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Wiklund T, Molander P, Lindner P, Andersson G, Gerdle B, Dragioti E. Internet-Delivered Cognitive Behavioral Therapy for Insomnia Comorbid With Chronic Pain: Randomized Controlled Trial. J Med Internet Res 2022; 24:e29258. [PMID: 35486418 PMCID: PMC9107050 DOI: 10.2196/29258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/26/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patients with chronic pain often experience insomnia symptoms. Pain initiates, maintains, and exacerbates insomnia symptoms, and vice versa, indicating a complex situation with an additional burden for these patients. Hence, the evaluation of insomnia-related interventions for patients with chronic pain is important. Objective This randomized controlled trial examined the effectiveness of internet-based cognitive behavioral therapy for insomnia (ICBT-i) for reducing insomnia severity and other sleep- and pain-related parameters in patients with chronic pain. Participants were recruited from the Swedish Quality Registry for Pain Rehabilitation. Methods We included 54 patients (mean age 49.3, SD 12.3 years) who were randomly assigned to the ICBT-i condition and 24 to an active control condition (applied relaxation). Both treatment conditions were delivered via the internet. The Insomnia Severity Index (ISI), a sleep diary, and a battery of anxiety, depression, and pain-related parameter measurements were assessed at baseline, after treatment, and at a 6-month follow-up (only ISI, anxiety, depression, and pain-related parameters). For the ISI and sleep diary, we also recorded weekly measurements during the 5-week treatment. Negative effects were also monitored and reported. Results Results showed a significant immediate interaction effect (time by treatment) on the ISI and other sleep parameters, namely, sleep efficiency, sleep onset latency, early morning awakenings, and wake time after sleep onset. Participants in the applied relaxation group reported no significant immediate improvements, but both groups exhibited a time effect for anxiety and depression at the 6-month follow-up. No significant improvements on pain-related parameters were found. At the 6-month follow-up, both the ICBT-i and applied relaxation groups had similar sleep parameters. For both treatment arms, increased stress was the most frequently reported negative effect. Conclusions In patients with chronic pain, brief ICBT-i leads to a more rapid decline in insomnia symptoms than does applied relaxation. As these results are unique, further research is needed to investigate the effect of ICBT-i on a larger sample size of people with chronic pain. Using both treatments might lead to an even better outcome in patients with comorbid insomnia and chronic pain. Trial Registration ClinicalTrials.gov NCT03425942; https://clinicaltrials.gov/ct2/show/NCT03425942
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Affiliation(s)
- Tobias Wiklund
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Peter Molander
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden.,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
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Oueini R, Goodin AJ, Hincapie-Castillo JM, Vouri SM. Co-utilization of opioids and nonbenzodiazepine hypnotic drugs in U.S. ambulatory care visits, 2006-2016. J Am Pharm Assoc (2003) 2021; 62:468-474.e2. [PMID: 34799261 DOI: 10.1016/j.japh.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/30/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE(S) This study aimed to characterize the co-utilization of non-benzodiazepine sedative 'Z'-drugs with opioids at ambulatory care visits in the United States. DESIGN A cross-sectional analysis of the National Ambulatory Medical Care Survey (NAMCS) from 2006 to 2016 was completed. SETTING AND PARTICIPANTS Ambulatory care visits in the United States involving adult patients with an opioid prescription were included in the analysis. OUTCOME MEASURES The primary outcome was initiation or continuation of a Z-drug (zolpidem, eszopiclone, or zaleplon) in a patient visit in conjunction with an opioid medication. RESULTS The authors analyzed 564,090,296 visits (weighted from a sample of 28,773) with a reported opioid prescription. Co-utilization of opioids with Z-drugs fluctuated during the study period beginning at 4.0% in 2006 (95% CI 2.2%-5.7%), 6.3% in 2012 (3.7%-8.9%), and 4.7% in 2016 (2.8%-6.5%). Among all opioid visits in the study period, co-utilization with a Z-drug was not significantly different among female patients compared with male patients (5.26% vs. 4.63%, P = 0.26). Among visits with concomitant opioid and Z-drugs, 7.0% reported new initiation of both medications in the same visit. CONCLUSION At ambulatory care visits between 2006 and 2016, co-utilization of opioids and Z-drugs fluctuated with some differences by sex. Major regulatory advisories and policy changes during this period may have contributed to these varying rates of utilization. Additional work is needed to identify predictors of co-utilization and downstream consequences more widely.
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Miller MB, Roumanis MJ, Kakinami L, Dover GC. Chronic Pain Patients' Kinesiophobia and Catastrophizing are Associated with Activity Intensity at Different Times of the Day. J Pain Res 2020; 13:273-284. [PMID: 32099451 PMCID: PMC6999761 DOI: 10.2147/jpr.s230039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/24/2019] [Indexed: 01/15/2023] Open
Abstract
Purpose To examine the relationship between baseline kinesiophobia and baseline pain catastrophizing with the 4-day average activity intensity at different times of the day while accounting for different wake and sleep-onset times in chronic pain patients. Methods Twenty-one participants suffering from idiopathic chronic pain completed baseline questionnaires about kinesiophobia, catastrophizing, disability, depression, and pain. We measured the participants' activity using accelerometers and calculated activity intensity in the morning, afternoon, and evening. We performed a 2-way repeated measures ANOVA to compare activity levels at different times of the day, and multiple linear regressions. Results Baseline kinesiophobia was significantly associated with 4-day average evening light activity and sedentary activity at all time periods while baseline catastrophizing was significantly associated with increased 4-day average light activity in the evening and more moderate to vigorous activity in the morning. Our participants engaged in more light activity on average than sedentary activity, and very little moderate-vigorous activity. Participants were most active in the afternoon. Conclusion Baseline kinesiophobia and baseline catastrophizing were not associated with the 4-day average total daily activity; however, they were associated with 4-day average activity intensities at different times throughout the day. Segmenting daily activity into morning, afternoon, evening may influence the relationship between daily activity, and kinesiophobia and pain catastrophizing. Individuals with chronic pain are less sedentary than previously thought which may affect future interventions.
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Affiliation(s)
- Matthew B Miller
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, Canada
| | - Melissa J Roumanis
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, Canada
| | - Lisa Kakinami
- Department of Mathematics & Statistics, Concordia University, Montreal, Canada.,PERFORM Centre, Concordia University, Montreal, Canada
| | - Geoffrey C Dover
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, Canada.,PERFORM Centre, Concordia University, Montreal, Canada.,Centre de Recherché Interdisciplinaire en Réadaptation du Montréal Metropolitain, Montreal, Canada
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Wang Y, Sun K, Zhang W, Zhang H, Wang C. Pain and Psychological Distress: Effect of Microvascular Decompression on Sleep Disorders and Obsessions in Trigeminal Neuralgia. J Neurol Surg B Skull Base 2020; 82:e285-e294. [PMID: 34306951 DOI: 10.1055/s-0039-3402040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/17/2019] [Indexed: 01/03/2023] Open
Abstract
Objective This study was aimed to investigate the effects of microvascular decompression (MVD) on sleep disorders and obsessions in trigeminal neuralgia. Methods Clinical data from 115 patients with trigeminal neuralgia treated with MVD from August 1, 2017 to May 31, 2018 at Jining First People's Hospital were analyzed retrospectively. The preoperative and postoperative risk factors for sleep disorders and obsessions, as well as the effects of MVD on sleep disorders and obsessions, were examined. Results In 115 patients, there were significant differences in preoperative sleep disorders associated with sex, monthly household income, pain in multiple branches, visual analog scale (VAS) score, and Self-Rating Depression Scale (SDS) score ( p < 0.05). Preoperative obsessions were significantly different according to age, gender, pain in multiple branches, monthly household income, VAS score, and Self-Rating Anxiety Scale (SAS) score groups ( p < 0.05). A 1-year recurrence was positively correlated with sleep disturbance (odds ratio = 3.829) and obsessions (odds ratio = 4.507). In addition, the results revealed a negative correlation between the manipulation of trigeminal neuralgia and postoperative sleep disorders ( B ≥ 1.043). Moreover, there was a significant difference in sleep disorders and obsessions before and 1 year after MVD ( p < 0.05). Conclusion For patients with trigeminal neuralgia, pain caused by sleep and obsession disorders should be examined early to identify an effective solution. Moreover, MVD, as a first treatment, is valuable for improving the physiological and psychological prognosis of patients.
