144. [PMID: 24902735 PMCID: PMC4054660 DOI: 10.1136/bmjopen-2014-005144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Depression and pain frequently occur together and impact on outcomes of existing treatment for depression. Additional treatment options are required. This study aimed to explore patients' experiences of depression, the processes of change within acupuncture and counselling, and the elements that contributed to longer-term change. METHODS In a substudy nested within a randomised controlled trial of acupuncture or counselling compared with usual care alone for depression, semistructured interviews of 52 purposively sampled participants were conducted and analysed using thematic analysis. RESULTS Differences were reported by participants regarding their experience of depression with comorbid pain compared with depression alone. Along with physical symptoms often related to fatigue and sleep, participants with depression and comorbid pain generally had fewer internal and external resources available to manage their depression effectively. Those who had physical symptoms and were receiving acupuncture commonly reported that these were addressed as part of the treatment. For those receiving counselling, there was less emphasis on physical symptoms and more on help with gaining an understanding of themselves and their situation. Over the course of treatment, most participants in both groups reported receiving support to cope with depression and pain independently of treatment, with a focus on relevant lifestyle and behaviour changes. The establishment of a therapeutic relationship and their active engagement as participants were identified as important components of treatment. CONCLUSIONS Participants with and without comorbid pain received acupuncture or counselling for depression, and reported specific identifiable treatment effects. The therapeutic relationship and participants' active engagement in recovery may play distinct roles in driving long-term change. Patients who present with depression and physical symptoms of care may wish to consider a short course of acupuncture to relieve symptoms prior to a referral for counselling if needed. TRIAL REGISTRATION NUMBER ISRCTN63787732.
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Affiliation(s)
- Ann Hopton
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Janet Eldred
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Hugh MacPherson
- Department of Health Sciences, University of York, York, North Yorkshire, UK
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Chouchou F, Khoury S, Chauny JM, Denis R, Lavigne GJ. Postoperative sleep disruptions: A potential catalyst of acute pain? Sleep Med Rev 2014; 18:273-82. [DOI: 10.1016/j.smrv.2013.07.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 07/08/2013] [Accepted: 07/09/2013] [Indexed: 12/29/2022]
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Emery PC, Wilson KG, Kowal J. Major depressive disorder and sleep disturbance in patients with chronic pain. Pain Res Manag 2014; 19:35-41. [PMID: 24367795 PMCID: PMC3938341 DOI: 10.1155/2014/480859] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Disturbed sleep is a common problem in both chronic pain and major depressive disorder (MDD). Moreover, many patients with chronic pain are depressed. OBJECTIVES To examine the effects of depression on the sleep behaviour of chronic pain patients by comparing patients who did or did not meet diagnostic criteria for MDD. METHODS A total of 60 patients with chronic musculoskeletal pain underwent structured diagnostic interviews for MDD and insomnia, and completed questionnaires assessing pain severity, disability, sleep quality, beliefs and attitudes about sleep, and sleep hygiene. For four consecutive days, they also completed a sleep diary, and reported on sleep hygiene practices and presleep arousal. RESULTS Thirty-three patients (55%) met diagnostic criteria for MDD, most of whom (n=32 [97%]) also fulfilled criteria for insomnia disorder. Insomnia was also common among patients without MDD (21 of 27 [78%]). Participants with MDD had higher self-reports of pain, disability, dysfunctional beliefs about sleep, and, on a prospective basis, greater presleep arousal and poorer sleep hygiene. However, diary assessments of specific sleep parameters (eg, sleep onset latency, total sleep time, sleep efficiency) did not differ between the groups. DISCUSSION Chronic pain patients with comorbid MDD exhibited more dysfunctional beliefs about sleep, poorer sleep hygiene practices and greater presleep arousal; however, diary-recorded sleep characteristics may not differ from those of patients without MDD. Chronic pain itself may disturb sleep so extensively that MDD introduces little additive effect. CONCLUSION MDD in chronic pain may be related to the cognitive and behavioural aspects of insomnia, rather than to an incremental disturbance in the initiation or maintenance of sleep.
