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Yang MM, Riva-Cambrin J, Cunningham J, Casha S. Impact of preoperative insomnia on poor postoperative pain control after elective spine surgery and the modified Calgary postoperative pain after spine surgery (MCAPPS) score. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100261. [PMID: 37753373 PMCID: PMC10518606 DOI: 10.1016/j.xnsj.2023.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 09/28/2023]
Abstract
Background Approximately 30% to 64% of patients experience inadequate pain control following spine surgery. The Calgary postoperative pain after spine surgery (CAPPS) score was developed to identify this subset of patients. The impact of preoperative insomnia on postoperative pain control is unknown. This study aimed to investigate the relationship between preoperative insomnia and poor pain control after spine surgery, as well as improve the predictive accuracy of the CAPPS score. Methods A prospective cohort study was conducted in patients undergoing elective spine surgery. Poor pain control was defined as a mean numeric rating scale pain score >4 at rest within the first 24-hours after surgery. Patients were evaluated using the CAPPS score, which included 7 prognostic factors. A multivariable logistic regression model was used to examine the association between preoperative insomnia severity index (ISI) and poor pain control, adjusting for the CAPPS score. The Modified CAPPS score was derived from this model. Results Of 219 patients, 49.7% experienced poorly controlled pain. Prevalence of clinical insomnia (ISI≥15) was 26.9%. Preoperative ISI was independently associated with poor pain control (odds ratio [OR] 1.09, [95%CI=1.03-1.16], p=.004), after adjusting for the CAPPS score (OR 1.61, [95%CI=1.38-1.89], p<.001). The model exhibited good discrimination (c-statistics 0.80, [95%CI=0.74-0.86]) and calibration (Hosmer-Lemeshow chi-square=8.95, p=.35). The Modified CAPPS score also demonstrated good discrimination (c-statistic 0.78, [95%CI=0.72-0.84]) and calibration (Hosmer-Lemeshow chi-square=2.92, p=.57). Low-, high-, and extreme-risk groups stratified by the Modified CAPPS score had 17.3%, 49.1%, and 80.7% predicted probability of experiencing inadequate pain control compared to 32.0%, 64.0%, and 85.1% in the CAPPS score. Conclusions Preoperative insomnia is prevalent and is a modifiable risk factor for poor pain control following spine surgery. Early identification and management of preoperative insomnia may lead to improved postoperative pain outcomes. Future external validation is needed to confirm the accuracy of the Modified CAPPS score.
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Affiliation(s)
- Michael M.H. Yang
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, 1403 29 St NW, Calgary, Alberta, T2N 2T9, Canada
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta, T2N 4Z6, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada
| | - Jay Riva-Cambrin
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, 1403 29 St NW, Calgary, Alberta, T2N 2T9, Canada
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Jonathan Cunningham
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, 1403 29 St NW, Calgary, Alberta, T2N 2T9, Canada
| | - Steven Casha
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, 1403 29 St NW, Calgary, Alberta, T2N 2T9, Canada
- Hotchkiss Brain Institute, University of Calgary, 3300 Hospital Dr, Calgary, Alberta, T2N 4N1, Canada
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Ambalavanar U, Berkers V, Haavik H, Murphy BA. Effect Sizes for Changes in Health and Well-Being Following Treatment With the One-To-Zero Technique in Individuals With Occipito-Atlantal Joint Dysfunction: A Repeated Measures Study. J Chiropr Med 2023; 22:302-312. [PMID: 38205225 PMCID: PMC10774879 DOI: 10.1016/j.jcm.2023.10.004] [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: 06/15/2023] [Revised: 10/07/2023] [Accepted: 10/07/2023] [Indexed: 01/12/2024] Open
Abstract
Objectives The purpose of this study was to determine effect sizes (ES) for changes in self-reported measures of musculoskeletal pain and dysfunction resulting from the one-to-zero method using a repeated measures study design. Methods Twenty participants presenting with articular dysfunction of the occipito-atlantal (C0-C1) complex were treated using the one-to-zero method, a high-velocity low-amplitude thrust administered between the C0-C1 complex before treating other restrictive segments in a cephalocaudal direction. The participants completed online questionnaires using Google Forms that assessed aspects of the biopsychosocial model of pain at baseline and within a week after treatment. The questionnaires included the following: (1) Demographic and Health Behavior Survey; (2) Neck Bournemouth Questionnaire (NBQ) or Neck Disability Index (NDI); (3) Beck Anxiety Index (BAI); (4) Insomnia Severity Index (ISI); and (5) 36-Item Short Form Health Survey (SF-36). Paired t test or Wilcoxon signed ranks test was performed, dependent on normality. Cohen's d values were calculated for each questionnaire score (0.20 indicative of small; ≥0.50 medium; and ≥0.80 large ES). Results The NDI, NBQ, BAI, and ISI had a large ES (all d ≥ 0.80). In the SF-36, 4 subscales had a small to near-medium ES, 1 subscale had a medium to near-large ES, and the remaining 2 had a large ES (d ≥ 0.80). The physical and mental component summary had a large (d = 0.88) and small ES (d = 0.35), respectively. Conclusion The effect sizes suggest the one-to-zero treatment induces change in various aspects of the biopsychosocial model.
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Affiliation(s)
- Ushani Ambalavanar
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Victoria Berkers
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Heidi Haavik
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
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Yalin M, Key S, Kazez M, Agar A. Carpal tunnel decompression: a comparison of elderly and younger patients' sleep quality. Acta Orthop Belg 2023; 89:253-256. [PMID: 37924542 DOI: 10.52628/89.2.11436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
The current study was conducted to evaluate sleep disturbances by age group in patients who underwent carpal tunnel decompression (CTD). Individuals who applied to the orthopedic outpatient clinic and had CTD between 2018 and 2022 had their medical records reviewed. Pre-operative data included patient demographics and the Pittsburgh Sleep Quality Index (PSQI). All post-surgery patients who returned for suture removal were clinically evaluated. Patients were requested to return for re-scoring on the PSQI 6 months after CTD. The cases' average age was 56.44±9.37 years. The study divided its subjects into two age ranges: those between the ages of 45 and 60 (82.2%) (Group1) and those between the ages of 70 and 85 (17.8%) (Group 2). The PSQI values of Group 1 were found to be significantly lower than Group 2. Preoperative PSQI levels were compared to post-op values at 2 weeks and 6 months, and both measurements decreased significantly. Sleep quality improved in all patient groups, regardless of their age, following CTD. Elderly patients had delayed improvements in sleep quality following CTD. The PSQI was effective in determining improvement following CTD, particularly in younger patients, and the progress remained for 6 months.
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Korabelnikova EA, Akavov AN, Baranov ML. [Insomnia in neurological patients with disabilities]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:12-20. [PMID: 36843454 DOI: 10.17116/jnevro202312302112] [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: 02/28/2023]
Abstract
Sleep is the most important factor reflecting the level of psychophysical well-being of a person and influencing him/her to the same extent. The greater susceptibility to sleep disturbances in patients with disabilities is associated with numerous factors. In the existing literature, there are few studies of insomnia in people with neurological disabilities. This article presents a current view on sleep disorders in disabled people and methods for their treatment.