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Affiliation(s)
- Yanglingxi Wang
- The Clinical College of Jining Medical University, Ji-Ning City, Shandong Province, People's Republic of China
| | - Kai Sun
- Deparment of Neurosurgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Wenling Zhang
- Department of Neurosurgery, Ji Ning No.1 People's Hospital, Ji-Ning City, Shandong, Shandong Province, People's Republic of China
| | - HaiTao Zhang
- Department of Neurosurgery, Ji Ning No.1 People's Hospital, Ji-Ning City, Shandong, Shandong Province, People's Republic of China
| | - Chong Wang
- Department of Neurosurgery, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, People's Republic of China
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To What Extent Does Radiotherapy Improve the Quality of Life of Patients With Bone Metastasis?: A Prospective, Single-Institutional Study. Am J Clin Oncol 2019; 41:163-166. [PMID: 26535991 DOI: 10.1097/coc.0000000000000249] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/OBJECTIVES Radiation therapy (RT) is an effective method of palliating painful bone metastases and improves the quality of life (QoL) of these patients. The purpose of this trial is 2-fold: to quantify the impact of RT in the QoL of patients with bone metastasis and to compare the QoL results between the most used schemes of RT at our Centre. MATERIALS AND METHODS A consecutive sample of patients with bone metastasis treated with RT in the Complejo Hospitalario de Navarra, Spain, was addressed between January 2011 and November 2012. The QoL was measured with the Quality of Life Questionnaire-C15-Palliative questionnaire, a short version of the European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire-C30 for palliative care. Two assessments were proposed for each patient: one on the first day of the treatment and the other one a month after the end of the radiotherapy sessions. One hundred and sixteen patients completed the first questionnaire and 75 completed the second one (65%). RESULTS Significant differences appeared in 9 domains, with better QoL in the second assessment. Five areas (physical functioning, global, fatigue, nausea, dyspnea, and constipation) showed little change (between 5 and 9 points), 3 (emotional functioning, insomnia, and appetite loss) showed moderate change (10 to 20 points), and 1 (pain) showed a very positive change (>30 points).When we compare the QoL scores between the 2 most used schemes of RT (30 Gy/10 fractions vs. 20 Gy/4 to 5 fractions), there are no significant differences in any QoL areas (and in 2 areas P was near 0.05). CONCLUSIONS Palliative RT is a very active treatment for patients with bone metastasis regardless of age, location, primary tumor, or RT scheme. RT significantly improves the QoL, fundamentally by controlling pain and reducing analgesic use. Shorter schemes of RT produce at least-if not better-the same effect on QL than longer schemes (30 Gy).
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Abstract
(1) Background: Chronic pain is a significant and prevalent condition in many industrialized nations. Pain and sleep’s reciprocal nature suggests that interventions to improve sleep may decrease pain symptoms. Little attention has been paid to the influence that owning a pet dog has on the pain/sleep relationship. Typical advice to remove pets from the bedroom negates the possible positive benefit of human-animal co-sleeping. Aim: To investigate pain patients’ perceived impact of pet dog ownership on sleep. (2) Methods: We carried out a content analysis of interview data focused on the impact of pet dog ownership on sleep. The qualitative dataset comes from a subgroup of participants in a larger study examining the pain patient/canine relationship. This subgroup of participants from the larger study was asked, “Does your dog have a positive or negative impact on your sleep?” The data were thematically coded using an iterative approach. (3) Findings: Codes included: companionship; physical presence/’cuddles’; routine/schedule; distraction from anxiety/worry at night; reassuring/protective presence; active intervention to keep participant safe; daytime activity to promote sleeping at night; and reciprocal concern for the sleep of the pet dog. (4) Conclusions: Pet dogs may play important roles in helping people with chronic pain achieve sleep onset and maintenance. Removing the dog to improved sleep could be counter-productive and lead to additional sleep-related issues.
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Huang G, Travison TG, Edwards RR, Basaria S. Effects of Testosterone Replacement on Pain Catastrophizing and Sleep Quality in Men with Opioid-Induced Androgen Deficiency. PAIN MEDICINE 2018; 18:1070-1076. [PMID: 27550959 DOI: 10.1093/pm/pnw159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective The objective of this investigation was to determine the effects of testosterone administration on pain catastrophizing and sleep quality in adult men with opioid-induced androgen deficiency. Design Sixty-two men aged 18-64 years using opioid analgesics for chronic non-cancer pain with total testosterone levels < 350 ng/dl were randomized to 14 weeks of transdermal testosterone gel or placebo gel daily. Total testosterone levels were measured by liquid chromatography mass spectrometry and free testosterone was calculated using the law of mass action equation. Outcomes were assessed by administering validated instruments such as Pain Catastrophizing Scale (PCS) and Insomnia Severity Index (ISI) at baseline and 14 weeks. Results Baseline characteristics were similar between the two groups. Mean (SD) total testosterone concentrations increased from 223 ± 86 to 775 ± 555 ng/dl in the testosterone group, but did not meaningfully change in placebo group. Mean changes in PCS and ISI scores during intervention did not differ significantly between groups and were not related to changes in on-treatment serum testosterone concentrations. Conclusion In this 14-week trial, testosterone administration in men with opioid-induced androgen deficiency was not associated with improvements in pain catastrophizing or sleep quality.
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Affiliation(s)
- Grace Huang
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, The Research Program on Men's Health, Aging and Metabolism, Boston, Massachusetts
| | - Thomas G Travison
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, The Research Program on Men's Health, Aging and Metabolism, Boston, Massachusetts.,Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts.,Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robert R Edwards
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shehzad Basaria
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, The Research Program on Men's Health, Aging and Metabolism, Boston, Massachusetts
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8
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Harvey MP, Lorrain D, Martel M, Bergeron-Vezina K, Houde F, Séguin M, Léonard G. Can we improve pain and sleep in elderly individuals with transcranial direct current stimulation? - Results from a randomized controlled pilot study. Clin Interv Aging 2017; 12:937-947. [PMID: 28652716 PMCID: PMC5472413 DOI: 10.2147/cia.s133423] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The prevalence of chronic pain and sleep disturbances substantially increases with age. Pharmacotherapy remains the primary treatment option for these health issues. However, side effects and drug interactions are difficult to control in elderly individuals. Aims The objective of this study was to assess the feasibility of conducting a randomized sham-controlled trial and to collect preliminary data on the efficacy of transcranial direct current stimulation (tDCS) to reduce pain and improve sleep in older adults suffering from chronic pain. Methods Fourteen elderly individuals (mean age 71±7 years) suffering from chronic pain and sleep complaints were randomized to receive either anodal tDCS, applied over the primary motor cortex (2 mA, 20 minutes), or sham tDCS, for 5 consecutive days. Pain was measured with visual analog scales, pain logbooks and questionnaires, while sleep was assessed with actigraphy, sleep diaries and questionnaires. Results There were no missing data for pain and sleep measures, except for actigraphy, that generated several missing data. Blinding was maintained throughout the study, for both the evaluator and participants. Active but not sham tDCS significantly reduced pain (P<0.05). No change was observed in sleep parameters, in both the active and sham tDCS groups (all P≥0.18). Conclusion The present study provides guidelines for the implementation of future tDCS studies in larger populations of elderly individuals. M1 anodal tDCS in this population appears to be effective to reduce pain, but not to improve sleep.
