Insomnia with Musculoskeletal Pain in Postmenopause: Associations with Symptoms, Mood, and Quality of Life

Features, measurements, determinants, treatments, and outcomes of musculoskeletal symptoms in postmenopausal women: A scoping review

BACKGROUND

The literature lacks a consistent review of musculoskeletal symptoms in postmenopausal women.

AIM

To identify features, measurements, determinants, treatments, and outcomes of musculoskeletal symptoms in postmenopausal women.

METHOD

A scoping review was completed using six databases: Embase, Medline, Cochrane, CINAHL, Web of Science, and Scopus up to December 2022. Sixty-three articles were identified.

RESULTS

Musculoskeletal symptoms in postmenopausal women include somatic symptoms of non-specific origin, upper and lower limb symptoms, spinal pain, and decline in physical performance. Measurements were categorized into four groups: musculoskeletal symptoms for menopause, general musculoskeletal symptoms, menopause-specific quality of life, and general quality of life questionnaires. The determinants were grouped into four themes: demographics, physical determinants, psychosocial determinants, and lifestyle. Pharmacological interventions, supplementation options, and exercise regimens exist for postmenopausal women with musculoskeletal symptoms.

CONCLUSION

A comprehensive policy is needed to address musculoskeletal symptoms in postmenopausal women, promoting diverse treatments for improved quality of life.

The prevalence of depression and its association with sociodemographic factors in menopausal women in South Korea

This study examined factors that may be associated with depression among middle-aged women in South Korea using data from the 2018 (7th) wave of the Korean Longitudinal Survey of Women and Families. A sample of 6,399 women aged 35-64 years was included. Multivariate logistic regression was performed to identify factors associated with depressive symptoms, as measured by the CES-D-10 scale (Center for Epidemiological Studies Depression), in pre- and post-menopausal women. Results indicated that being single, having poorer self-rated health, and having a lower economic background were associated with an increased risk of depression in both groups. Being unemployed also increased the risk of depressed mood in pre-menopausal women, while factors significantly associated with an increased risk of depressive symptoms in post-menopausal women included having a lower level of education, musculoskeletal pain, and having pain or discomfort. Thus, these factors should be considered when developing interventions to improve the mood and quality of life of middle-aged women. Interventions in the local community may include health services (hormone therapy), educational learning programs, counselling, and improved access to leisure activities.

Association between night pain and quality of life in women: A general population sleep study

BACKGROUND

Women with pain present decreased sleep duration and quality of life, but little is known about the consequences of nighttime pain on overall health. Our goal was to compare levels of anxiety, depression and fatigue in women with pain during the night with those without pain. We hypothesized that pain perception is associated with the worsening of fatigue and mood.

METHODS

In total, 244 women aged 20-80 years who took part in the Epidemiologic Sleep Study (EPISONO) met the inclusion criteria, 85 in the self-reported pain group and 171 in the control group. Participants were assigned to the pain group if they both responded (i) they generally had pain, according to Pre-Sleep Questionnaire (PSQ) and (ii) their pain generally interfered with their sleep 3 or more times a week, according to Pittsburg Sleep Quality Index (PSQI). Those who answered negatively to both questions were allocated to the control group. All participants underwent a full night laboratory polysomnography, and completed questionnaires related to fatigue, depression, anxiety and quality of life.

RESULTS

Pain group participants had a significantly lower perception of quality of life, and significantly higher levels of fatigue (5.4 times), anxiety and depression. Pain perception was also correlated to levels of anxiety and depression in the psychological (r_s  = -0.463, -0.607, respectively) and social (r_s  = -0.423, -0.438, respectively) quality of life domains.

CONCLUSIONS

Nighttime pain in women was associated with decreased quality of life, worsening mood and fatigue. Our data shows the importance of investigating pain and its deleterious effects on women's health.

SIGNIFICANCE

Our study highlights that women experiencing nighttime pain also reported worse mood outcomes and decreased quality of life, regardless of the level and type of pain. Our data, based on association analysis and not investigating causality, suggest it is important to consider nighttime pain in clinical care to improve quality of life and general health.