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Affiliation(s)
- E A Korabelnikova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A N Akavov
- Dagestan State Medical University, Makhachkala, Russia
| | - M L Baranov
- Main Military Clinical Hospital of the National Guard Forces, Moscow, Russia
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Garnæs KK, Mørkved S, Tønne T, Furan L, Vasseljen O, Johannessen HH. Mental health among patients with chronic musculoskeletal pain and its relation to number of pain sites and pain intensity, a cross-sectional study among primary health care patients. BMC Musculoskelet Disord 2022; 23:1115. [PMID: 36544130 PMCID: PMC9773452 DOI: 10.1186/s12891-022-06051-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Chronic musculoskeletal pain (CMP) is characterised by pain related to the muscles or the joints with a duration of three months or more and is associated with high symptomatic burden in patients in primary health care. CMP is commonly associated with impaired mental health, which may affect the rehabilitation process. The primary aim of this study was to compare symptoms of anxiety, depression, fatigue, and insomnia in patients in primary health care with and without CMP. The secondary aim was to assess difference in mental health symptoms related to number of pain sites and pain intensity. METHODS This cross-sectional study was conducted in Trondheim, Norway. All patients aged 21-58 from randomly selected general practitioners (GPs) were invited to participate. Participants were classified into two groups according to presence of CMP. Symptoms of anxiety, depression, fatigue, and insomnia were assessed by the Hospital Anxiety and Depression Scale (HADS), Chalder Fatigue Questionnaire (CFQ), and Insomnia Severity Index (ISI), respectively, using an online survey system. RESULTS From the patient lists of six GPs, we included 969 patients. Mean age 46 years (SD: 10.1), and 517 reported CMP. CMP patients reported higher mean symptom score for anxiety (5.4 vs 3.7), depression (3.4 vs 2.0), fatigue (14.2 vs 11.2), and insomnia (8.1 vs 4.4), all p < 0.01 compared to no-CMP patients. Symptoms of impaired mental health increased with increasing number of pain sites and pain intensity (p < 0.001). CONCLUSIONS Primary health care patients with CMP reported significantly more symptoms of anxiety, depression, fatigue, and insomnia than patients without CMP. The higher number of pain sites and pain intensity, the more mental health symptoms, especially of anxiety. Primary health care personnel have to address mental health issues when treating patients with CMP. TRIAL REGISTRATION Clinicaltrials.gov (NCT02020772, 25/12/2013).
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Affiliation(s)
- Kirsti Krohn Garnæs
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), P.O. Box 8905, N-7491 Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Obstetrics and Gynaecology, St. Olavs Hospital, Trondheim University Hospital, P.O Box 3250, Trondheim, Norway
| | - Siv Mørkved
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), P.O. Box 8905, N-7491 Trondheim, Norway ,grid.453770.20000 0004 0467 8898Central Norway Regional Health Authority, P.O Box 464, Stjørdal, Norway
| | - Torgrim Tønne
- Tiller Physiotherapy and Manual Therapy. Ivar Lykkes Veg 9, 7075 Tiller, Norway
| | - Lars Furan
- Stokmoen Physiotherapy, Wergelandsveien 27, 7504 Stjørdal, Norway
| | - Ottar Vasseljen
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), P.O. Box 8905, N-7491 Trondheim, Norway
| | - Hege Hølmo Johannessen
- grid.446040.20000 0001 1940 9648Department of Health and Welfare, Østfold University College, Kobberslagerstredet 5, Fredrikstad, Norway
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Objective and subjective measures of sleep in men with Muscular Dystrophy. PLoS One 2022; 17:e0274970. [PMID: 36137167 PMCID: PMC9499246 DOI: 10.1371/journal.pone.0274970] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/07/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose Despite poor sleep quality being recognised in Duchenne Muscular Dystrophy, reports from milder forms of Muscular Dystrophy (MD), and accompanied associations with quality of life (QoL), pain and fatigue, remain limited however. Methods Adult males (n = 15 Beckers MD (BMD), n = 12 Limb-Girdle MD (LGMD), n = 12 Fascioscapulohumeral (FSHD), n = 14 non-MD (CTRL)) completed assessments of body composition (Bio-electrical impedance), sleep (7-day 24-hour tri-axial accelerometer, Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index, QoL (SF36-v2), pain (Visual analogue scale), fatigue (Modified Fatigue Index Scale) and functional assessments (Brookes and Vignos). Results FSHD and BMD reported worse sleep than CTRL on the PSQI. FSHD scored worse than CTRL on the Insomnia Severity Index (P<0.05). 25–63% and 50–81% of adults with MD reported poor sleep quality using the Insomnia Severity Index and PSQI, respectively. Accelerometery identified no difference in sleep quality between groups. Associations were identified between sleep measures (PSQI global and insomnia severity) with mental or physical QoL in LGMD, BMD and FSHD. Multiple regression identified associations between sleep impairment and fatigue severity (all MDs), body composition (BMD & LGMD), upper and lower limb function (LGMD, FSHD) and age (FSHD). Conclusions 25–81% of men with MD, depending on classification, experience sleep impairment, using self-report sleep measures. Whilst BMD and FSHD showed worse sleep outcomes than CTRL, no group difference was observed between LGMD and CTRL, however all groups showed associations with sleep impairment and higher levels of fatigue. These findings, and associations with measures of health and wellbeing, highlight an area for further research which could impact QoL in adults with MD.
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Prevalence of sleep disturbances in patients with chronic non-cancer pain: A systematic review and meta-analysis. Sleep Med Rev 2021; 57:101467. [PMID: 33827029 DOI: 10.1016/j.smrv.2021.101467] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 12/16/2022]
Abstract
In individuals with chronic pain, sleep disturbances have been suggested to increase suffering, perception of pain, and to negatively affect long-term prognosis. This systematic review and meta-analysis aims to determine the pooled prevalence of sleep disturbances in chronic non-cancer pain patients with no other sleep disorders, using the patient-rated questionnaires Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Multiple databases were searched for studies reporting the prevalence of sleep disturbances in chronic pain patients. The meta-analysis was conducted to examine the pooled prevalence of PSQI and ISI data using the inverse-variance random-effects model and to examine mean differences in PSQI scores. The systematic search resulted in 25,486 articles and 20 were included for analysis. In 12 studies using PSQI, the pooled prevalence of sleep disturbance was 75.3% among 3597 chronic pain patients. In eight studies using ISI, the pooled prevalence was 72.9% among 2578 chronic pain patients. The meta-analysis showed a significant mean difference of 2.75 (p < 0.001) in the global PSQI score between the chronic pain group versus the non-chronic pain group. The relatively high prevalence of sleep disturbances in chronic pain patients emphasizes the importance of further characterizing the relationship between sleep and chronic pain.
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Delgado-Enciso I, Paz-Garcia J, Valtierra-Alvarez J, Preciado-Ramirez J, Olmedo-Buenrostro BA, Delgado-Enciso J, Guzman-Esquivel J, Barajas-Saucedo CE, Ceja-Espiritu G, Rodriguez-Sanchez IP, Martinez-Fierro ML, Zaizar-Fregoso SA, Tiburcio-Jimenez D, Plata-Florenzano JE, Paz-Michel B. A novel cell-free formulation for the treatment of knee osteoarthritis generates better patient-reported health outcomes in more severe cases. J Orthop Surg (Hong Kong) 2021; 28:2309499020938121. [PMID: 32691672 DOI: 10.1177/2309499020938121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The bioactive cell-free formulation (BIOF2) for cartilage regeneration has shown a major therapeutic response in severe knee osteoarthritis. However, its effect on patients with mild or moderate stages of the disease has not been studied. OBJECTIVE To evaluate the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, minimal clinically important improvement (MCII) and sleep disturbances in mild, moderate, and severe stages of knee osteoarthritis (OA) with the novel cell-free formulation treatment (BIOF2). METHODS An open-label, nonrandomized, baseline-controlled, parallel group study on patients with mild, moderate, and severe knee OA was conducted to evaluate the effect of intra-articular administration of BIOF2. Clinical improvement was determined through the WOMAC score and MCII, whereas sleep disturbances were measured through a Likert scale questionnaire. RESULTS At 6 months post-treatment, the mean decrease in the total WOMAC score was 16.4 +/- 4.7%, 49.9 +/- 6.4%, and 62.7 +/- 4.5% in the patients with mild, moderate, and severe disease, respectively (p < 0.001, analysis of variance test). MCII at 6 months was 18%, 78%, and 100% for mild, moderate, and severe disease, respectively (p < 0.001, likelihood-ratio χ2 test). Concerning sleep disturbances, 60% of the patients with severe OA had important sleep problems before beginning treatment, and those difficulties were overcome 6 months after treatment. Only 18% of the patients with mild disease and 16% with moderate disease had serious sleep disturbances at the beginning of the study, and there was slight improvement after treatment. No adverse events were recorded during follow-up. CONCLUSION BIOF2 generates better patient-reported health outcomes (on pain, stiffness, function, and sleep) in the more severe cases of knee OA.