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Affiliation(s)
- Marie-Philippe Harvey
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Faculty of Medicine and Health Sciences, Université de Sherbrooke
| | - Dominique Lorrain
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Department of Psychology, Université de Sherbrooke
| | - Marylie Martel
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Faculty of Medicine and Health Sciences, Université de Sherbrooke
| | | | - Francis Houde
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Faculty of Medicine and Health Sciences, Université de Sherbrooke
| | - Mario Séguin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke.,Department of Neurosurgery, Centre Hospitalier Universitaire de Sherbrooke
| | - Guillaume Léonard
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Faculty of Medicine and Health Sciences, Université de Sherbrooke.,School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada
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Almoznino G, Benoliel R, Sharav Y, Haviv Y. Sleep disorders and chronic craniofacial pain: Characteristics and management possibilities. Sleep Med Rev 2017; 33:39-50. [DOI: 10.1016/j.smrv.2016.04.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 02/07/2023]
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Stavem K, Kristiansen HA, Kristoffersen ES, Kværner KJ, Russell MB. Association of excessive daytime sleepiness with migraine and headache frequency in the general population. J Headache Pain 2017; 18:35. [PMID: 28321593 PMCID: PMC5359193 DOI: 10.1186/s10194-017-0743-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/07/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Some previous studies have postulated an association between migraine and excessive daytime sleepiness (EDS). This study evaluated the association of EDS with migraine and headache frequency in a general population, after adjusting for potential confounding variables. METHODS The study was a postal survey of a random age and gender-stratified sample of 40,000 persons aged 20 to 80 years old drawn by the National Population Register in Norway. The questionnaire included questions about migraine, headache, the Epworth sleepiness scale (ESS) and various comorbidities. EDS was defined as ESS > 10. The association of EDS and migraine/headache were analysed by bivariate and multivariable logistic regression analyses. RESULTS A total of 21,177 persons responded to the ESS and were included in the analyses. The odds ratio (OR) for EDS was increased for migraineurs (1.42 (95% CI 1.31─1.54), p < 0.001) compared to non-migraineurs; however, this finding was not significant after adjustment for a number of possible confounders. EDS increased with increasing headache frequency, with an OR of 2.74 (95% CI 2.05─3.65), p < 0.001) for those with headache on >179 days per year compared to those without headache in multivariable analysis. CONCLUSIONS In a general population, the odds for EDS increased significantly with the headache frequency, irrespective of migraine status. EDS was not associated with reported migraine in multivariable analysis.
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Affiliation(s)
- Knut Stavem
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Lørenskog, Norway. .,Department of Pulmonary Medicine, Medical Division, Akershus University Hospital, Lørenskog, Norway. .,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
| | - Håvard Anton Kristiansen
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Lørenskog, Norway
| | - Espen Saxhaug Kristoffersen
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway.,Department of General Practice, University of Oslo, Oslo, Norway
| | - Kari Jorunn Kværner
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway.,C3 Centre for Connected Care, Oslo University Hospital, Oslo, Norway.,BI Norwegian Business School, Oslo, Norway
| | - Michael Bjørn Russell
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Lørenskog, Norway
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Almoznino G, Haviv Y, Sharav Y, Benoliel R. An update of management of insomnia in patients with chronic orofacial pain. Oral Dis 2017; 23:1043-1051. [DOI: 10.1111/odi.12637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/26/2016] [Accepted: 01/03/2017] [Indexed: 01/03/2023]
Affiliation(s)
- G Almoznino
- Department of Oral Medicine; Hebrew University-Hadassah School of Dental Medicine; Jerusalem Israel
- Department of Oral Medicine; Oral and Maxillofacial center; Medical Corps; Israel Defense Forces; Tel-Hashomer Israel
| | - Y Haviv
- Department of Oral Medicine; Hebrew University-Hadassah School of Dental Medicine; Jerusalem Israel
| | - Y Sharav
- Department of Oral Medicine; Hebrew University-Hadassah School of Dental Medicine; Jerusalem Israel
| | - R Benoliel
- Rutgers School of Dental Medicine; Rutgers, The State University of New Jersey; Newark NJ USA
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The impact of chronic orofacial pain on daily life: the vulnerable patient and disruptive pain. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:58-66. [PMID: 27727115 DOI: 10.1016/j.oooo.2016.08.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/10/2016] [Accepted: 08/15/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify patient and pain characteristics associated with negative impacts on daily life among patients with chronic orofacial pain (COFP). STUDY DESIGN Medical records of 200 COFP patients were analyzed. RESULTS Diagnostic categories included temporomandibular disorders (85; 42.7%), headaches (47; 23.6%), neuropathic pain (37; 18.5%), trigeminal neuralgia (16; 8.0%), and painful posttraumatic trigeminal neuropathy (PTTN) (14; 7.0%). Of these, 47 (23.7%) had medical and 13 (6.5%) had psychiatric comorbidities and 71 (35.7%) experienced physical trauma. Seven (5%) had stopped working, and mean days absent from work was 3.3 ± 19.3. Patients were previously treated by 2.7 ± 1.4 caregivers. Mean scores on a 0-10 scale were as follows: pain (7.13 ± 2.3), sleep quality (6.6 ± 2.4), and quality of life (5.58 ± 3.1). PTTN patients were more likely to quit work (P = .009) and had more days absent from work (mean 24.3; P = .009). We identified patient and pain profiles that predict these poor outcomes. The "vulnerable patient" profile includes health and psychiatric comorbidities and trauma history, particularly PTTN. The "disruptive pain" profile includes severe, continuous, burning, electrical pain accompanied by systemic signs. These profiles intersect in a complex manner, creating a complex feedback loop. CONCLUSIONS A multidisciplinary team approach is recommended to manage COFP patients, in order to improve treatment outcomes and avert more serious consequences.
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Ramineni T, Prusik J, Patel S, Lange S, Haller J, Fama C, Argoff C, Pilitsis J. The Impact of Spinal Cord Stimulation on Sleep Patterns. Neuromodulation 2016; 19:477-81. [DOI: 10.1111/ner.12382] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/26/2015] [Accepted: 10/28/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Tina Ramineni
- Department of Neurosurgery; Albany Medical College; Albany NY USA
| | - Julia Prusik
- Department of Neurosurgery; Albany Medical College; Albany NY USA
- Department of Neurology; Albany Medical College; Albany NY USA
| | - Samik Patel
- Department of Neurosurgery; Albany Medical College; Albany NY USA
| | - Steven Lange
- Department of Neurosurgery; Albany Medical College; Albany NY USA
| | - Jessica Haller
- Department of Neurosurgery; Albany Medical College; Albany NY USA
| | - Chris Fama
- Department of Neurosurgery; Albany Medical College; Albany NY USA
| | - Charles Argoff
- Department of Neurology; Albany Medical College; Albany NY USA
| | - Julie Pilitsis
- Department of Neurosurgery; Albany Medical College; Albany NY USA
- Center for Neuroscience and Neuropharmacology; Albany Medical College; Albany NY USA
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Wilt JA, Davin S, Scheman J. A multilevel path model analysis of the relations between sleep, pain, and pain catastrophizing in chronic pain rehabilitation patients. Scand J Pain 2016; 10:122-129. [PMID: 28361763 DOI: 10.1016/j.sjpain.2015.04.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 04/26/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIM Pain catastrophizing is linked to heightened pain and poorer coping among individuals with chronic pain, yet little is known about how pain catastrophizing associates with sleep and pain over the course of treatment for chronic pain. Previous research employing a cross-sectional design suggests that sleep mediates the association between pain catstrophizing and pain, but there have been no longitudinal studies examining the directionality of these associations. Thus, the aim of this study was to test two competing theoretical models. The first model specified that pain catastrophizing leads to increased pain via poor sleep. The second model specified that poor sleep leads to increased pain catastrophizing via increased pain. METHODS This study examined the relations between pain catastrophizing, sleep, and pain among 50 consecutive patients (36 female, 14 male) ages 20-80 (M=45.96, SD=13.94) with chronic, non-malignant pain who were admitted to the Cleveland Clinic, Chronic Pain Rehabilitation Programme (CPRP). The CPRP, within the Neurological Centre for Restoration, Neurologic Institute at the Cleveland Clinic, is a comprehensive, interdisciplinary programme designed to treat patients with disabling chronic pain. As part of their daily, morning update with their case manager, patients completed self-report ratings of their previous night's sleep time (TST), and their current pain, anxiety, and depression. Pain catastrophizing was assessed at admission and discharge. RESULTS Over the course of treatment, daily TST increased from approximately 5h and 20min per night to nearly 6h and 30min per night, and average daily pain, daily depression, and daily anxiety decreased over the course of treatment. As the data in this study has a multilevel structure, with daily reports nested with in patients, we conducted multilevel path models to examine the longitudinal relations between pain catastrophizing, sleep, and pain. Multilevel path analysis permits the analysis of interdependent data without violating the assumptions of standard multiple regression. Models were conducted for pain catastrophizing and each of its subscales: rumination, magnification and helplessness. The findings were uniform across the composite pain catastrophizing scale and its subscales. There was an indirect path from sleep to pain catastrophizing (post-treatment) via pain, but not from pain catastrophizing (pre-treatment) to pain via sleep. There were also direct effects of sleep on pain and from pain to pain catastrophizing (post-treatment). Additionally, decreases in pain over the course of treatment were related to lower pain catastrophizing post-treatment. CONCLUSION AND IMPLICATIONS These results call into question previous evidence that pain catastrophizing indirectly affects pain by way of its impact on sleep. Rather, our findings suggest that pain mediates the relationship between sleep and levels of pain catastrophizing. These results therefore underscore importance and value in collecting longitudinal data and potential influence on the conclusions gained with regards to sleep, pain and psychological variables. These findings may be of clinical importance when tailoring interventions for individuals with chronic pain and perhaps even more so for those with comorbid pain and sleep disturbance; prioritizing the treatment of sleep difficulties could result in improvements to pain-related outcomes.