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

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).

Efficacy of Internet-based cognitive behavioral therapy on sleeping difficulties in menopausal women: A randomized controlled trial

Sleeping difficulties are the most significant cause of disability in menopausal women. Cognitive behavioral therapy (CBT) is the first line of management for sleeping difficulties and chronic insomnia.

PURPOSE

To evaluate the efficacy of an Internet-based CBT program on sleeping difficulties in menopausal women.

DESIGN

This was a randomized controlled trial. A total of 80 eligible menopausal women who fit the criteria of poor sleep quality were randomly and evenly assigned to the CBT intervention group or the control group.

TOOLS

The tools used for data collection were the demographic sheet, Pittsburgh Sleep Quality Index, Insomnia Severity Index, and sleep diary. Internet-based CBT modules were administered to the intervention group. Six consecutive modules were held weekly for each participant. Sleep quality scores and insomnia index scores were considered the primary outcomes, while sleep diaries were the secondary outcomes. Self-administered questionnaires were given at baseline and 6 weeks after randomization.

FINDINGS

Internet-based CBT is effective in reducing sleeping difficulties, particularly sleep quality scores (-3.60 ± 2.76) and insomnia index scores (-5.10 ± 3.54) from baseline. Moreover, the program induced significant changes in sleep parameters, such as increased total sleep hours (t = 2.734, p = 0.008), increased sleep efficiency ≥85%, (t = 3.558, p = 0.001), and decreased sleep latency (t = 2.180, p = 0.033) compared with the control group.

CONCLUSION

The strong predictors of having very poor sleep quality were short duration since last menopause, severity of hot flashes, and short duration of sleep difficulties.

PRACTICE IMPLICATION

Internet-based CBT is a useful practical intervention for managing sleeping difficulties in menopausal women. The current study provides evidence on the efficacy and cost-effectiveness of Internet-based cognitive behavioral intervention; thus, we recommend this method as a practical and accessible intervention to improve sleep in menopausal women.

Health Promoting Lifestyle Behaviors and Sleep Quality Among Saudi Postmenopausal Women

Background

One of the most effective measures regarding improving women's health is to promote healthy lifestyle behaviors. This study aimed to investigate the relationship between health-promoting behaviors and sleep quality among a sample of Saudi menopausal women.

Methods

A descriptive cross-sectional study was used to collect data from 410 Saudi postmenopausal women visiting primary healthcare care centers located in Sakaka, Jouf, Saudi Arabia, using the Menopause Rating Scale (MRS), Health-Promoting Lifestyle Profile II (HPLPII) and Pittsburgh Sleep Quality Index (PSQI).

Results

The mean age of the study participants was 52.60 ± 4.65 years, the study findings highlighted that among all the HPLP domains, the highest mean score was observed for spiritual growth (24.00 ± 6.60) whereas the lowest score was observed for physical activity (16.18 ± 1.8). Statistically significant negative relations between the total score of HPLP and sleep quality score and menopausal symptoms (p &lt; 0.001, p &lt; 0.005), respectively. Total scores of lifestyle, health responsibility, and stress management were significant differences between participants with good and poor sleep quality. Being overweight/obese, physically inactive, having a chronic illness and poor sleep quality were predictors influencing health-promoting behavior.

Conclusion

Health-Promoting Lifestyle Profile II was more obvious in the good sleeper in form of health responsibility and stress management. Being overweight and or obese, having a chronic illness, and having poor sleep quality were the significant factors influencing health-promoting behaviors. Designing and performing educational interventional plans are crucial to create motivation toward a healthy lifestyle and improve the quality of their sleep.

Sleep quality and its association with menopausal and climacteric symptoms

OBJECTIVE

to assess sleep quality in menopausal women and its association with symptoms related to this period.

METHOD

this is a cross-sectional, analytical and correlational study. Sleep was assessed using the Pittsburgh Sleep Quality Index; and climacteric symptoms, according to the Menopause Rating Scale. To compare the total score and each Menopause Rating Scale domain with the PSQI classification, the Mann-Whitney U non-parametric test was used. P<0.05 was considered significant.