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Affiliation(s)
| | - Keith G Wilson
- School of Psychology
- Department of Medicine, University of Ottawa
- Department of Psychology, The Ottawa Hospital Rehabilitation Centre
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario
| | - John Kowal
- School of Psychology
- Department of Psychology, The Ottawa Hospital Rehabilitation Centre
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario
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Sandoval R, Roddey T, Giordano TP, Mitchell K, Kelley C. Randomized Trial of Lower Extremity Splinting to Manage Neuropathic Pain and Sleep Disturbances in People Living with HIV/AIDS. ACTA ACUST UNITED AC 2013; 15:240-7. [DOI: 10.1177/2325957413511112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background/Aims: Distal symmetrical peripheral neuropathy (DSPN) and sleep disturbances are among the most common complications reported in people living with the human immunodeficiency virus infection and acquired immunodeficiency syndrome (PLWHA). DSPN-pain is predominantly managed by using systemic agents with little evidence supporting their analgesic efficacy. The purpose of this study is to evaluate the effect of nighttime lower extremity splinting application on DSPN-related pain and sleep disturbances compared to a parallel splint liner application in PLWHA. Methods: Forty-six PLWHA and DSPN were randomized to nighttime wearing of bilateral lower extremity splints or the liners only. Pain and sleep outcomes were measured at baseline, week 3, and week 6. The pain was measured using the Neuropathic Pain Scale and sleep using the Pittsburgh Sleep Quality Index. Results: Pain and sleep scores improved in both groups over time. The median percentage pain reduction at week 6 was 8% in the liner group and 34% in the splint group. The change in pain scores in the splint group was found to be significant over time, P < .0005. The contrast between the splint and liner groups was underpowered (26%) and was not found to be significant, P > .05. Sleep scores improved 20% from baseline to the end of the study in both groups; all participants were classified as poor sleepers. Conclusion: The 6-week use of nighttime splints reduces DSPN-pain possibly by providing peripheral inhibition of external stimuli. Future studies are needed to validate this inhibitory intervention to manage DSPN in PLWHA and other neuropathic conditions.
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Affiliation(s)
- Roberto Sandoval
- Harris Health System, Thomas Street Health Center, Houston, TX, USA
- School of Physical Therapy, Texas Woman’s University, Houston, TX, USA
| | - Toni Roddey
- School of Physical Therapy, Texas Woman’s University, Houston, TX, USA
| | - Thomas Peter Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Scientist, HSR&D Center of Excellence, DeBakey VA Medical Center, Houston, TX, USA
| | - Katy Mitchell
- School of Physical Therapy, Texas Woman’s University, Houston, TX, USA
| | - Carolyn Kelley
- School of Physical Therapy, Texas Woman’s University, Houston, TX, USA
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Alföldi P, Wiklund T, Gerdle B. Comorbid insomnia in patients with chronic pain: a study based on the Swedish quality registry for pain rehabilitation (SQRP). Disabil Rehabil 2013; 36:1661-9. [PMID: 24320022 DOI: 10.3109/09638288.2013.864712] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE This study investigates the prevalence of insomnia and its relationship to other symptoms and health aspects in patients with chronic pain. METHODS Patients with chronic pain conditions (n = 845) referred to a multidisciplinary pain centre completed surveys provided by the Swedish quality registry for pain rehabilitation (SQRP). The SQRP collects data on socio-demographics, health status, symptoms of pain, mood and insomnia and life satisfaction. RESULTS The majority of patients (65.3%) had clinical insomnia according to the insomnia severity index (ISI). Insomnia correlated significantly but weakly with pain, depression, anxiety and coping; the strongest multivariate correlations were found with depression and anxiety followed by pain interference and pain severity. Pain intensity, depression and anxiety correlated stronger than ISI with respect to the two investigated aspects of health. CONCLUSIONS The prevalence of insomnia is high in patients with chronic pain conditions, but the level of importance in relation to other symptoms for health aspects is low, and the associations with other important symptoms are relatively weak. One way to increase the effects of multimodal rehabilitation programs may be to provide interventions directed specifically at insomnia rather than focusing only on interventions that address pain, depression and anxiety. Implications for Rehabilitation The prevalence of insomnia is high in patients with complex chronic pain conditions. Relatively low correlations existed between insomnia and pain intensity, depression, anxiety and other psychological aspects. Pain intensity, anxiety and depression were more important for perceived health aspects than insomnia. One way to increase the effects of multimodal rehabilitation programs may be to also include interventions directed directly to insomnia.