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Affiliation(s)
- Ivan Delgado-Enciso
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima, Mexico.,Department of Research, Cancerology State Institute, Colima State Health Services, Colima, Mexico
| | - Juan Paz-Garcia
- Department of Traumatology, Union Hospital Center, Villa de Alvarez, Colima, Mexico
| | - Jose Valtierra-Alvarez
- Department of Traumatology, University Regional Hospital, Colima State Health Services, Colima, Mexico
| | - Jorge Preciado-Ramirez
- Department of Research, Foundation for Cancer Ethics, Education and Research of the Cancerology State Institute, Colima, Mexico
| | - Bertha A Olmedo-Buenrostro
- Department of Research, Foundation for Cancer Ethics, Education and Research of the Cancerology State Institute, Colima, Mexico
| | - Josuel Delgado-Enciso
- Department of Research, Foundation for Cancer Ethics, Education and Research of the Cancerology State Institute, Colima, Mexico
| | | | - Carlos E Barajas-Saucedo
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima, Mexico.,Department of Research, Cancerology State Institute, Colima State Health Services, Colima, Mexico
| | - Gabriel Ceja-Espiritu
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima, Mexico.,Department of Research, Cancerology State Institute, Colima State Health Services, Colima, Mexico
| | - Iram P Rodriguez-Sanchez
- Department of Cellular Biology, School of Biological Sciences, Autonomous University of Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Margarita L Martinez-Fierro
- Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Autonomous University of Zacatecas, Zacatecas, Mexico
| | - Sergio A Zaizar-Fregoso
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima, Mexico.,Department of Research, Cancerology State Institute, Colima State Health Services, Colima, Mexico
| | - Daniel Tiburcio-Jimenez
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima, Mexico.,Department of Research, Cancerology State Institute, Colima State Health Services, Colima, Mexico
| | - Jorge E Plata-Florenzano
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima, Mexico.,Department of Research, Cancerology State Institute, Colima State Health Services, Colima, Mexico
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Zarean E, Azadeh A, Pirali H, Doroushi B, Edrisi A, Ahmadi A, Baharizadeh A, Torkian S. Association between depression, anxiety, and insomnia with musculoskeletal pain source: a multi-center study. MIDDLE EAST CURRENT PSYCHIATRY 2021. [DOI: 10.1186/s43045-021-00083-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background
Musculoskeletal pain syndrome (MPS) is one of the modern diseases. Musculoskeletal pain (MP) may develop at any age and impact physical and mental health. This study aimed to evaluate the association between anxiety, depression, and insomnia with musculoskeletal pain source. This cross-sectional study was conducted on 450 patients with musculoskeletal pain. Goldberg depression (GB), Beck Anxiety Inventory (BAI), and Morin Insomnia Severity Index (ISI) questionnaires were used to collect data. Participants have divided into two groups: individuals with unknown musculoskeletal pain sources and individuals with known musculoskeletal pain sources. Anxiety, depression, and insomnia scores were compared between the two groups. For statistical analysis of data mean (SD), frequency (%), Chi-square, Mann-Whitney test, and Logistic regression models were used. All analysis was performed using SPSS 26.
Results
In this study, 39.4% of the participants were in severe depression, 31.1% in severe anxiety, 34.7% in the no clinically significant, and 32.9% in the sub-threshold insomnia group. There was a significant difference between the severity of anxiety and insomnia in the two groups with the known and unknown pain sources (p < 0.05). However, the score of depression (OR = 1.00, 95% CI 0.99–1.01), anxiety (OR = 1.00, 95% CI 0.99–1.02), and insomnia (OR = 1.01, 95% CI 0.98–1.03) was not related to the pain source.
Conclusion
There was a statistically significant relationship between anxiety and insomnia severity with musculoskeletal pain source. According to the high prevalence of depression, anxiety, and depression in both groups with known and unknown musculoskeletal pain sources, the cooperation of orthopedists, rheumatologists, and physical therapists with psychiatrist can be useful in improving the condition of patients.
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Sznitman SR, Vulfsons S, Meiri D, Weinstein G. Medical cannabis and insomnia in older adults with chronic pain: a cross-sectional study. BMJ Support Palliat Care 2020; 10:415-420. [PMID: 31959585 DOI: 10.1136/bmjspcare-2019-001938] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Medical cannabis (MC) is increasingly being used for treatment of chronic pain symptoms. Among patients there is also a growing preference for the use of MC to manage sleep problems. The aim of the current study was to examine the associations between use of whole plant cannabis and sleep problems among chronic pain patients. METHODS A total of 128 individuals with chronic pain over the age of 50 years were recruited from the Rambam Institute for Pain Medicine in Haifa, Israel. Of them, 66 were MC users and 62 were non-users. Regression models tested the differences in sleep problems between the two groups. Furthermore, Pearson correlations between MC use measures (dose, length and frequency of use, number of strains used, tetrahydrocannabinol/cannabidiol levels) and sleep problems were assessed among MC users. RESULTS After adjustment for age, sex, pain level and use of sleep and anti-depressant medications, MC use was associated with less problems with waking up at night compared with non-MC use. No group differences were found for problems with falling asleep or waking up early without managing to fall back asleep. Frequent MC use was associated with more problems waking up at night and falling asleep. CONCLUSIONS MC use may have an overall positive effect on maintaining sleep throughout the night in chronic pain patients. At the same time, tolerance towards potential sleep-inducing properties of MC may occur with frequent use. More research based on randomised control trials and other longitudinal designs is warranted.
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Affiliation(s)
- Sharon R Sznitman
- School of Public Health, University of Haifa Faculty of Social Welfare and Health Sciences, Haifa, Israel
| | - Simon Vulfsons
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
- Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel
| | - David Meiri
- Department of Biology, Technion Israel Institute of Technology, Haifa, Israel
| | - Galit Weinstein
- School of Public Health, University of Haifa Faculty of Social Welfare and Health Sciences, Haifa, Israel
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Phelps C, Bellon S, Hinkey M, Nash A, Boyd J, Cook CE, Garcia AN. Measurement properties of Patient-Reported Outcome Measures used to assess the sleep quality in adults with high prevalence chronic pain conditions: a systematic review. Sleep Med 2020; 74:315-331. [DOI: 10.1016/j.sleep.2020.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
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Sex-Specific Impact of Pain Severity, Insomnia, and Psychosocial Factors on Disability due to Spinal Degenerative Disease. Pain Res Manag 2020; 2020:8496527. [PMID: 32454923 PMCID: PMC7229535 DOI: 10.1155/2020/8496527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/29/2020] [Accepted: 03/05/2020] [Indexed: 11/17/2022]
Abstract
Purpose Pain experience due to spinal degenerative disease decreases activity of daily living and quality of life. The present cross-sectional study was aimed at examining the sex-specific impact of pain severity, psychosocial factors, and insomnia on the disability due to chronic pain arising from spinal degenerative disease. Methods In total, 111 outpatients with chronic spinal degenerative on initial diagnosis were analyzed. The definition of chronic spinal degenerative disease was (1) pain duration ≥3 months, (2) findings of nerve root compression on neurological examination and imaging, and (3) localized neck or lower back pain (not widespread, upper or lower limb pain). We used Numerical Rating Scale (NRS), Pain Disability Assessment Scale (PDAS), Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), and Athens Insomnia Scale (AIS) to assess patients. Univariate regression analysis was performed to investigate whether sex influences the PDAS score, and sex-stratified multivariate regression analysis was conducted to identify the variables associated with the PDAS score. Results Sex was identified as a predictor of the PDAS score (standardized coefficient (β) = 0.28; 95% confidence interval (CI), 0.10–0.46; p=0.003). In men, the AIS score was associated with PDAS (β = 0.36, 95% CI 0.09–0.63). Age (β = 0.31, 95% CI 0.06–0.55) and NRS (β = 0.40, 95% CI 0.14–0.67) were associated with PDAS in women. HADS-A, HADS-D, and PCS were not associated with PDAS in both sexes. Conclusion Insomnia was associated with disability in men, whereas aging and pain severity were associated with disability in women. Catastrophic thinking was not associated with disability in both sexes.