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Affiliation(s)
- Joshua A Wilt
- Case Western Reserve University, ClevelandUnited States
| | - Sara Davin
- Neurological Center for Pain, Neurological Institute, Cleveland Clinic, ClevelandUnited States
| | - Judith Scheman
- Neurological Center for Pain, Neurological Institute, Cleveland Clinic, ClevelandUnited States
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Subedi A, Chaudakshetrin P, Chotisukarat H, Mandee S. Effect of Co-Morbid Conditions on Persistent Neuropathic Pain after Brachial Plexus Injury in Adult Patients. J Clin Neurol 2016; 12:489-494. [PMID: 27819420 PMCID: PMC5063877 DOI: 10.3988/jcn.2016.12.4.489] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 02/06/2023] Open
Abstract
Background and Purpose Neuropathic pain (NeuP) associated with traumatic brachial plexus injury (BPI) can be severe, persistent, and resistant to treatment. Moreover, comorbidity associated with NeuP may worsen the pain and quality of life. This study compared persistent NeuP after BPI between patients with and without co-morbid conditions (psychiatric dysfunction and other painful conditions) and tramadol usage as a second-line agent in combination with an antiepileptic and/or antidepressant during a 2-year follow-up. Methods The medical records of patients diagnosed with BPI referred to a pain center between 2006 and 2010 were reviewed for 2 years retrospectively. Data regarding patient demographics, injury and surgical profiles, characteristics of NeuP and its severity, and treatment received were compared between patients with and without manifesting co-morbid conditions. The NeuP and pain intensity assessments were based on the DN4 questionnaire and a numerical rating scale, respectively. Results Of the 45 patients studied, 24 patients presented with one of the following co-morbid conditions: myofascial pain (21%), psychiatric disorder (17%), phantom limb pain (4%), complex regional pain syndrome (21%), and insomnia (37%). Tramadol was required by 20 patients with co-morbidity and, 9 patients without co-morbidity (p<0.001). The mean pain score after 2 years was higher in patients with co-morbidity than in those without co-morbidity (p<0.05). Conclusions Persistent pain following BPI was more common in patients manifesting other painful conditions or psychiatric co-morbidity. A higher proportion of the patients in the co-morbid group required tramadol as a second-line of agent for pain relief.
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Affiliation(s)
- Asish Subedi
- Department of Anesthesiology, BPKIHS, Dharan, Nepal.
| | | | | | - Sahatsa Mandee
- Department of Anesthesiology, Siriraj Hospital, Bangkok, Thailand
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Kravitz HM, Zheng H, Bromberger JT, Buysse DJ, Owens J, Hall MH. An actigraphy study of sleep and pain in midlife women: the Study of Women's Health Across the Nation Sleep Study. Menopause 2015; 22:710-8. [PMID: 25706182 PMCID: PMC4481159 DOI: 10.1097/gme.0000000000000379] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We examined whether women reporting nighttime pain would have more actigraphy-measured evidence for disturbed sleep and would report feeling less rested compared with women without nighttime pain. METHODS Up to 27 consecutive nights of actigraphy and sleep diary data from each participant were analyzed in this community-based study of 314 African-American (n = 118), white (n = 141), and Chinese (n = 55) women, aged 48 to 58 years, who were premenopausal, perimenopausal, or postmenopausal and were participating in the Study of Women's Health Across the Nation Sleep Study. Dependent variables were actigraphy-measured movement and fragmentation index, total sleep time, sleep efficiency, and diary self-report of "feeling rested" after waking up. All outcomes were fitted using linear mixed-effects models to examine covariate-adjusted associations between the independent variable (nighttime pain severity) and sleep outcomes. RESULTS Higher pain severity scores were associated with longer sleep duration but reduced sleep efficiency and less restful sleep. Women reporting nocturnal vasomotor symptoms had more sleep-related movement and sleep fragmentation, had reduced sleep efficiency, and were less likely to feel rested after wakening whether or not they reported pain. CONCLUSIONS Midlife women who report higher nighttime pain levels have more objective evidence for less efficient sleep, consistent with self-reported less restful sleep. Nocturnal vasomotor symptoms also can contribute to restlessness and wakefulness in midlife women.
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Affiliation(s)
- Howard M Kravitz
- From the 1Department of Psychiatry, Rush University Medical Center, Chicago, IL; 2Department of Preventive Medicine, Rush University Medical Center, Chicago, IL; 3Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI; 4Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; and 5Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Bjurstrom MF, Irwin MR. Polysomnographic characteristics in nonmalignant chronic pain populations: A review of controlled studies. Sleep Med Rev 2015; 26:74-86. [PMID: 26140866 DOI: 10.1016/j.smrv.2015.03.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 12/18/2022]
Abstract
Sleep and pain are critical homeostatic systems that interact in a bidirectional manner. Complaints of sleep disturbance are ubiquitous among patients with chronic pain disorders, and conversely, patients with persistent insomnia symptoms commonly report suffering from chronic pain. Sleep deprivation paradigms demonstrate that partial or complete sleep loss induce hyperalgesia, possibly due to shared mechanistic pathways including neuroanatomic and molecular substrates. Further, chronic pain conditions and sleep disturbances are intertwined through comorbidities, which together cause detrimental psychological and physical consequences. This critical review examines 29 polysomnography studies to evaluate whether nonmalignant chronic pain patients, as compared to controls, show differences in objective measures of sleep continuity and sleep architecture. Whereas these controlled studies did not reveal a consistent pattern of objective sleep disturbances, alterations of sleep continuity were commonly reported. Alterations of sleep architecture such as increases in light sleep or decreases in slow-wave sleep were less commonly reported and findings were mixed and also inconsistent. Methodological flaws were identified, which complicated interpretation and limited conclusions; hence, recommendations for future research are suggested. Knowledge of abnormalities in the sleep process has implications for understanding the pathophysiology of chronic pain conditions, which might also direct the development of novel intervention strategies.
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Affiliation(s)
- Martin F Bjurstrom
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, USA.
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, USA
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Almoznino G, Zini A, Sharav Y, Shahar A, Zlutzky H, Haviv Y, Lvovsky A, Aframian DJ. Sleep quality in patients with dental anxiety. J Psychiatr Res 2015; 61:214-22. [PMID: 25529787 DOI: 10.1016/j.jpsychires.2014.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 09/26/2014] [Accepted: 11/28/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Psychological distress is associated with sleep disturbances; however there is little research on sleep quality in dental anxiety (DA) patients. OBJECTIVES To measure the sleep quality in patients with DA compared to patients with an exacerbated gag reflex (GAG) and controls and to analyze its association with various demographic and behavioral parameters. METHODS 67 DA patients, 54 GAG patients and 100 controls with no history of DA or GAG participated in the study. Data regarding: demographic details, smoking habits, the Pittsburgh Sleep Quality Index (PSQI), Numeric Rating Scale (NRS) for pain assessment, Corah's dental anxiety scale (DAS) and Oral Health Impact Profile-14 (OHIP-14), plaque index (PI) and Decay, Missing and Filled Teeth (DMFT) scores were collected. RESULTS 49.3% of the DA group and 38.9% of the GAG group were poor sleepers (mean PSQI score > 5), compared to 29.0% of the controls (PSQI mean scores: 5.8 ± 3.4, DA group; 5.2 ± 3.6 GAG group vs. 4.5 ± 2.7, control group; p = 0.029). Compared to controls, DA and GAG patients exhibited poorer scores in the sleep disturbances PSQI component (p = 0.001). DA patients exhibited poorer scores in the sleep duration PSQI component compared to the control (p = 0.002) and GAG groups (p = 0.033). Female gender (p = 0.039), higher current (p = 0.046) and maximal NRS (p = 0.019), higher DAS (p < 0.001) and OHIP-14 (p < 0.001) scores and more missing teeth (p = 0.003) were positively associated with higher PSQI scores. CONCLUSIONS DA patients suffered more from impaired sleep than controls and GAGs. Impaired sleep in DA patients is multidimensional phenomenon influenced by the specific diagnosis, gender, pain, dental anxiety levels, dental experience and oral health related quality of life.