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Affiliation(s)
- Peter Alföldi
- Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Rehabilitation Medicine, University of Linköping , Linköping , Sweden and
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Salazar A, Dueñas M, Mico JA, Ojeda B, Agüera-Ortiz L, Cervilla JA, Failde I. Undiagnosed mood disorders and sleep disturbances in primary care patients with chronic musculoskeletal pain. PAIN MEDICINE 2013; 14:1416-25. [PMID: 23742219 DOI: 10.1111/pme.12165] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The study aims to determine the prevalence of undiagnosed comorbid mood disorders in patients suffering chronic musculoskeletal pain in a primary care setting and to identify sleep disturbances and other associated factors in these patients, and to compare the use of health services by chronic musculoskeletal pain patients with and without comorbid mood disorders. DESIGN Cross-sectional study. SUBJECTS A total of 1,006 patients with chronic musculoskeletal pain from a representative sample of primary care centers were evaluated. OUTCOME MEASURES Pain was measured using a visual analog scale and the Primary Care Evaluation of Mental Disorders questionnaire was used to measure mood disorders. RESULTS We observed a high prevalence of undiagnosed mood disorders in chronic musculoskeletal pain patients (74.7%, 95% confidence interval [CI] 71.9-77.4%), with greater comorbidity in women (adjusted odds ratio [OR] = 1.91, 95% CI 1.37-2.66%) and widow(er)s (adjusted OR = 1.87, 95% CI 1.19-2.91%). Both sleep disturbances (adjusted OR = 1.60, 95% CI 1.17-2.19%) and pain intensity (adjusted OR = 1.02, 95% CI 1.01-1.02%) displayed a direct relationship with mood disorders. Moreover, we found that chronic musculoskeletal pain patients with comorbid mood disorders availed of health care services more frequently than those without (P < 0.001). CONCLUSIONS The prevalence of undiagnosed mood disorders in patients with chronic musculoskeletal pain is very high in primary care settings. Our findings suggest that greater attention should be paid to this condition in general practice and that sleep disorders should be evaluated in greater detail to achieve accurate diagnoses and select the most appropriate treatment.
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Affiliation(s)
- Alejandro Salazar
- Preventive Medicine and Public Health Department, University of Cádiz, Cádiz, Spain
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Schuh-Hofer S, Wodarski R, Pfau DB, Caspani O, Magerl W, Kennedy JD, Treede RD. One night of total sleep deprivation promotes a state of generalized hyperalgesia: a surrogate pain model to study the relationship of insomnia and pain. Pain 2013; 154:1613-1621. [PMID: 23707287 DOI: 10.1016/j.pain.2013.04.046] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 04/03/2013] [Accepted: 04/19/2013] [Indexed: 12/25/2022]
Abstract
Sleep disturbances are highly prevalent in chronic pain patients. Understanding their relationship has become an important research topic since poor sleep and pain are assumed to closely interact. To date, human experimental studies exploring the impact of sleep disruption/deprivation on pain perception have yielded conflicting results. This inconsistency may be due to the large heterogeneity of study populations and study protocols previously used. In addition, none of the previous studies investigated the entire spectrum of nociceptive modalities. To address these shortcomings, a standardized comprehensive quantitative sensory protocol was used in order to compare the somatosensory profile of 14 healthy subjects (6 female, 8 male, 23.5 ± 4.1 year; mean ± SD) after a night of total sleep deprivation (TSD) and a night of habitual sleep in a cross-over design. One night of TSD significantly increased the level of sleepiness (P<0.001) and resulted in higher scores of the State Anxiety Inventory (P<0.01). In addition to previously reported hyperalgesia to heat (P<0.05) and blunt pressure (P<0.05), study participants developed hyperalgesia to cold (P<0.01) and increased mechanical pain sensitivity to pinprick stimuli (P<0.05) but no changes in temporal summation. Paradoxical heat sensations or dynamic mechanical allodynia were absent. TSD selectively modulated nociception, since detection thresholds of non-nociceptive modalities remained unchanged. Our findings show that a single night of TSD is able to induce generalized hyperalgesia and to increase State Anxiety scores. In the future, TSD may serve as a translational pain model to elucidate the pathomechanisms underlying the hyperalgesic effect of sleep disturbances.