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Liu M, Taylor JL, Perrin NA, Szanton SL. Distinct clusters of older adults with common neuropsychological symptoms: Findings from the National Health and Aging Trends Study. Geriatr Nurs 2020; 41:222-228. [DOI: 10.1016/j.gerinurse.2019.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/22/2019] [Accepted: 09/24/2019] [Indexed: 01/29/2023]
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Tajika T, Kuboi T, Endo F, Shinagawa S, Kobayashi H, Hashimoto S, Sakane H, Hamano N, Sasaki T, Ichinose T, Shitara H, Chikuda H. Association between upper extremity dysfunction and sleep disturbance in an elderly general population. SAGE Open Med 2020; 8:2050312120901584. [PMID: 32030126 PMCID: PMC6977088 DOI: 10.1177/2050312120901584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/26/2019] [Indexed: 11/16/2022] Open
Abstract
Objective Several upper extremity disorders are associated with sleep disturbance in patient populations. This study evaluated the relation between self-assessment of upper extremity function and sleep disturbance in an elderly general population. Methods A total of 159 participants (56 men, 103 women, 38-88 years old, mean age of 66.4 years) completed a self-administered questionnaire including items for sex, weight, height, and dominant hand. Upper extremity dysfunction was investigated using Quick Disabilities of the Arm, Shoulder, and Hand of the Japanese Society for Surgery of the Hand. The sleep disturbance severity was evaluated using a Japanese version of the Athens Insomnia Scale. Quality of life was assessed using the EuroQol-5-dimension-3-level, Japanese version. We measured the bilateral hand grip as an indicator of hand muscle function. Statistical tests were applied to clarify the association between upper extremity dysfunction and screening results for sleep disturbance. Results Of 159 participants, 45 (28.3%) had sleep disturbance as assessed using Japanese version of the Athens Insomnia Scale (11 men and 34 women; mean age of 68.1 years). Japanese version of the Athens Insomnia Scale scores correlated with the EuroQol index; EuroQol visual analog scale; and Quick Disabilities of the Arm, Shoulder, and Hand scores. The Quick Disabilities of the Arm, Shoulder, and Hand score and dominant grip strength of the participants with sleep disturbance were significantly higher than those of the no sleep disturbance group. The EuroQol index score and visual analog scale of those reporting a sleep disturbance were significantly lower than those of the no sleep disturbance group. Conclusion Self-administered upper extremity health condition as assessed using Quick Disabilities of the Arm, Shoulder, and Hand correlated with sleep disturbance. Our results suggest a link between upper extremity conditions and sleep disturbance.
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Affiliation(s)
- Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Takuro Kuboi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Fumitaka Endo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Satoshi Shinagawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hiroki Kobayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Shogo Hashimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hideo Sakane
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Noritaka Hamano
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Tsuyoshi Sasaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
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Husak AJ, Bair MJ. Chronic Pain and Sleep Disturbances: A Pragmatic Review of Their Relationships, Comorbidities, and Treatments. PAIN MEDICINE 2020; 21:1142-1152. [DOI: 10.1093/pm/pnz343] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AbstractObjectiveThe objective of this review is to answer three questions: 1) How are chronic pain severity and pain duration affected in patients with chronic pain and sleep disturbances that occur simultaneously? 2) What are common comorbidities and pain-related symptoms seen in patients with chronic pain and sleep disturbances? and 3) What are potentially effective pharmacological and nonpharmacological treatment options for both conditions?MethodsOvid Medline and PubMed were searched. Search terms included sleep wake disorder, chronic pain, fibromyalgia, treatment outcome, psychotherapy, complementary therapies, and therapeutics. Studies that assessed outcomes between individuals with chronic pain and those with concurrent chronic pain and sleep disturbances were included. Randomized controlled clinical trials of treatments for both conditions were included.ResultsSixteen studies indicated that patients with both chronic pain and sleep disturbances have greater pain severity, longer duration of pain, greater disability, and are less physically active than those without sleep disturbances. Patients with both conditions are more likely to have concurrent depression, catastrophizing, anxiety, and suicidal ideation. Thirty-three randomized controlled trials assessed treatment for both chronic pain and sleep disturbances. Pregabalin was the most frequently studied medication, showing improvement in pain and sleep symptoms. Cognitive behavioral therapy for insomnia showed long-term improvement in sleep for patients with chronic pain.ConclusionsIndividuals with chronic pain and sleep disturbances have greater symptom severity, longer duration of symptoms, more disability, and additional comorbidities. Pharmacological and nonpharmacological treatments may be useful in the treatment of concurrent chronic pain and sleep disturbances, but further study is needed.
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Affiliation(s)
- Aubrey J Husak
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Matthew J Bair
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- VA Health Services Research and Development Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Indianapolis, Indiana
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
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A Mediational Analysis of Stress, Inflammation, Sleep, and Pain in Acute Musculoskeletal Trauma. Clin J Pain 2019; 36:197-202. [DOI: 10.1097/ajp.0000000000000790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE To investigate the specific effect of insomnia on neuropsychological functioning in patients with very complex chronic pain. BACKGROUND Individuals with insomnia disorder or chronic pain often experience cognitive deficits, with both conditions appearing to correlate with impairments in neuropsychological functions. As insomnia often occurs comorbid with chronic pain, distinguishing the differential effects of these two syndromes on an individual's neuropsychological functioning can be challenging. Comorbid depressive symptoms in these individuals, which may also affect cognitive function, may further obscure the associations between chronic pain, insomnia, and the neuropsychological profile. METHODS The neuropsychological function of 22 individuals with very complex chronic pain was assessed using specialized tests examining aspects of memory and executive functioning. The severity of insomnia, depression, and anxiety was measured using questionnaires, and pain levels were assessed using a visual analog scale. Pain medications were transformed to the morphine-equivalent daily dose. RESULTS Insomnia severity was found to predict memory function, accounting for 32.4% of the variance: A 1 SD increase in insomnia severity decreased memory function by 0.57 SD. The negative correlation between insomnia and memory was significant even after controlling for pain level, morphine-equivalent daily dose, and comorbid levels of anxiety and depression. CONCLUSIONS Insomnia severity independently predicted memory function in patients with very complex chronic pain, even after controlling for other factors known to impair cognitive function. Insomnia may possibly explain some of the cognitive impairments related to chronic pain; thus, screening for, and treating, sleep disturbances may be a central aspect of chronic pain rehabilitation.