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Affiliation(s)
- Galit Almoznino
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel; Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel.
| | - Avraham Zini
- Department of Community Dentistry, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Yair Sharav
- Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Adi Shahar
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel; In partial fulfillment of DMD Degree, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Hulio Zlutzky
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel
| | - Yaron Haviv
- Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Alex Lvovsky
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel
| | - Doron J Aframian
- Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
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Sandoval R, Roddey T, Giordano TP, Mitchell K, Kelley C. Pain, sleep disturbances, and functional limitations in people living with HIV/AIDS-associated distal sensory peripheral neuropathy. J Int Assoc Provid AIDS Care 2015; 13:328-34. [PMID: 23887924 DOI: 10.1177/2325957413494237] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Pain, sleep, and functional disturbances are a common occurrence in people living with HIV/AIDS-related distal sensory peripheral neuropathy (PLWHA-DSPN) yet lack group classification and quantification. METHODS A total of 46 PLWHA-DSPN were recruited, as part of a 2-group intervention study, to complete the Neuropathic Pain Scale and the Pittsburgh Sleep Quality Index (PSQI) questionnaires. The participant's performance during a forward reach task and walking distance in 6 minutes was recorded as a measure of function. RESULTS The pain (60.77 +/- 17.85) and sleep (14.62 +/- 4.28) scores denote marked pain and sleep disturbances, compared to seronegative, age-matched individuals. The ambulation distance was limited (243.99 +/- 141.04 m) and inversely associated with the PSQI-sleep efficiency subscale (rs = -.35, P < .05). The average reaching distances measured (36.07 +/- 7.37 cm) were similar to seronegative, age-matched individuals. Pain, sleep, and functional measures exhibited significant associations. CONCLUSIONS The data collected suggest that PLWHA-DSPN report moderate-to-severe pain and significant sleep disturbances and exhibit limited ambulation distances.
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Davin S, Wilt J, Covington E, Scheman J. Variability in the Relationship Between Sleep and Pain in Patients Undergoing Interdisciplinary Rehabilitation for Chronic Pain. PAIN MEDICINE 2014; 15:1043-51. [DOI: 10.1111/pme.12438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sandoval R, Roddey T, Giordano TP, Mitchell K, Kelley C. Randomized Trial of Lower Extremity Splinting to Manage Neuropathic Pain and Sleep Disturbances in People Living with HIV/AIDS. ACTA ACUST UNITED AC 2013; 15:240-7. [DOI: 10.1177/2325957413511112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background/Aims: Distal symmetrical peripheral neuropathy (DSPN) and sleep disturbances are among the most common complications reported in people living with the human immunodeficiency virus infection and acquired immunodeficiency syndrome (PLWHA). DSPN-pain is predominantly managed by using systemic agents with little evidence supporting their analgesic efficacy. The purpose of this study is to evaluate the effect of nighttime lower extremity splinting application on DSPN-related pain and sleep disturbances compared to a parallel splint liner application in PLWHA. Methods: Forty-six PLWHA and DSPN were randomized to nighttime wearing of bilateral lower extremity splints or the liners only. Pain and sleep outcomes were measured at baseline, week 3, and week 6. The pain was measured using the Neuropathic Pain Scale and sleep using the Pittsburgh Sleep Quality Index. Results: Pain and sleep scores improved in both groups over time. The median percentage pain reduction at week 6 was 8% in the liner group and 34% in the splint group. The change in pain scores in the splint group was found to be significant over time, P < .0005. The contrast between the splint and liner groups was underpowered (26%) and was not found to be significant, P > .05. Sleep scores improved 20% from baseline to the end of the study in both groups; all participants were classified as poor sleepers. Conclusion: The 6-week use of nighttime splints reduces DSPN-pain possibly by providing peripheral inhibition of external stimuli. Future studies are needed to validate this inhibitory intervention to manage DSPN in PLWHA and other neuropathic conditions.
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Affiliation(s)
- Roberto Sandoval
- Harris Health System, Thomas Street Health Center, Houston, TX, USA
- School of Physical Therapy, Texas Woman’s University, Houston, TX, USA
| | - Toni Roddey
- School of Physical Therapy, Texas Woman’s University, Houston, TX, USA
| | - Thomas Peter Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Scientist, HSR&D Center of Excellence, DeBakey VA Medical Center, Houston, TX, USA
| | - Katy Mitchell
- School of Physical Therapy, Texas Woman’s University, Houston, TX, USA
| | - Carolyn Kelley
- School of Physical Therapy, Texas Woman’s University, Houston, TX, USA
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Sun J, Kang J, Wang P, Zeng H. Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial. J Clin Nurs 2013; 22:1270-80. [PMID: 23574290 DOI: 10.1111/jocn.12096] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2012] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVE To evaluate the effects of self-relaxation training on sleep quality and cognitive functions in the older. BACKGROUND Ageing causes declines in sleep quality and cognitive functions in older adults, and decreased sleep quality also accelerates declines in cognitive functions. Therefore, it is necessary to find cost-effective interventions to enhance sleep quality in the older, thereby improving their cognitive functions or delaying cognitive decline. DESIGN Randomised controlled study. METHODS The study was conducted between July 2010 and June 2011 at Wangyuehu Community in Changsha, China. Eighty older adults with reduced sleep quality were selected and randomly assigned to experimental (n = 40) or control (n = 40) group. Subjects in the experimental group received self-relaxation training including progressive muscle relaxation and meditation based on sleep hygiene education, while the control group received sleep hygiene education only. Sleep quality and cognitive functions of the two groups were measured prior to training and at the end of the 3rd, 6th and 12th months using four reliable and valid questionnaires. RESULTS Repeated measures anova revealed that the self-relaxation training had significant main effect as well as interaction effect with time on sleep quality and cognitive functions. Except for scores of Epworth Sleepiness Scale, Mini-Mental State Examination and number memory, time had significant main effect on scores of Pittsburgh Sleep Quality Index, picture memory, associative memory and understanding memory. CONCLUSION Self-relaxation training can improve sleep quality and cognitive functions in the older. RELEVANCE TO CLINICAL PRACTICE Self-relaxation training is a non-invasive, simple and inexpensive therapeutic method of improving sleep quality and cognitive functions in community-dwelling older people.
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Affiliation(s)
- Jingxian Sun
- School of Nursing, Central South University, Changsha, Hunan Province, China
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Improvement of pain, sleep, and quality of life in chronic pain patients with vitamin D supplementation. Clin J Pain 2013; 29:341-7. [PMID: 22699141 DOI: 10.1097/ajp.0b013e318255655d] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the effects of vitamin D supplementation in outpatient veterans with multiple areas of chronic pain. METHODS A case series was performed as an outpatient vitamin D supplementation quality improvement project. A total of 28 US veterans with multiple areas of chronic pain and low serum 25-hydroxyvitamin D [25(OH)D] (<30 ng/mL) concentrations at baseline were identified in a major Veterans Affairs Medical Center from May 2009 till November 2010. They were supplemented with vitamin D 1200 IU daily if serum 25(OH)D was in the insufficient range (20 to 29 ng/mL) or 50,000 IU weekly if serum 25(OH)D was in the deficient range (<20 ng/mL). Standardized outcome measures were assessed before and after supplementation, including pain assessed by the 0 to 10 pain score and the bodily pain domain score of the Veterans Rand 36 item, sleep by the Pittsburgh Sleep Quality Index, and quality of life (QoL) by the Veterans Rand 36 item. RESULTS Participants reported no side effects during the study. Relative to baseline, pain, sleep, and QoL all improved except for role-functioning emotional. The improvements remained significant in pain score (P<0.001), sleep latency (P=0.019), sleep duration (P=0.012), bodily pain (P=0.014), general health (P=0.006), vitality (P=0.048), and social functioning (P=0.017) after controlling for age, sex, race, body mass index, season, baseline serum 25(OH)D concentration subgroup, and whether or not participants received additional procedural intervention during the supplementation period. CONCLUSIONS Standardized vitamin D supplementation in veterans with multiple areas of chronic pain can be effective in improving their pain levels, sleep, and various aspects of QoL.