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Affiliation(s)
- Sigrid Schuh-Hofer
- Institute of Neurophysiology, Centre of Biomedicine and Medical Technology Mannheim, Heidelberg University, 68167 Mannheim, Germany Zentrum für Neurologie, Abteilung Epileptologie, Universitätsklinikum Tübingen der Eberhard Karls Universität, Germany Eli Lilly & Company, Erl Wood Manor, Windlesham, Surrey GU2 06PH, UK Eli Lilly & Company, Indianapolis, IN, USA
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Khoury S, Chouchou F, Amzica F, Giguère JF, Denis R, Rouleau GA, Lavigne GJ. Rapid EEG activity during sleep dominates in mild traumatic brain injury patients with acute pain. J Neurotrauma 2013; 30:633-41. [PMID: 23510169 DOI: 10.1089/neu.2012.2519] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Chronic pain is a highly prevalent post-concussion symptom occurring in a majority of patients with mild traumatic brain injury (mTBI). About half of patients with mTBI report sleep-wake disturbances. It is known that pain can alter sleep quality in this population, but the interaction between pain and sleep is not fully understood. This study aimed to identify how pain affects subjective sleep (Pittsburgh Sleep Quality Index [PSQI]), sleep architecture, and quantitative electroencephalographic (qEEG) brain activity after mTBI. Twenty-four mTBI patients complaining of sleep-wake disturbances, with and without pain (8 and 16, respectively), were recruited 45 (±22.7) days post-trauma on average. Data were compared with those of 18 healthy controls (no sleep or pain complaints). The PSQI, sleep architecture, and qEEG activity were analyzed. Pain was assessed using questionnaires and a 100-mm visual analogue scale. Patients with mTBI reported three times poorer sleep quality than controls on the PSQI. Sleep architecture significantly differed between patients with mTBI and controls but was within normal range. Global qEEG showed lower delta (deep sleep) and higher beta and gamma power (arousal) at certain EEG derivations in patients with mTBI compared with controls (p<0.04). Patients with mTBI with pain, however, showed greater increase in rapid EEG frequency bands, mostly during REM sleep, and beta bands in non-REM sleep compared with patients with mTBI without pain and controls (p<0.001). Pain in patients with mTBI was associated with more rapid qEEG activity, mostly during REM sleep, suggesting that pain is associated with poor sleep and is a critical factor in managing post-concussion symptoms.
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Affiliation(s)
- Samar Khoury
- Centre for Advanced Research in Sleep Medicine, Sacré-Cœur Hôspital, Montreal, Québec H4J 1C5, Canada
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Doufas AG, Panagiotou OA, Ioannidis JPA. Concordance of sleep and pain outcomes of diverse interventions: an umbrella review. PLoS One 2012; 7:e40891. [PMID: 22815856 PMCID: PMC3398909 DOI: 10.1371/journal.pone.0040891] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 06/14/2012] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVE Pain influences sleep and vice versa. We performed an umbrella review of meta-analyses on treatments for diverse conditions in order to examine whether diverse medical treatments for different conditions have similar or divergent effects on pain and sleep. METHODS We searched published systematic reviews with meta-analyses in the Cochrane Database of Systematic Reviews until October 20, 2011. We identified randomized trials (or meta-analyses thereof, when >1 trial was available) where both pain and sleep outcomes were examined. Pain outcomes were categorized as headache, musculoskeletal, abdominal, pelvic, generic or other pain. Sleep outcomes included insomnia, sleep disruption, and sleep disturbance. We estimated odds ratios for all outcomes and evaluated the concordance in the direction of effects between sleep and various types of pain and the correlation of treatment effects between sleep and pain outcomes. RESULTS 151 comparisons with 385 different trials met our eligibility criteria. 96 comparisons had concordant direction of effects between each pain outcome and sleep, while in 55 the effect estimates were in opposite directions (P<0.0001). In the 20 comparisons with largest amount of evidence, the experimental drug always had worse sleep outcomes and tended to have worse pain outcomes in 17/20 cases. For headache and musculoskeletal pain, 69 comparisons showed concordant direction of effects with sleep outcomes and 36 showed discordant direction (P<0.0001). For the other 4 pain types there were overall 27 vs. 19 pairs with concordant vs. discordant direction of effects (P = 0.095). There was a weak correlation of the treatment effect sizes for sleep vs. headache/musculoskeletal pain (r = 0.17, P = 0.092). CONCLUSIONS Medical interventions tend to have effects in the same direction for pain and sleep outcomes, but exceptions occur. Concordance is primarily seen for sleep and headache or musculoskeletal pain where many drugs may both disturb sleep and cause pain.
