Relationship between chronic painful condition and insomnia
Stanford Sleep Epidemiology Research Center, School of Medicine, Stanford University, 3430 W. Bayshore Road, Suite 102, Palo Alto, Stanford, CA 94303, USA. Journal of Psychiatric Research
(Impact Factor: 3.96).
04/2005; 39(2):151-9. DOI: 10.1016/j.jpsychires.2004.07.001
A chronic painful physical condition (CPPC) can be a major cause of sleep disturbances. Few community-based surveys examined the specific relationship between these two conditions.
Eighteen thousand, nine hundred and eighty participants aged 15 years or older from five European countries (the United Kingdom, Germany, Italy, Portugal and Spain) and representative of approximately 206 millions Europeans were interviewed by telephone. The interview included questions about sleeping habits, health, sleep and mental disorders. Painful physical conditions were ascertained through questions about medical treatment, consultations and/or hospitalizations for medical reasons and a list of 42 diseases. A painful physical condition was considered chronic when it lasted at least six months. Insomnia symptoms were defined as difficulty initiating or maintaining sleep or non-restorative sleep, present at least three nights per week, lasting at least one month, and accompanied by daytime consequences.
(1) The point prevalence of at least one CPPC was set at 17.1% (95% CI: 16.5-17.6%) in the sample. (2) Difficulty initiating sleep was found in 5.1% (95% CI: 4.8-5.4%) of the sample, disrupted sleep in 7.5% (95% CI: 7.2-7.9%); early morning awakenings in 4.8% (95% CI: 7.2-7.9%) and non-restorative sleep in 4.5% (95% CI: 4.2-4.8%). (3) More than 40% of individuals with insomnia symptoms reported at least one CPPC. (4) CPPC was associated with more frequent difficulty or inability to resume sleep once awake and a shorter sleep duration. (5) In middle-aged subjects (45-64 years of age), CPPC was associated with longer insomnia duration. At any age, insomnia with CPPC was associated with a greater number of daytime consequences (average of four consequences) than in insomnia without CPPC (average of 2.3 consequences). (6) In multivariate models, CPPC, especially backaches and joint/articular diseases, were at least as importantly associated with insomnia than were mood disorders with odds ratios ranging from 4.1 to 5.0 for backaches and from 3.0 to 4.8 for joint/articular diseases.
CPPC is associated with a worsening of insomnia on several aspects: a greater number of insomnia symptoms, more severe daytime consequences and more chronic insomnia situation. CPPC plays a major role on insomnia. Its place as major contributive factor for insomnia is as much important as mood disorders.
Available from: bmcfampract.biomedcentral.com
- "Our analysis on three pain sites showed differential associations, i.e. sleep disorders with lower back pain, restrictions of daily activities with knee pain, and insufficient exercise with hip or lower back pain. Sleep disorders occurred in combination with backache , limb pain and headaches in a large European adult population survey. In an older population survey in Boston the only single pain sites independently related to sleep disorders were the hand and the shoulder. "
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ABSTRACT: Background To investigate what a geriatric assessment in general practice adds towards previous findings of prevalence, location, impact and the dyadic doctor-patient perception of pain in this age group. Methods Cross-sectional study. Consecutive patients aged 70 and over underwent a comprehensive geriatric assessment in general practice that included a basic pain assessment (severity, sites and impact). Patients with pain and their doctors then independently rated its importance. Pain was correlated with further findings from the assessment, such as overall health, physical impairments, everyday function, falls, mood, health related lifestyle, social circumstances, using bivariate and multivariate statistics. Patient-doctor agreement on the importance of pain was calculated using kappa statistics. Results 219 out of 297 patients (73.7 %) reported pain at any location. Pain was generally located at multiple sites. It was most often present at the knee (33.9 %), the lumbar spine (33.5 %) as well as the hip (13.8 %) and correlated with specific impairments such as restrictions of daily living (knee) or sleep problems (spine). Patients with pain and their physicians poorly agreed on the importance of the pain problem. Conclusions A basic pain assessment can identify older patients with pain in general practice. It has resulted in a high prevalence exceeding that determined by encounters in consultations. It has been shown that a geriatric assessment provides an opportunity to address pain in a way that is adapted to older patients’ needs – addressing all sites, its specific impact on life, and the patients’ perceived importance of pain. Since there is little doctor-patient agreement, this seems a valuable strategy to optimize concrete treatment decisions and patient centered care. Trial registration This study is registered in the German Clinical Trial Register (DRKS00000792)
- "For example, 50–88% of patients with chronic pain also suffer from sleep disorders   . Alternatively, > 40% of patients with insomnia also report chronic pain . Several pharmaceutical studies, including studies on eszopiclone , triazolam , or pregabalin , showed a simultaneous improvement of both sleep and pain. "
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There is strong evidence indicating an interaction between sleep and pain. However, the size of this effect, as well as the clinical relevance, is unclear. Therefore, this meta-analysis was conducted to quantify the effect of sleep deprivation on pain perception.