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Cho CH, Jung SW, Park JY, Song KS, Yu KI. Is shoulder pain for three months or longer correlated with depression, anxiety, and sleep disturbance? J Shoulder Elbow Surg 2013; 22:222-8. [PMID: 22738644 DOI: 10.1016/j.jse.2012.04.001] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 03/26/2012] [Accepted: 04/01/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recent studies have found a high prevalence of depression, anxiety, and sleep disturbance in patients with chronic musculoskeletal pain. We conducted a study to determine whether shoulder pain for 3 months or longer is correlated with depression, anxiety, and sleep disturbance. MATERIALS AND METHODS We prospectively evaluated 130 patients who had had shoulder pain for 3 months or longer (group I) and 60 healthy controls (group II). We obtained visual analog scale (VAS) pain score, and scores for the American Shoulder and Elbow Surgeons (ASES), Korean Shoulder Scale (KSS), Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index (PSQI). RESULTS The mean VAS pain score, ASES score, and KSS score in group I were 6.2, 46.6, and 51.5, respectively. In that group, 22.3% had depression, 19.2% had anxiety, and 81.5% had sleep disturbance. The prevalences were higher in group I than in group II. There were no differences in depression, anxiety, or sleep disturbance by age, sex, type of disease, or duration of symptoms in group I. VAS pain scores positively correlated with PSQI scores (P = .01). ASES and KSS scores negatively correlated with HADS depression and anxiety subscale and PSQI scores (P < .001). Shoulder pain for 3 months or longer was the strongest predictor of sleep disturbance (P < .001). CONCLUSIONS Our study demonstrated high prevalence and close relationships of depression, anxiety, and sleep disturbance in patients with shoulder pain for 3 months or longer. These results may indicate importance of the psychologic approach as well as adequate pain control.
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Affiliation(s)
- Chul-Hyun Cho
- Pain Research Center, Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, South Korea
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Dietz I, Schmitz A, Lampey I, Schulz C. Evidence for the use of Levomepromazine for symptom control in the palliative care setting: a systematic review. BMC Palliat Care 2013; 12:2. [PMID: 23331515 PMCID: PMC3602665 DOI: 10.1186/1472-684x-12-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 01/15/2013] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Levomepromazine is an antipsychotic drug that is used clinically for a variety of distressing symptoms in palliative and end-of-life care. We undertook a systematic review based on the question "What is the published evidence for the use of levomepromazine in palliative symptom control?". METHODS To determine the level of evidence for the use of levomepromazine in palliative symptom control, and to discover gaps in evidence, relevant studies were identified using a detailed, multi-step search strategy. Emerging data was then scrutinized using appropriate assessment tools, and the strength of evidence systematically graded in accordance with the Oxford Centre for Evidence-Based Medicine's 'levels of evidence' tool. The electronic databases Medline, Embase, Cochrane, PsychInfo and Ovid Nursing, together with hand-searching and cross-referencing provided the full research platform on which the review is based. RESULTS 33 articles including 9 systematic reviews met the inclusion criteria: 15 on palliative sedation, 8 regarding nausea and three on delirium and restlessness, one on pain and six with other foci. The studies varied greatly in both design and sample size. Levels of evidence ranged from level 2b to level 5, with the majority being level 3 (non-randomized, non-consecutive or cohort studies n = 22), with the quality of reporting for the included studies being only low to medium. CONCLUSION Levomepromazine is widely used in palliative care as antipsychotic, anxiolytic, antiemetic and sedative drug. However, the supporting evidence is limited to open series and case reports. Thus prospective randomized trials are needed to support evidence-based guidelines.
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Affiliation(s)
- Isabel Dietz
- Clinic for Anaesthesiology HELIOS Clinic Wuppertal, University Witten/Herdecke, Witten, Germany
| | - Andrea Schmitz
- Interdisciplinary Center for Palliative Medicine, University Hospital Dusseldorf, Dusseldorf University, Dusseldorf, Germany
| | - Ingrid Lampey
- Interdisciplinary Center for Palliative Medicine, University Hospital Dusseldorf, Dusseldorf University, Dusseldorf, Germany
- NELCS Northeast London (NHS) Community Services, London, United Kingdom
| | - Christian Schulz
- Interdisciplinary Center for Palliative Medicine, University Hospital Dusseldorf, Dusseldorf University, Dusseldorf, Germany
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Hartz A, Ross JJ, Noyes R, Williams P. Somatic symptoms and psychological characteristics associated with insomnia in postmenopausal women. Sleep Med 2012; 14:71-8. [PMID: 23041035 DOI: 10.1016/j.sleep.2012.08.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 07/05/2012] [Accepted: 08/12/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of the study was to assess the association of sleep disturbance with psychological characteristics, somatic symptoms and previously identified risk factors. METHODS Data were from 148,938 postmenopausal women enrolled in The Women's Health Initiative who provided cross-sectional information about psychological characteristics, somatic symptoms and the character of their sleep. Overall sleep quality was based on the Women's Health Initiative Insomnia Rating Scale (WHI IRS), a measure that assessed five types of sleep disturbance. RESULTS Three factors accounted for nearly 20% of the variation in the WHI IRS: a scale for somatic symptoms, daytime restlessness and either depression or emotional well-being. Other independently associated factors were night sweats, pain and worry about expressing anger. Several factors that had been linked to sleep disturbance in other studies were found to have at most a weak independent association in this analysis. These included income, education, marital status, activity level, obesity level, hot flashes, coffee drinking and smoking. CONCLUSION Factors strongly associated with sleep disturbance in this study deserve further evaluation to determine the reasons for the association and whether the associations suggest possible treatments for sleep disturbance.
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Affiliation(s)
- Arthur Hartz
- Department of Medicine, University of Utah, Salt Lake City, UT 84112, USA.
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Siu YF, Chan S, Wong KM, Wong WS. The Comorbidity of Chronic Pain and Sleep Disturbances in a Community Adolescent Sample: Prevalence and Association with Sociodemographic and Psychosocial Factors. PAIN MEDICINE 2012; 13:1292-303. [DOI: 10.1111/j.1526-4637.2012.01473.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Wong WS, Fielding R. The co-morbidity of chronic pain, insomnia, and fatigue in the general adult population of Hong Kong: Prevalence and associated factors. J Psychosom Res 2012; 73:28-34. [PMID: 22691556 DOI: 10.1016/j.jpsychores.2012.04.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 04/24/2012] [Accepted: 04/24/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Although research suggests there is considerable overlap among chronic pain, fatigue, and sleep disturbances, no research to date has concurrently examined their interrelationships. This study estimates the co-occurrence of these three conditions in terms of prevalence and associated factors in the general adult population. METHODS In a population-based, cross-sectional telephone survey, 5001 adults aged ≥18 years drawn from the Hong Kong general population completed the Chronic Pain Grade (CPG) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Chronic Fatigue Scale (CFS), Hospital Anxiety and Depression Scale (HADS), and socio-demographic questions. RESULTS The overall prevalence of reporting all three chronic conditions was 5.6% (95% CI: 4.9-6.4) and increased with age, being higher in women, and those in lower income and education level groups. Individuals with multiple symptoms also reported poorer mental health, and self-perceived health. Results of multi-ordinal regression analyses identified female, divorced/separated, having part time employment, retirees, unemployment, housewives, existing long-term health problems, higher HADS scores, and low self-perceived health to be significantly associated with reporting all three symptoms. CONCLUSION This study has shown that the co-occurrence of chronic pain, fatigue, and sleep disturbances was common in the general adult population. Multiple symptoms are comorbid of psychological distress.
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Affiliation(s)
- Wing S Wong
- Department of Psychological Studies, The Hong Kong Institute of Education, 10 Lo Ping Road, Tai Po, Hong Kong.