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Affiliation(s)
- Anthony G. Doufas
- Department of Anesthesia, Stanford University School of Medicine, Stanford, California, United States of America
- Outcomes Research Consortium, Cleveland, Ohio, United States of America
| | - Orestis A. Panagiotou
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - John P. A. Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California, United States of America
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Roth T, Lankford DA, Bhadra P, Whalen E, Resnick EM. Effect of pregabalin on sleep in patients with fibromyalgia and sleep maintenance disturbance: a randomized, placebo-controlled, 2-way crossover polysomnography study. Arthritis Care Res (Hoboken) 2012; 64:597-606. [PMID: 22232085 DOI: 10.1002/acr.21595] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the effect of pregabalin on polysomnographic (PSG) measures of sleep and patient-rated sleep, tiredness, and pain in fibromyalgia patients. METHODS We performed a randomized, double-blind, placebo-controlled, 2-period crossover PSG study. Patients ages ≥18 years with fibromyalgia satisfied subjective and objective sleep disturbance criteria prior to randomization. Eligible patients were randomized (1:1) to pregabalin (300-450 mg/day) or placebo for crossover period 1, and vice versa for period 2. Each crossover period comprised a dose-adjustment and dose-maintenance phase, with a 2-week taper/washout between periods. In-laboratory PSGs were recorded during 2 consecutive nights at screening and at the end of each crossover period. The primary end point was the difference in sleep maintenance defined by PSG-recorded wake after sleep onset (WASO; minutes) between 4 weeks of treatment with pregabalin and with placebo. Other PSG measures; patient-rated sleep, tiredness, and pain; and tolerability were assessed. RESULTS Of 119 patients randomized (103 women [86.6%], mean age 48.4 years), 102 (85.7%) completed both periods. Patients treated with pregabalin showed a reduction in PSG-determined WASO versus treatment with placebo (week 4 difference: -19.2 minutes [95% confidence interval (95% CI) -26.7, -11.6]; P < 0.0001). Pain score improved (decreased) with pregabalin versus placebo treatment at all 4 weeks (week 4 difference: -0.52 [95% CI -0.90, -0.14]; P = 0.0084). Modest (ρ = <0.3) but significant correlations were found between PSG sleep assessments and ratings of pain and sleep quality. Frequently reported all-causality adverse events (pregabalin versus placebo) were: dizziness (30.4% versus 9.9%), somnolence (20.5% versus 4.5%), and headache (8.9% versus 8.1%). CONCLUSION Patients with fibromyalgia treated with pregabalin had statistically significant and meaningful improvements in sleep, as assessed by PSG. Patients with fibromyalgia also reported decreased daily pain. Pregabalin was well tolerated.
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Affiliation(s)
- Thomas Roth
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, Michigan, USA.
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Stålnacke BM. Psychological symptoms in patients with injury-related chronic pain. ISRN PSYCHIATRY 2012; 2012:196069. [PMID: 23738197 PMCID: PMC3658705 DOI: 10.5402/2012/196069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 01/08/2012] [Indexed: 11/23/2022]
Abstract
Background. Chronic injury-related pain could be influenced by psychological symptoms such as depression, anxiety, and stress that also affect daily life. Methods. Patients with chronic pain caused by an injury (n = 86) aged 18-65 years referred to the Pain Rehabilitation Clinic at the Umeå University Hospital answered a set of questionnaires to assess pain intensity, depression, anxiety, posttraumatic stress, sleep disturbance, and fatigue. Results. A significantly higher proportion of women (47.5%) reported depression (Hospital Anxiety and Depression Scale (HAD)) than men (22.2%). In all patients anxiety (HAD) was reported by 39.5% and moderate/severe posttraumatic stress (Impact of Event Scale) by 30.2%. A majority reported sleep disturbance (84.9%) and fatigue (90.7%). Significant relationships were found between posttraumatic stress and depression and anxiety. Conclusion. These findings indicate the importance of assessing and treating psychological symptoms associated with chronic pain as the result of trauma.
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