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Ho KKN, Ferreira PH, Pinheiro MB, Aquino Silva D, Miller CB, Grunstein R, Simic M. Sleep interventions for osteoarthritis and spinal pain: a systematic review and meta-analysis of randomized controlled trials. Osteoarthritis Cartilage 2019; 27:196-218. [PMID: 30342087 DOI: 10.1016/j.joca.2018.09.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 09/11/2018] [Accepted: 09/24/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine if sleep interventions improve pain and sleep in people with osteoarthritis (OA) and/or spinal pain compared to control/placebo. DESIGN Medline, Embase, AMED, PsycINFO, CENTRAL, CINAHL and PEDro were searched from their inception date to July 2017. Keywords relating to "sleep", "OA", "spinal pain", and "randomized controlled trial (RCT)" were combined. Included RCTs investigated the use of sleep interventions for people with OA and/or spinal pain, and measured at least one sleep and health related outcome. Meta-analyses were performed to pool mean differences for pain and sleep quality. PROSPERO CRD42016036315. RESULTS Of 1445 unique records, 24 studies were included. Sixteen studies included participants with spinal pain, seven with OA, and one included a mixed population. Sleep interventions included established sleep interventions (ESI) [cognitive behavioural therapy (CBT) and pharmacological interventions], and a range of others. Intervention periods ranged from 4 to 10 weeks. Thirteen studies were of moderate to high quality (PEDro ≥ 6/10). Due to high heterogeneity between studies we also performed sub-group and sensitivity analyses. ESI decreased Insomnia Severity Index (ISI) for people with low back pain (LBP) (pooled mean difference: -6.78/28, 95% confidence interval (95% CI): [-9.47, -4.09], I2 = 40%) and OA (-2.41, [-4.19, -0.63], 0%). However ESI decreased pain for people with LBP (pooled mean difference: visual analogue scale (VAS) -12.77/100, 95% CI: [-17.57, -7.97], I2 = 0%), but not OA (-2.32, [-7.18, 2.54], 27%). CONCLUSION ESI appeared to improve sleep and pain for people with LBP, and sleep for people with OA. However more vigorous studies need to be conducted.
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Affiliation(s)
- K K N Ho
- The University of Sydney, Musculoskeletal Research Group, Faculty of Health Sciences, 75 East St, Lidcombe, Sydney, 2141 NSW, Australia.
| | - P H Ferreira
- The University of Sydney, Musculoskeletal Research Group, Faculty of Health Sciences, 75 East St, Lidcombe, Sydney, 2141 NSW, Australia.
| | - M B Pinheiro
- The University of Sydney, Musculoskeletal Research Group, Faculty of Health Sciences, 75 East St, Lidcombe, Sydney, 2141 NSW, Australia.
| | - D Aquino Silva
- Universidade Federal de Minas Gerais, Departamento de Fisioterapia, Av. Pres. Antônio Carlos, 6627 Pampulha, Belo Horizonte, MG, Brazil.
| | - C B Miller
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney and Sydney Health Partners, 431 Glebe Point Road, Sydney, 2037 NSW, Australia.
| | - R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney and Sydney Health Partners, 431 Glebe Point Road, Sydney, 2037 NSW, Australia.
| | - M Simic
- The University of Sydney, Musculoskeletal Research Group, Faculty of Health Sciences, 75 East St, Lidcombe, Sydney, 2141 NSW, Australia.
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Exercise in Children with Disabilities. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-0213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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The Association of Dry Eye Symptom Severity and Comorbid Insomnia in US Veterans. Eye Contact Lens 2018; 44 Suppl 1:S118-S124. [PMID: 28181961 DOI: 10.1097/icl.0000000000000349] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate the association between dry eye (DE) and insomnia symptom severity. METHODS Cross-sectional study of 187 individuals seen in the Miami Veterans Affairs eye clinic. An evaluation was performed consisting of questionnaires regarding insomnia (insomnia severity index [ISI]) and DE symptoms, including ocular pain, followed by a comprehensive ocular surface examination. Using a two-step cluster analysis based on intensity ratings of ocular pain, the patient population was divided into two groups (high and low ocular pain groups: HOP and LOP). A control group was ascertained at the same time from the same clinic as defined by no symptoms of DE (Dry Eye Questionnaire 5 [DEQ5], <6). The main outcome measure was the frequency of moderate or greater insomnia in the DE groups. RESULTS The mean age of the study sample was 63 years, and 93% were male. All insomnia complaints were rated higher in the HOP group compared with the LOP and control groups (P<0.0005). Most (61%) individuals in the HOP group experienced insomnia of at least moderate severity (ISI≥15) compared with the LOP (41%) and control groups (18%) (P<0.0005). Black race (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.2-6.0; P=0.02), depression severity (OR, 1.2; 95% CI, 1.1-1.3; P<0.0005), and DE symptom severity (DEQ5; OR, 1.1; 95% CI, 1.01-1.2; P=0.03) were significantly associated with clinical insomnia (ISI≥15) after controlling for potential confounders. CONCLUSIONS After adjusting for demographics and medical comorbidities, we show that DE symptom severity is positively associated with insomnia severity.
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The Fear-Avoidance Components Scale (FACS): Responsiveness to Functional Restoration Treatment in a Chronic Musculoskeletal Pain Disorder (CMPD) Population. Clin J Pain 2018; 33:1088-1099. [PMID: 28328697 DOI: 10.1097/ajp.0000000000000501] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the clinical validity and factor structure of the Fear-Avoidance Components Scale (FACS), a new fear-avoidance measure. MATERIALS AND METHODS In this study, 426 chronic musculoskeletal pain disorder patients were admitted to a Functional Restoration Program (FRP). They were categorized into 5 FACS severity levels, from subclinical to extreme, at admission, and again at discharge. Associations with objective lifting performance and other patient-reported psychosocial measures were determined at admission and discharge, and objective work outcomes for this predominantly disabled cohort, were assessed 1 year later. RESULTS Those patients in the severe and extreme FACS severity groups at admission were more likely to "drop out" of treatment than those in the lower severity groups (P=0.05). At both admission and discharge, the FACS severity groups were highly and inversely correlated with objective lifting performance and patient-reported fear-avoidance-related psychosocial variables, including kinesiophobia, pain intensity, depressive symptoms, perceived disability, perceived injustice, and insomnia (Ps<0.001). All variables showed improvement at FRP discharge. Patients in the extreme FACS severity group at discharge were less likely to return to, or retain, work 1 year later (P≤0.02). A factor analysis identified a 2-factor solution. DISCUSSION Strong associations were found among FACS scores and other patient-reported psychosocial and objective lifting performance variables at both admission and discharge. High discharge-FACS scores were associated with worse work outcomes 1 year after discharge. The FACS seems to be a valid and clinically useful measure for predicting attendance, physical performance, distress, and relevant work outcomes in FRP treatment of chronic musculoskeletal pain disorder patients.
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Musculoskeletal pain in Primary Care Physiotherapy: Associations with demographic and general health characteristics. Musculoskelet Sci Pract 2018; 35:61-66. [PMID: 29547788 DOI: 10.1016/j.msksp.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 02/22/2018] [Accepted: 03/05/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Many patients reporting musculoskeletal pain present to Primary Care Physiotherapy with costly comorbid overlapping complaints that remain medically unexplained. These subjective health complaints (SHC) incorporate coexisting multi-site musculoskeletal pain and varied non-musculoskeletal complaints (e.g. anxiety, tiredness). The role of these non-musculoskeletal complaints is acknowledged in spinal musculoskeletal disorders, but less so for peripheral musculoskeletal disorders. OBJECTIVE This cross-sectional study explored the relationships between self-reported musculoskeletal pain sites, non-musculoskeletal complaints and disability among people reporting spinal or peripheral musculoskeletal pain. METHODS Fifty individuals with spinal musculoskeletal pain and fifty with peripheral musculoskeletal pain provided data on disability, number of musculoskeletal pain sites and non-musculoskeletal complaints. Relationships between these variables were examined for each group using Pearson's correlation coefficient and linear regression analysis. RESULTS Participants with spinal musculoskeletal pain recorded significantly more pain sites and non-musculoskeletal complaints than participants with peripheral musculoskeletal pain. However, there was no significant difference in disability between the groups. Non-musculoskeletal complaints were significantly associated with disability (correlation = 0.41, p < 0.01) and number of pain sites (correlation = 0.42, p < 0.01). Number of pain sites and disability were not significantly associated in either group. Participants with spinal musculoskeletal pain reported more tiredness, dizziness, anxiety and sleep problems. Participants reporting dizziness, anxiety, sadness/depression and sleep problems had higher disability. CONCLUSION Further studies must confirm the robustness of these associations, to permit comparisons between clinical and general populations and aid identification of causal factors. Considering SHC within individualised management programmes may improve outcomes.