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The differential effects of gratitude and sleep on psychological distress in patients with chronic pain. J Health Psychol 2012; 18:263-71. [DOI: 10.1177/1359105312439733] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to examine the possible cross-sectional mediating role of sleep in the relationship of gratitude with depression and anxiety in patients with chronic pain. A total of 224 patients with chronic pain completed structured questionnaires assessing chronic pain, depression and anxiety symptoms, gratitude, and sleep disturbances. Results of multiple regression analyses yielded a modest mediating effect for sleep on the gratitude–depression link whereas a stronger mediating effect was found for sleep on the gratitude–anxiety link. These data show much of the effect of gratitude on depression was direct whereas sleep exerted a stronger mediating effect on the gratitude–anxiety link.
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Wong WS, Chen PP, Yap J, Mak KH, Tam BKH, Fielding R. Chronic Pain and Psychiatric Morbidity: A Comparison between Patients Attending Specialist Orthopedics Clinic and Multidisciplinary Pain Clinic. PAIN MEDICINE 2011; 12:246-59. [DOI: 10.1111/j.1526-4637.2010.01044.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sandoval R, Runft B, Roddey T. Pilot Study: Does Lower Extremity Night Splinting Assist in the Management of Painful Peripheral Neuropathy in the HIV/AIDS Population? ACTA ACUST UNITED AC 2010; 9:368-81. [DOI: 10.1177/1545109710373828] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: The pain associated with peripheral neuropathy (PN) observed in patients living with HIV/AIDS represents a difficult complication to manage. Participants: A total of 22 participants with a diagnosis of PN were recruited to assess the effects of using night splints on pain and sleep quality. Methods: For 3 weeks, the participants were instructed to use bilateral night splints and given an exercise regimen for 3 additional weeks. Scores from pain and sleep questionnaires were analyzed using repeated measures analysis of variance (ANOVA). Results: The change in pain scores (F(1.16) = 13.41,η2 =.456, P = .002) and sleep index scores (z = -2.69, P = .004, 1-tailed) was found to be significant following the use of night splints. No difference was found with the use of the exercises. Discussion: The use of night splints in HIV-infected patients with PN represents an additional tool for managing pain and improving sleep.
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Affiliation(s)
- Roberto Sandoval
- Harris County Hospital District, Rehabilitation Services Department, Thomas Street Health Center, 2015 Thomas St, Houston, TX, USA,
| | - Britt Runft
- Harris County Hospital District, Rehabilitation Services Department, Thomas Street Health Center, 2015 Thomas St, Houston, TX, USA
| | - Toni Roddey
- Texas Woman's University, School of Physical Therapy, Houston, TX, USA
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Quartana PJ, Wickwire EM, Klick B, Grace E, Smith MT. Naturalistic changes in insomnia symptoms and pain in temporomandibular joint disorder: a cross-lagged panel analysis. Pain 2010; 149:325-331. [PMID: 20359824 DOI: 10.1016/j.pain.2010.02.029] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 01/04/2010] [Accepted: 02/17/2010] [Indexed: 01/20/2023]
Abstract
An increasing number of prospective studies suggest a bi-directional association between the pain and sleep quality. Few of these investigations have controlled for synchronous correlations, an important source of extraneous variance in lagged associations, which may have confounded conclusions of prior investigations. Despite high rates of insomnia in temporomandibular joint disorders (TMD), no studies have examined temporal associations between naturalistic fluctuations in insomnia and pain in TMD. We conducted cross-lagged panel analysis to examine reciprocal temporal associations between 1-month changes in insomnia symptom severity and self-reported pain over 3 months among 53 TMD patients. This rigorous analytic strategy represents a comprehensive method to explore possible reciprocal temporal associations between insomnia and pain that controls for both auto- and synchronous correlations. Analyses revealed that initial-month increases in insomnia were associated with next-month increases in average daily pain, but not vice versa. The direction of the effect was such that initial-month increases in insomnia symptom severity were associated with next-month increases in average daily pain. These data suggest that naturally occurring fluctuations in insomnia symptom severity are prospectively associated with fluctuations in daily pain experience for persons with TMD. Potential mechanisms by which insomnia might influence pain in TMD and therapeutic implications of these findings are discussed.
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Affiliation(s)
- Phillip J Quartana
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences Medicine, MD, USA University of Maryland Dental School, Department of Neural and Pain Sciences, MD, USA
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Collen M. The Case for Pain Insomnia Depression Syndrome (PIDS): A Symptom Cluster in Chronic Nonmalignant Pain. J Pain Palliat Care Pharmacother 2009; 22:221-5. [DOI: 10.1080/15360280802251231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Sleep disorders are common and may result in significant morbidity. Examples of the major sleep disturbances in primary care practice include insomnia; sleep-disordered breathing, such as obstructive sleep apnea; central nervous system hypersomnias, including narcolepsy; circadian rhythm sleep disturbances; parasomnias, such as REM sleep behavior disorder; and sleep-related movement disorders, including restless legs syndrome. Diagnosis is based on meticulous inventory of the clinical history and careful physical examination. In some cases referral to a sleep laboratory for further evaluation with polysomnography, a sleep study, is indicated.
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Affiliation(s)
- Lori A Panossian
- UCLA Department of Neurology, UCLA Medical Center, Los Angeles, CA 90095-1767, USA
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Turk DC, Cohen MJM. Sleep as a marker in the effective management of chronic osteoarthritis pain with opioid analgesics. Semin Arthritis Rheum 2009; 39:477-90. [PMID: 19136144 DOI: 10.1016/j.semarthrit.2008.10.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 09/04/2008] [Accepted: 10/01/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Sleep disturbances frequently accompany chronic pain from osteoarthritis (OA), and their effective management may reflect successful treatment of chronic pain. The objective of this article is to provide a rationale for using improvement in sleep as a marker for effective management of chronic OA pain with opioid analgesics. For this purpose, available evidence evaluating the relationship between successful management of chronic pain with opioids and improvements in sleep in patients with OA is reviewed. METHODS We conducted a comprehensive PubMed search to identify studies that systematically measured the impact of opioid treatment on pain and sleep parameters in the context of chronic pain from OA. Our search criteria included publication in a recognized peer-reviewed journal, randomized placebo-controlled design, and assessment of both pain intensity and sleep as outcomes. RESULTS In each of the 10 placebo-controlled studies identified, concurrent improvements in pain intensity and measured sleep disturbances were observed in patients receiving the long-acting opioid analgesics under study. Improved overall sleep quality, reduced awakenings from pain, and increased duration of sleep were among the favorable changes observed in patients with OA treated with long-acting opioids. CONCLUSIONS Current evidence suggests that various long-acting opioid analgesics simultaneously achieve pain control and improve sleep. However, the complex interaction between reduced pain and improved sleep requires further study.
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Affiliation(s)
- Dennis C Turk
- John and Emma Bonica Professor of Anesthesiology and Pain Research, Department of Anesthesiology, University of Washington, Seattle, Washington 98195, USA.
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Bardwell WA, Profant J, Casden DR, Dimsdale JE, Ancoli-Israel S, Natarajan L, Rock CL, Pierce JP. The relative importance of specific risk factors for insomnia in women treated for early-stage breast cancer. Psychooncology 2008; 17:9-18. [PMID: 17428006 PMCID: PMC2575103 DOI: 10.1002/pon.1192] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Many individual risk factors for insomnia have been identified for women with a history of breast cancer. We assessed the relative importance of a wide range of risk factors for insomnia in this population. METHODS Two thousand six hundred and forty-five women < or =4 years post-treatment for Stage I (> or =1 cm)-IIIA breast cancer provided data on cancer-related variables, personal characteristics, health behaviors, physical health/symptoms, psychosocial variables, and the Women's Health Initiative-Insomnia Rating Scale (WHI-IRS; scores > or =9 indicate clinically significant insomnia). RESULTS Thirty-nine per cent had elevated WHI-IRS scores. In binary logistic regression, the variance in high/low insomnia group status accounted for by each risk factor category was: cancer-specific variables, 0.4% (n.s.); personal characteristics, 0.9% (n.s.); health behaviors, 0.6% (n.s.); physical health/symptoms, 13.4% (p<0.001); and, psychosocial factors, 11.4% (p<0.001). Insomnia was associated with worse depressive (OR = 1.32) and vasomotor symptoms (particularly night sweats) (OR = 1.57). CONCLUSION Various cancer-specific, demographic, health behavior, physical health, and psychosocial factors have been previously reported as risk factors for insomnia in breast cancer. In our study (which was powered for simultaneous examination of a variety of variables), cancer-specific, health behavior, and other patient variables were not significant risk factors when in the presence of physical health and psychosocial variables. Only worse depressive and vasomotor symptoms were meaningful predictors.