A systematic literature search was conducted using the electronic databases PubMed, Cochrane, Psyndex, Psycinfo, and Scopus. By conducting a random-effect model, the pooled standardized mean differences (SMDs) of sleep deprivation on pain perception was calculated. Studies that investigated any kind of sleep deprivation in conjunction with a pain measurement were included. In cases of several pain measurements within a study, the average effect size of all measures was calculated.
Five eligible studies (N = 190) for the between-group analysis and ten studies (N = 266) for the within-group analysis were identified. Sleep deprivation showed a medium effect in the between-group analysis (SMD = 0.62; CI95: 0.12, 1.12; z = 2.43; p = 0.015) and a large effect in the within-group analysis (SMD = 1.49; CI95: 0.82, 2.17; z = 4.35; p <0.0001). The test for heterogeneity was not significant in the between-group analysis (Q = 5.29; df = 4; p = 0.2584), but it was significant in the within-group analysis (Q = 53.49; df = 9; p <0.0001).
This meta-analysis confirms a medium effect (SMD = 0.62) of sleep deprivation on pain perception. As this meta-analysis is based on experimental studies in healthy subjects, the clinical relevance should be clarified.
Available from: Gilles J Lavigne
- "Pain may be associated with sleep instability, disruption of non-rapid eye movement (REM) to REM sleep cycles continuity and excessive sleep fragmentation , which may in turn increase the perception of unrefreshing or nonrestorative sleep (NRS). Non-restorative sleep refers to the subjective experience of sleep as insufficiently refreshing or to the feeling that sleep is restless , light or of poor quality, even though traditionally assessed objective sleep parameters (eg, total duration, sleep stage distribution ) appear to be normal  . Different etiologies for NRS and insomnia symptoms, such as difficulty initiating or maintaining sleep, are discussed in the literature . "
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ABSTRACT: Patients with temporomandibular disorders (TMD) and/or orofacial pain (OFP) frequently experience poor sleep quality or suffer from comorbid sleep disorders. Study results suggest that in chronic pain patients, an improvement in sleep quality critically influences the outcomes of interventions on mood and pain. Yet, only a few studies have systematically sought to evaluate the sleep quality of TMD/OFP patients. Standardized and validated self-reported instruments designed for screening sleep disturbances or for the evaluation of treatment outcomes in this population would therefore enhance evidence and improve treatment options. The objectives of the present study were: (1) to review the self-reported instruments that measure sleep dysfunction in studies on TMD/OFP patients, by conducting a systematic literature search; (2) to evaluate their clinimetric evidence; and (3) to provide guidance for future research using such instruments. A total of 26 papers, using eight different instruments, were identified. The most frequently used questionnaires and the only ones with good clinimetric properties were the Insomnia Severity Index followed by the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. They were most reliable, valid and time-effective for measuring sleep dysfunctions in patients with TMD/OFP, with only a few practical constraints. Yet, in future studies, an assessment of the relationship between sleep disturbances and chronic pain will have to include instruments measuring the effect of mediator variables such as cognitive or emotional arousal. Research is required to clarify if existing self-reported questionnaires measuring these aspects will promote further insights or if there is a need for new instruments. This future research direction would blend into the overall biopsychosocial concept of TMD/OFP diagnoses and treatment.
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