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Adamo D, Sardella A, Varoni E, Lajolo C, Biasotto M, Ottaviani G, Vescovi P, Simonazzi T, Pentenero M, Ardore M, Spadari F, Bombeccari G, Montebugnoli L, Gissi DB, Campisi G, Panzarella V, Carbone M, Valpreda L, Giuliani M, Aria M, Lo Muzio L, Mignogna MD. The association between burning mouth syndrome and sleep disturbance: A case-control multicentre study. Oral Dis 2018; 24:638-649. [PMID: 29156085 DOI: 10.1111/odi.12807] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 01/03/2023]
Affiliation(s)
- D Adamo
- Oral Medicine Complex Unit; Head & Neck Clinical Section; Department of Neurosciences, Reproductive and Odontostomatological Sciences; “Federico II” University of Naples; Naples Italy
| | - A Sardella
- Unit of Oral Pathology, Oral Medicine and Gerodontology; Department of Biomedical, Surgical and Dental Sciences; AO San Paolo Hospital of Milan; University of Milan; Milan Italy
| | - E Varoni
- Unit of Oral Pathology, Oral Medicine and Gerodontology; Department of Biomedical, Surgical and Dental Sciences; AO San Paolo Hospital of Milan; University of Milan; Milan Italy
| | - C Lajolo
- Oral Pathology and Medicine; School of Dentistry; Catholic University of Rome; Rome Italy
| | - M Biasotto
- Oral Medicine and Pathology Unit; Department of Medical, Surgical and Health Sciences; University of Trieste; Trieste Italy
| | - G Ottaviani
- Oral Medicine and Pathology Unit; Department of Medical, Surgical and Health Sciences; University of Trieste; Trieste Italy
| | - P Vescovi
- Unit of Oral Pathology, Medicine and Laser Surgery; Department of Biomedical, Biotechnological and Translational Sciences; University of Parma; Parma Italy
| | - T Simonazzi
- Unit of Oral Pathology, Medicine and Laser Surgery; Department of Biomedical, Biotechnological and Translational Sciences; University of Parma; Parma Italy
| | - M Pentenero
- Oral Medicine and Oral Oncology Unit; Department of Oncology; University of Turin; Turin Italy
| | - M Ardore
- Oral Medicine and Oral Oncology Unit; Department of Oncology; University of Turin; Turin Italy
| | - F Spadari
- Unit of Oral Pathology and Medicine; Department of Biomedical, Surgical and Dental Sciences; University of Milan; Ospedale Maggiore Policlinico IRCCS Ca’ Granda Foundation; Milan Italy
| | - G Bombeccari
- Unit of Oral Pathology and Medicine; Department of Biomedical, Surgical and Dental Sciences; University of Milan; Ospedale Maggiore Policlinico IRCCS Ca’ Granda Foundation; Milan Italy
| | - L Montebugnoli
- Unit of Oral Pathology and Medicine; Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - DB Gissi
- Unit of Oral Pathology and Medicine; Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - G Campisi
- Department of Surgical, Oncological, and Oral Sciences; Sector of Oral Medicine “Valerio Margiotta”; University of Palermo; Palermo Italy
| | - V Panzarella
- Department of Surgical, Oncological, and Oral Sciences; Sector of Oral Medicine “Valerio Margiotta”; University of Palermo; Palermo Italy
| | - M Carbone
- Oral Medicine Section; Department of Surgical Sciences; CIR Dental School; University of Turin; Turin Italy
| | - L Valpreda
- Oral Medicine Section; Department of Surgical Sciences; CIR Dental School; University of Turin; Turin Italy
| | - M Giuliani
- Department of Clinical and Experimental Medicine; University of Foggia; Foggia Italy
| | - M Aria
- Laboratory and Research Group STAD Statistics, Technology; Data Analysis Department of Economics and Statistics; “Federico II University of Naples”; Naples Italy
| | - L Lo Muzio
- Department of Clinical and Experimental Medicine; University of Foggia; Foggia Italy
| | - MD Mignogna
- Oral Medicine Complex Unit; Head & Neck Clinical Section; Department of Neurosciences, Reproductive and Odontostomatological Sciences; “Federico II” University of Naples; Naples Italy
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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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Neblett R, Hartzell MM, Williams M, Bevers KR, Mayer TG, Gatchel RJ. Use of the Central Sensitization Inventory (CSI) as a treatment outcome measure for patients with chronic spinal pain disorder in a functional restoration program. Spine J 2017; 17:1819-1829. [PMID: 28619687 DOI: 10.1016/j.spinee.2017.06.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 05/15/2017] [Accepted: 06/07/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The Central Sensitization Inventory (CSI) is a valid and reliable patient-reported instrument designed to identify patients whose presenting symptoms may be related to central sensitization (CS). Part A of the CSI measures a full array of 25 somatic and emotional symptoms associated with CS, and Part B asks if patients have previously been diagnosed with one or more specific central sensitivity syndromes (CSSs) and related disorders. The CSI has previously been validated in a group of patients with chronic pain who were screened by a trained psychiatrist for specific CSS diagnoses. It is currently unknown if the CSI can be a useful treatment-outcome assessment tool for patients with chronic spinal pain disorder (CSPD) who are not screened for comorbid CSSs. It is known, however, that previous studies have identified CS-related symptoms, and comorbid CSSs, in subsets of patients with CSPDs. Studies have also shown that CS-related symptoms can be influenced by cognitive and psychosocial factors, including abuse history in both childhood and adulthood, sleep disturbance, catastrophic and fear-avoidant cognitions, and symptoms of depression and anxiety. PURPOSE This study aimed to evaluate CSI scores, and their associations with other clinically relevant psychosocial variables, in a cohort of patients with CSPD who entered and completed a functional restoration program. STUDY DESIGN/SETTING A retrospective study of prospectively collected data from a cohort study of patients with CSPD, who completed the CSI at admission to, and discharge from, an interdisciplinary function restoration program (FRP) was carried out. PATIENT SAMPLE A cohort of 763 patients with CSPD comprised the study sample. OUTCOME MEASURES Clinical interviews evaluated mood disorders and abuse history. A series of self-reported measures evaluated comorbid psychosocial symptoms, including pain intensity, pain-related anxiety, depressive symptoms, somatization symptoms, perceived disability, and sleep disturbance, at FRP admission and discharge. METHODS Patients were grouped into five severity level groups, from mild to extreme, based on total CSI scores, at FRP admission, and then again at discharge. The FRP included a quantitatively directed and medically supervised exercise process, as well as a multimodal psychosocial disability management component. RESULTS The CSI severity groups were strongly associated with Major Depressive Disorder and previous abuse history (p<.01), which are known risk factors for CS-related symptoms and diagnoses. The CSI scores were also strongly associated with patient-reported CSS diagnoses on CSI Part B. The percentage of patients who reported a comorbid CSS diagnosis increased in each higher CSI-severity group, from 11% in the Subclinical group, to 56% in the Extreme group. The CSI severity groups were significantly related to other CS-related patient-reported symptoms, including pain intensity, pain-related anxiety, depressive symptoms, somatization symptoms, perceived disability, and sleep disturbance (p's<.001). The CSI scores, along with all other psychosocial measures, decreased at treatment discharge. CONCLUSIONS In the present study, admission CSI scores were highly associated with previous CSS diagnoses, CS-related symptoms, and clinically relevant patient-reported psychosocial variables. All psychosocial variables, as well as scores on the CSI, were significantly improved at FRP discharge. The CSI may have important clinical utility, as a screener and as a treatment outcome measure, for patients with CSPD participating in an interdisciplinary FRP.