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Affiliation(s)
- Wayne A Bardwell
- Rebecca & John Moores Cancer Center, University of California, San Diego, CA 92093, USA.
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Abstract
Chronic pain represents one of the most important public health problems and, in addition to classical analgesics, antidepressants are an essential part of the therapeutic strategy. This article reviews available evidence on the efficacy and safety of antidepressants in major chronic pain conditions; namely, neuropathic pain, headaches, low back pain, fibromyalgia, irritable bowel syndrome (IBS) and cancer pain. Studies, reviews and meta-analyses published from 1991 to March 2008 were retrieved through MEDLINE, PsycINFO and the Cochrane database using numerous key words for pain and antidepressants. In summary, evidence supports the use of tricyclic antidepressants in neuropathic pain, headaches, low back pain, fibromyalgia and IBS. The efficacy of the newer serotonin and norepinephrine reuptake inhibitors is less supported by evidence, but can be recommended in neuropathic pain, migraines and fibromyalgia. To date, evidence does not support an analgesic effect of serotonin reuptake inhibitors, but beneficial effects on well-being were reported in several chronic pain conditions. These results are discussed in the light of current insights in the neurobiology of pain, the reciprocal relationship between pain and depression, and future developments in this field of research.
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Affiliation(s)
- Bénédicte Verdu
- Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
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Altersinsomnie. SOMNOLOGIE 2007. [DOI: 10.1007/s11818-007-0306-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Palesh OG, Collie K, Batiuchok D, Tilston J, Koopman C, Perlis ML, Butler LD, Carlson R, Spiegel D. A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer. Biol Psychol 2006; 75:37-44. [PMID: 17166646 PMCID: PMC1894689 DOI: 10.1016/j.biopsycho.2006.11.002] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Revised: 10/21/2006] [Accepted: 11/13/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Sleep disturbances are common among women with breast cancer and can have serious consequences. The present study examined depression, pain, life stress, and participation in group therapy in relation to sleep disturbances in a sample of women with metastatic breast cancer. METHODS Ninety-three women with metastatic breast cancer participated in a large intervention trial examining the effect of the group therapy on their symptoms. They completed measures of depression, pain, life stress, and sleep disturbance at baseline, 4, 8 and 12 months. RESULTS The results showed that higher initial levels of depression at baseline predicted problems associated with getting up in the morning, waking up during the night, and daytime sleepiness. Increases in depression over the course of 12 months were associated with fewer hours of sleep, more problems with waking up during the night and more daytime sleepiness. Higher levels of pain at baseline predicted more problems getting to sleep. Increases in pain predicted more difficulty getting to sleep and more problems waking up during the night. Greater life stress at baseline predicted more problems getting to sleep and more daytime sleepiness. CONCLUSIONS Depression, pain, and life stress scores were each associated with different types of negative change in self-reported sleep disturbances. Depression, especially worsening depression, was associated with the greatest number of types of negative change. The relationships found between sleep disturbance and depression, pain, and life stress suggest specific ways to address the problem of sleep disturbance for women with metastatic breast cancer and show how different types of disturbed sleep may be clinical markers for depression, pain, or life stress in this population.
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Calhoun AH, Ford S, Finkel AG, Kahn KA, Mann JD. The prevalence and spectrum of sleep problems in women with transformed migraine. Headache 2006; 46:604-10. [PMID: 16643555 DOI: 10.1111/j.1526-4610.2006.00410.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES It is our clinical observation that patients with transformed migraine (TM) almost invariably report nonrestorative sleep. In this study we sought first to validate that clinical observation, then to describe the prevalence and spectrum of factors that might contribute to nonrestorative sleep in a TM population. BACKGROUND Although headaches have been linked with sleep problems for over a century, there is little information about the spectrum or prevalence of specific sleep problems associated with TM in adults. METHODS We conducted a detailed sleep interview on 147 consecutive women with TM. Subjective sleep quality was assessed by asking patients to describe their state upon awakening as "refreshed" or "tired." RESULTS None of the 147 patients reported awakening "refreshed," and 83.7% stated that they awakened "tired." Sleep complaints were prevalent and varied in this population. CONCLUSIONS Although the relationship between pain and sleep is complex and ill understood, we found a very high prevalence of nonrestorative sleep and a similarly high prevalence of modifiable poor sleep habits in patients with TM. Since behavioral approaches have been found effective in improving sleep quality in patients with poor sleep hygiene, we propose that studies be undertaken to assess the impact of such treatment on TM.
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Affiliation(s)
- Anne H Calhoun
- Neurology, University of North Carolina, Chapel Hill, 27599-7025, USA
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Sullivan MD, Robinson JP. Antidepressant and anticonvulsant medication for chronic pain. Phys Med Rehabil Clin N Am 2006; 17:381-400, vi-vii. [PMID: 16616273 DOI: 10.1016/j.pmr.2005.12.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Antidepressants and anticonvulsants have been shown to be efficacious in the treatment of neuropathic pain, chronic headache, and other chronic pain conditions. They may be useful in the treatment of disorders in which central nervous system hypersensitivity con-tributes to pain. They provide valuable alternatives or adjuncts to the use of opioid medications in the treatment of chronic pain. Antidepressants have several potential roles in the treatment of chronic pain in addition to their analgesic effects. Specifically, they effectively address the sleep disturbance, depression, and anxiety that are common in patients with chronic pain.
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Affiliation(s)
- Mark D Sullivan
- Department of Psychiatry, University of Washington, 1959 Pacific Street, Box 356560, Seattle, WA 98195, USA.
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&NA;. Ramelteon: profile report. DRUGS & THERAPY PERSPECTIVES 2006. [DOI: 10.2165/00042310-200622030-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abstract
Ramelteon, approved in the US for the treatment of insomnia characterised by difficulty with sleep onset, is a highly selective agonist for the melatonin MT1/MT2 receptors, which are believed to mediate the circadian rhythm in mammals. Ramelteon has negligible affinity for the MT3 binding sites and other receptors in the brain, including the opiate, dopamine, benzodiazepine and serotonin receptors, which may explain the lack of significant adverse events and lack of abuse or dependence potential observed with ramelteon. In three clinical trials in patients with chronic insomnia, ramelteon 8mg was effective in reducing sleep latency, without being associated with any significant or clinically relevant residual effects. It also generally increased total sleep time and, where assessed, sleep efficiency. In a first-night-effect model of transient insomnia, ramelteon 8mg was significantly more effective than placebo at reducing sleep latency and increasing total sleep time. Ramelteon was generally well tolerated; the most commonly reported adverse events occurring in more ramelteon than placebo recipients were somnolence (5% vs 3%), fatigue (4% vs 2%) and dizziness (5% vs 3%). Adverse events were mostly mild or moderate in nature. Ramelteon has been shown to have no potential for abuse or dependence.
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Parker KP, Kimble LP, Dunbar SB, Clark PC. Symptom interactions as mechanisms underlying symptom pairs and clusters. J Nurs Scholarsh 2005; 37:209-15. [PMID: 16235860 DOI: 10.1111/j.1547-5069.2005.00037.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To present a summary of the potential shared or interactive mechanisms underlying an exemplar symptom pair: sleep disturbances and pain. ORGANIZING CONSTRUCT Understanding of the multidimensional shared and interactive mechanisms underlying symptoms pairs and clusters has the potential to enhance symptom management. METHODS Reviews of the literature were conducted to search for information on shared or interactive mechanisms underlying sleep disturbances and pain; minimal data were available. Relevant information about individual symptoms was outlined and categorized in areas often used to describe the multidimensional nature of symptoms, including the physiological, psychological, behavioral, and sociocultural domains. This information was examined for relationships and commonalities. CONCLUSIONS Many potential shared and interactive mechanisms underlying the symptom pair of sleep disturbances and pain were identified. These results indicate the need for further work and theory development in this area. The symptom interactional framework is a beginning conceptual perspective designed to facilitate this work. Implications for interdisciplinary translational research designed to optimize symptom management are discussed.
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Affiliation(s)
- Kathy P Parker
- Center for Research on Symptoms, Symptom Interactions, and Health Outcomes, USA.
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