RESULTS

261 women (67.8%) were classified as bad sleepers. There was a positive and significant correlation between the sleep scale scores and the total menopause score and its domains. Women categorized as poor sleepers had worse scores on the menopause symptom scale.

CONCLUSION

women with worse sleep quality revealed greater severity of symptoms related to menopause.

Musculoskeletal Pain during the Menopausal Transition: A Systematic Review and Meta-Analysis

Musculoskeletal pain (MSP) is one of the most severe complaints in women undergoing menopause. The prevalence of MSP varied when taking the menopausal state and age factor into consideration. This study investigated the prevalence of MSP in perimenopausal women and its association with menopausal state. The MEDLINE, Embase, Web of Science, and PubMed databases were searched from inception to July 2020, and 16 studies were retrieved for the current meta-analysis. The primary outcome measure was the MSP Odds Ratio (OR). The estimated overall prevalence of MSP among perimenopausal women was 71% (4144 out of 5836, 95% confidence interval (CI): 64%-78%). Perimenopausal women demonstrated a higher risk for MSP than premenopausal ones (OR: 1.63, 95% CI: 1.35-1.96, P = 0.008, I² = 59.7%), but similar to that in postmenopausal ones (OR: 1.07, 95% CI: 0.95–1.20, P = 0.316, I² = 13.4%). The postmenopausal women were at a higher risk of moderate/severe MSP than the premenopausal ones (OR: 1.45, 95% CI: 1.21-1.75, P = 0.302, I² = 16.5%) or the perimenopausal ones (OR: 1.40, 95% CI: 1.09–1.79, P = 0.106, I² = 55.4%). In conclusion, the perimenopause is a state during which women are particularly predisposed to develop MSP. As to moderate to severe degrees of MSP, the odds increase linearly with age, from premenopause to peri- and then to postmenopause.

How nurse leaders can support staff going through the menopause

The menopause is a normal biological stage in a woman's life that is often accompanied by physical and psychological symptoms, such as hot flushes and low mood. Symptoms vary widely between women, and can be unpleasant, burdensome and distressing. Many women going through the menopause remain in employment and some will experience symptoms that adversely affect them in their working lives. Menopausal symptoms can also be exacerbated by work and working conditions. This article describes the common symptoms of the menopause and how they may affect women at work, including nurses, as well as discussing what nurse leaders, employers and managers can do to support staff and enable them to continue to work comfortably and productively.

Temporal Analysis of Chronic Musculoskeletal Pain and Sleep in Postmenopausal Women

STUDY OBJECTIVES

To investigate the temporal association between chronic musculoskeletal pain (CMP) and sleep in women who are postmenopausal in a 10-day actigraphic study. This is a microlongitudinal study in which 52 participants were allocated to 4 groups women who are postmenopausal: control (CTRL, n = 10), chronic musculoskeletal pain (CMP, n = 12), insomnia (INS, n = 15) and chronic musculoskeletal pain+insomnia (CMP+INS, n = 15).

METHODS

All volunteers underwent a clinical interview and completed questionnaires, used an actigraph, and kept sleep diaries for 10 consecutive days.

RESULTS

Women in the CMP+INS group presented more sleep episodes (mean of 1.02 episodes) and longer sleep latency (8.97 minutes), as well as higher pain intensity during the day compared to the other groups. Sleep duration recorded by actigraphy directly predicted pain intensity the following morning on waking, with a 1-unit increase in pain intensity, for every 6.9 minutes more of sleep. Higher pain intensity at bedtime was a significant predictor of both increased time in bed and sleep duration, meaning that for each 1-unit increase in pain intensity at bedtime, sleep duration increased by an average of 6.7 minutes.

CONCLUSIONS

Data showed that the coexistence of insomnia and CMP results in greater pain intensity and alterations in sleep homeostasis. Collectively, the data indicate that there is a bidirectional and directly proportional relationship between sleep duration and pain intensity in women who are postmenopausal with insomnia. This result strongly suggests that both sleep and pain conditions should be targeted in the treatment of women who are postmenopausal.