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Affiliation(s)
- Randy Neblett
- PRIDE Research Foundation, 5701 Maple Ave. #100, Dallas, TX 75235, USA
| | - Meredith M Hartzell
- Department of Psychology, University of Texas at Arlington, College of Science, 301 Life Science Building, Arlington, TX 76019, USA
| | - Mark Williams
- PRIDE Research Foundation, 5701 Maple Ave. #100, Dallas, TX 75235, USA
| | - Kelley R Bevers
- Department of Psychology, University of Texas at Arlington, College of Science, 301 Life Science Building, Arlington, TX 76019, USA
| | - Tom G Mayer
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA.
| | - Robert J Gatchel
- Department of Psychology, University of Texas at Arlington, College of Science, 301 Life Science Building, Arlington, TX 76019, USA
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Reyes BA, Hull BR, Kurth AB, Kukowski NR, Mulligan EP, Khazzam MS. Do Magnetic Resonance Imaging Characteristics of Full-Thickness Rotator Cuff Tears Correlate With Sleep Disturbance? Orthop J Sports Med 2017; 5:2325967117735319. [PMID: 29147668 PMCID: PMC5669319 DOI: 10.1177/2325967117735319] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Many patients with rotator cuff tears suffer from nocturnal shoulder pain, resulting in sleep disturbance. Purpose: To determine whether rotator cuff tear size correlated with sleep disturbance in patients with full-thickness rotator cuff tears. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients with a diagnosis of unilateral full-thickness rotator cuff tears (diagnosed via magnetic resonance imaging [MRI]) completed the Pittsburgh Sleep Quality Index (PSQI), a visual analog scale (VAS) quantifying their shoulder pain, and the American Shoulder and Elbow Surgeons (ASES) questionnaire. Shoulder MRI scans were analyzed for anterior-posterior tear size (mm), tendon retraction (mm), Goutallier grade (0-4), number of tendons involved (1-4), muscle atrophy (none, mild, moderate, or severe), and humeral head rise (present or absent). Bivariate correlations were calculated between the MRI characteristics and baseline survey results. Results: A total of 209 patients with unilateral full-thickness rotator cuff tears were included in this study: 112 (54%) female and 97 (46%) male (mean age, 64.1 years). On average, shoulder pain had been present for 24 months. The mean PSQI score was 9.8, and the mean VAS score was 5.0. No significant correlations were found between any of the rotator cuff tear characteristics and sleep quality. Only tendon retraction had a significant correlation with pain. Conclusion: Although rotator cuff tears are frequently associated with nocturnal pain and sleep disruption, this study demonstrated that morphological characteristics of full-thickness rotator cuff tears, such as size and tendon retraction, do not correlate with sleep disturbance and have little to no correlation with pain levels.
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Affiliation(s)
- Bryan A Reyes
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brandon R Hull
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alexander B Kurth
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nathan R Kukowski
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Edward P Mulligan
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael S Khazzam
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Prather H, Creighton A, Sorenson C, Simpson S, Reese M, Hunt D, Rho M. Anxiety and Insomnia in Young and Middle-Aged Adult Hip Pain Patients With and Without Femoroacetabular Impingement and Developmental Hip Dysplasia. PM R 2017; 10:455-461. [PMID: 29111466 DOI: 10.1016/j.pmrj.2017.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/09/2017] [Accepted: 10/21/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND In young and middle-aged adults with and without hip deformity, hip pain receives treatment focused primarily related to hip structure. Because this hip pain may be chronic, these patients develop other coexisting, modifiable disorders related to pain that may go undiagnosed in this young and active population, including insomnia and anxiety. OBJECTIVE The objective of this study was to compare assessments of insomnia and anxiety in young and middle-aged adults presenting with hip pain with no greater than minimal osteoarthritis (OA) compared to asymptomatic healthy controls. Comparisons between types of hip deformity and no hip deformity in hip pain patients were performed to assess whether patients with specific hip deformities were likely to have insomnia or anxiety as a cofounding disorder to their hip pain. DESIGN Prospective case series with control comparison. SETTING Two tertiary university physiatry outpatient clinics. PARTICIPANTS A total of 50 hip pain patients aged 18-40 years and 50 gender- and age-matched healthy controls. METHODS Patients were enrolled if 2 provocative hip tests were found on physical examination and hip radiographs had no or minimal OA. Radiographic hip deformity measurements were completed by an independent examiner. Comparisons of insomnia and anxiety were completed between 50 hip pain patients and 50 controls and between patients with different types of hip deformity. MAIN OUTCOME MEASURES Insomnia Severity Index (ISI) and Pain Anxiety Symptoms Scale (PASS). RESULTS A total of 50 hip pain patients (11 male and 39 female) with mean age of 31.2 ± 8.31 years enrolled. Hip pain patients slept significantly less (P = .001) per night than controls. Patients experienced significantly greater insomnia (P = .0001) and anxiety (P = .0001) compared to controls. No differences were found in insomnia and anxiety scores between hip pain patients with and without hip deformity or between different types of hip deformity. CONCLUSION Hip pain patients with radiographs demonstrating minimal to no hip arthritis with and without hip deformity experience significant cofounding yet modifiable disorders of sleep and anxiety. If recognized early in presentation, treatment of insomnia and anxiety ultimately will improve outcomes for hip patients treated either conservatively or surgically for their hip disorder. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Heidi Prather
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St Louis, MO 63110.,Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, St Louis, MO.,Program in Physical Therapy, Washington University School of Medicine, St Louis, MO.,Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St Louis, MO.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew Creighton
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St Louis, MO 63110.,Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, St Louis, MO.,Program in Physical Therapy, Washington University School of Medicine, St Louis, MO.,Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St Louis, MO.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Chris Sorenson
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St Louis, MO 63110.,Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, St Louis, MO.,Program in Physical Therapy, Washington University School of Medicine, St Louis, MO.,Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St Louis, MO.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Scott Simpson
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St Louis, MO 63110.,Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, St Louis, MO.,Program in Physical Therapy, Washington University School of Medicine, St Louis, MO.,Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St Louis, MO.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Maria Reese
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St Louis, MO 63110.,Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, St Louis, MO.,Program in Physical Therapy, Washington University School of Medicine, St Louis, MO.,Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St Louis, MO.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Devyani Hunt
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St Louis, MO 63110.,Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, St Louis, MO.,Program in Physical Therapy, Washington University School of Medicine, St Louis, MO.,Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St Louis, MO.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Monica Rho
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St Louis, MO 63110.,Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, St Louis, MO.,Program in Physical Therapy, Washington University School of Medicine, St Louis, MO.,Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St Louis, MO.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
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Yun SY, Kim DH, Do HY, Kim SH. Clinical insomnia and associated factors in failed back surgery syndrome: a retrospective cross-sectional study. Int J Med Sci 2017; 14. [PMID: 28638269 PMCID: PMC5479122 DOI: 10.7150/ijms.18926] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Insomnia frequently occurs to patients with persistent back pain. By worsening pain, mood, and physical functioning, insomnia could lead to the negative clinical consequences of patients with failed back surgery syndrome (FBSS). This retrospective and cross-sectional study aims to identify the risk factors associated with clinical insomnia in FBSS patients. Methods A total of 194 patients with FBSS, who met the study inclusion criteria, were included in this analysis. The Insomnia Severity Index (ISI) was utilized to ascertain the presence of clinical insomnia (ISI score ≥ 15). Logistic regression analysis evaluates patient demographic factors, clinical factors including prior surgical factors, and psychological factors to identify the risk factors of clinical insomnia in FBSS patients. Results After the persistent pain following lumbar spine surgery worsened, 63.4% of patients reported a change from mild to severe insomnia. In addition, 26.2% of patients met the criteria for clinically significant insomnia. In a multivariate logistic regression analysis, high pain intensity (odds ratio (OR) =2.742, 95% confidence interval (CI): 1.022 - 7.353, P=0.045), high pain catastrophizing (OR=4.185, 95% CI: 1.697 - 10.324, P=0.002), greater level of depression (OR =3.330, 95% CI: 1.127 - 9.837, P=0.030) were significantly associated with clinical insomnia. However, patient demographic factors and clinical factors including prior surgical factors were not significantly associated with clinical insomnia. Conclusions Insomnia should be addressed as a critical part of pain management in FBSS patients with these risk factors, especially in patients with high pain catastrophizing.
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Affiliation(s)
- Soon Young Yun
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Do Heon Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Yoon Do
- 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
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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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30
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Neblett R, Hartzell MM, Mayer TG, Cohen H, Gatchel RJ. Establishing Clinically Relevant Severity Levels for the Central Sensitization Inventory. Pain Pract 2016; 17:166-175. [DOI: 10.1111/papr.12440] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/19/2015] [Accepted: 11/10/2015] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Tom G. Mayer
- Department of Orthopedic Surgery; University of Texas Southwestern Medical Center at Dallas; Dallas Texas U.S.A
| | - Howard Cohen
- Graduate School of Nursing; University of Texas at Arlington; Arlington Texas U.S.A
| | - Robert J. Gatchel
- Department of Psychology; University of Texas at Arlington; Arlington Texas U.S.A
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31
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Koffel E, Krebs EE, Arbisi PA, Erbes CR, Polusny MA. The Unhappy Triad: Pain, Sleep Complaints, and Internalizing Symptoms. Clin Psychol Sci 2016; 4:96-106. [PMID: 27390627 PMCID: PMC4928372 DOI: 10.1177/2167702615579342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is limited understanding of the etiology and temporal relations of chronic pain, sleep complaints, and depression/anxiety. Several models have been proposed by which sleep disruption represents a common mechanism for the comorbidity of these symptoms. The goals of this study were to 1) clarify the boundaries of these domains and to 2) examine the relations of these symptoms over time following exposure to stressful and potentially traumatic experiences during a combat deployment. We found support for three distinct domains of sleep complaints, internalizing symptoms, and physical complaints. We tested two competing models that have been proposed in the literature, controlling for negative and positive emotionality. Internalizing symptoms strongly mediated the relation between sleep complaints and pain (total effect = .15, direct effect = -.05). The study suggests that increases in sleep complaints immediately following deployment increase the risk of internalizing symptoms and pain several years after deployment.
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Affiliation(s)
- Erin Koffel
- Center for Chronic Disease Outcomes Research, Minneapolis Veteran Affairs Health Care System, Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | - Erin E Krebs
- Center for Chronic Disease Outcomes Research, Minneapolis Veteran Affairs Health Care System, University of Minnesota Medical School, Minneapolis, MN
| | - Paul A Arbisi
- Minneapolis Veteran Affairs Health Care System, Departments of Psychology and Psychiatry, University of Minnesota, Minneapolis, MN
| | - Christopher R Erbes
- Center for Chronic Disease Outcomes Research, Minneapolis Veteran Affairs Health Care System, Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | - Melissa A Polusny
- Center for Chronic Disease Outcomes Research, Minneapolis Veteran Affairs Health Care System, Department of Psychiatry, University of Minnesota, Minneapolis, MN
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32
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Koffel E, Kroenke K, Bair MJ, Leverty D, Polusny MA, Krebs EE. The bidirectional relationship between sleep complaints and pain: Analysis of data from a randomized trial. Health Psychol 2016; 35:41-9. [PMID: 26076002 PMCID: PMC4900176 DOI: 10.1037/hea0000245] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The goal of this study was to examine the bidirectional relationship of sleep and pain to determine whether changes in sleep complaints over the course of a chronic pain treatment trial predict pain outcomes and vice versa, controlling for changes in depression and anxiety. METHODS Data were analyzed from a 12-month randomized, controlled trial that tested the effectiveness of a collaborative care intervention for veterans with chronic musculoskeletal pain. Participants were 250 veterans from 5 primary care clinics in a Veteran Affairs (VA) medical center. Measures of pain, sleep, and depression/anxiety symptoms were collected at baseline, 3 months, and 12 months. Factor analysis was used to clarify the boundaries of these domains, and structural equation modeling was used to examine whether changes in sleep complaints and depression/anxiety during the trial predicted pain at the end of the trial, controlling for covariates. An alternative model was also tested in which changes in pain predicted sleep complaints. RESULTS Changes in sleep complaints at 3 months significantly predicted changes in pain at 12 months (standardized path coefficient = .29, p < .001). To a lesser extent, changes in pain predicted changes in sleep (standardized path coefficient = .15, p < .05). Changes in depression/anxiety did not significantly predict changes in pain or sleep. There was also evidence of differential relations of specific sleep complaints with pain. CONCLUSIONS This work helps to further disentangle the complex relationship between pain and sleep. This bidirectional relationship may need to be considered to improve pain outcomes.
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Affiliation(s)
- Erin Koffel
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System
| | - Kurt Kroenke
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center
| | - Matthew J Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center
| | | | - Melissa A Polusny
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System
| | - Erin E Krebs
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System
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33
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Neblett R, Mayer TG, Hartzell MM, Williams MJ, Gatchel RJ. The Fear-avoidance Components Scale (FACS): Development and Psychometric Evaluation of a New Measure of Pain-related Fear Avoidance. Pain Pract 2015; 16:435-50. [PMID: 26228238 DOI: 10.1111/papr.12333] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/25/2015] [Indexed: 11/30/2022]
Abstract
Pain-related fear avoidance (FA), a common problem for patients with painful medical conditions, involves pain-related catastrophizing cognitions, hypervigilance, and avoidance behaviors, which can ultimately lead to decreased functioning, depression, and disability. Several patient-reported instruments have been developed to measure FA, but they have been criticized for limited construct validity, inadequate item specificity, lack of cutoff scores, and missing important FA components. The Fear-Avoidance Components Scale (FACS) is a new patient-reported measure designed to comprehensively evaluate FA in patients with painful medical conditions. It combines important components of FA found in prior FA scales, while trying to correct some of their deficiencies, within a framework of the most current FA model. Psychometric evaluation of the FACS found high internal consistency (α = 0.92) and high test/retest reliability (r = 0.90-0.94, P < 0.01). FACS scores differentiated between 2 separate chronic pain patient samples and a nonpatient comparison group. When clinically relevant severity levels were created, FACS severity scores were highly associated with FA-related patient-reported psychosocial and objective lifting performance variables. These results suggest that the FACS is a psychometrically strong and reliable measure that can help healthcare providers assess FA-related barriers to function and recovery.
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Affiliation(s)
| | - Tom G Mayer
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | | | | | - Robert J Gatchel
- Department of Psychology, College of Science, The University of Texas at Arlington, Arlington, Texas, U.S.A
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Parmelee PA, Tighe CA, Dautovich ND. Sleep disturbance in osteoarthritis: linkages with pain, disability, and depressive symptoms. Arthritis Care Res (Hoboken) 2015; 67:358-65. [PMID: 25283955 PMCID: PMC4342277 DOI: 10.1002/acr.22459] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 08/26/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE It is known that osteoarthritis (OA) increases the risk of sleep disturbance, and that both pain and sleep problems may trigger functional disability and depression. However, studies examining all 4 variables simultaneously are rare. The aim of this study was to examine cross-sectional and longitudinal associations of self-reported sleep disturbance with OA-related pain and disability and depressive symptoms. METHODS At baseline, 367 persons with physician-diagnosed knee OA reported sleep disturbances, pain, functional limitations, and depressive symptoms. At 1-year followup, all measures were repeated in 288 of the subjects. Baseline analyses examined the independent and interactive associations of sleep disturbance with pain, disability, and depression, net of demographics and general health. Longitudinal analyses used baseline sleep disturbance to predict the 1-year change in pain, disability, and depression. RESULTS At baseline, sleep was independently associated with pain and depression but not disability. The sleep-pain relationship was mediated by depressive symptoms; sleep interacted with pain to exacerbate depression among persons with high levels of pain. Baseline sleep disturbance predicted increased depression and disability, but not pain, at followup. CONCLUSION These data confirm known cross-sectional relationships between sleep disturbance and pain and depression and provide new insights regarding longitudinal associations among those variables. Depression appears to play a strong role in the sleep-pain linkage, particularly when pain is severe. The unique predictive role of sleep in the progression of disability requires further study but may be an important point of intervention to prevent OA-related functional decline among persons whose sleep is disrupted by OA-related pain.
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