There Are Not Enough Sheep

2021 ◽  
pp. 117-126
Author(s):  
Daniel M. Doleys ◽  
Nicholas D. Doleys
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Sleep Apnea ◽  
Sleep Disturbance ◽  
Pain Intensity ◽  
Sleep Disorders ◽  
Physical Factor ◽  
Pain Clinic ◽  
Poor Sleep ◽  
Potential Impact

It is difficult to overemphasize the potential impact of sleep and sleep disorders on chronic pain. Indeed, there are data indicating that sleep disturbance mat be a significant causal factor in the development and maintenance of chronic pain. One would think that daytime pain would predict degree of sleep. But, in fact, it is the opposite; sleep is better predictor of daytime pain intensity. The factor associated with poor sleep are many and varied. Ruling out sleep apnea should be a priority. The availability of in-home studies simplifies the assessment/screening, and may engender greater cooperation. Sleep apnea contributes to hypogonadism, which, in turn, impact a number of physical factor that influence mood, function, and pain. There is a number of approaches that can be implemented in the primary care and pain clinic setting to address the problem of sleep disorders in the patient with chronic pain.

scholarly journals The Association of Unreported Sleep Disturbances and Systemic Inflammation: Findings from the 2005-2008 NHANES

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Jeff A. Dennis ◽  
Ahmad Alazzeh ◽  
Ann Marie Kumfer ◽  
Rebecca McDonald-Thomas ◽  
Alan N. Peiris
Keyword(s):  
Sleep Apnea ◽  
Sleep Disturbance ◽  
Sleep Disorders ◽  
Sleep Disorder ◽  
Inflammatory Markers ◽  
Sleep Disturbances ◽  
Laboratory Data ◽  
Poor Sleep ◽  
Distribution Width ◽  
Inflammatory Status

Background/Objective. Sleep apnea is associated with elevated inflammatory markers. A subgroup of patients never report sleep disturbances to their physician. The inflammatory status of this subgroup is not known. The present study aims to evaluate two inflammatory markers, C-reactive protein (CRP) and red cell distribution width (RDW), in those with unreported sleep disturbances and compares these findings to those with and without reported sleep disorders. We also investigate the utility of RDW as an inflammatory marker in sleep disorders. Methods. Sample includes 9,901 noninstitutionalized, civilian, nonpregnant adults from the 2005-2008 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional U.S. study. Sleep questionnaire and laboratory data were used to compare inflammatory markers (CRP and RDW) in five subgroups of individuals: reporting physician-diagnosed sleep apnea, reporting another physician-diagnosed sleep disorder, reported sleep disturbance to physician with no resulting diagnosis, unreported sleep disturbance (poor sleep quality not reported to physician), and no diagnosed sleep disorder or sleep disturbance. Results. Individuals with unreported sleep disturbance had significantly higher odds of elevated RDW (>13.6%) when compared to those without a sleep disturbance in adjusted models (OR=1.33). Those with unreported sleep disturbance had significantly higher odds of elevated CRP levels (>1 mg/L) than those without sleep disturbances (OR 1.34), although the association was not significant when adjusted for obesity and other controls. Conclusion. Self-identified unreported sleep disturbances are associated with significantly higher odds of elevated RDW than those without sleep disturbances. RDW may serve as a valuable indicator in identifying individuals at higher risk for sleep apnea and other sleep disorders.

scholarly journals 0827 The Association Among Diagnosed and Suspected Sleep Disorders and Pain

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A315-A315
Author(s):  
S Ravyts ◽  
J Dzierzewski
Keyword(s):  
Sleep Apnea ◽  
Pain Intensity ◽  
Sleep Disorders ◽  
Sleep Disorder ◽  
Severity Index ◽  
Future Research ◽  
Poor Sleep ◽  
Pain Scores ◽  
Pain Outcomes ◽  
Average Pain

Abstract Introduction Poor sleep has increasingly been linked to adverse pain outcomes. Yet, the complex interplay between sleep apnea, insomnia, or comorbid sleep apnea and insomnia (COMISA), and pain are less well understood. The purpose of the present study was twofold: 1) assess pain intensity in individuals with diagnoses of insomnia, sleep apnea, and COMISA, and 2) examine pain intensity in individuals who are at a high risk for having either sleep apnea, insomnia, or both sleep disorders. Methods Participants included 3401 adults (mean age= 42.77, male= 45.6%) who participated in an online study investigating sleep across the lifespan. Sleep apnea and insomnia diagnoses were self-reported while participant risk profiles for these disorders were assessed via the Insomnia Severity Index and the STOP-BANG questionnaire respectively. Average pain intensity over the last two weeks was rated from 0 (no pain) to 100 (very severe). Results Participants with self-reported comorbid sleep disorders reported higher pain scores than individuals with one or no sleep disorder (F(2,3398) = 71.61, p < .001). Among individuals with no previously diagnosed sleep disorder, participants with more insomnia symptoms reported greater pain intensity (F(3,3100) = 201.64, p < .001), as did those with higher scores on the STOP-BANG (F(2,3125) = 46.79, p < .001). Participants with suspected comorbid sleep disorders reported higher pain scores than individuals with either sleep apnea or no sleep disorder, but not insomnia (F(3,2887) = 110.15, p < .001). Conclusion Results suggest that individuals with known sleep disorders report high levels of pain particularly in the context of comorbid sleep apnea and insomnia. Additionally, individuals with suspected, but untreated, sleep disorders also report increased pain. Future research should examine whether treating one of more sleep disorders can improve pain outcomes. Support This work was supported by the National Institute on Aging (K23AG049955, PI: Dzierzewski).

scholarly journals Phase II double-blind randomised controlled trial of exogenous administration of melatonin in chronic pain (DREAM—CP): a study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e034443
Author(s):  
Rosalind Adam ◽  
Saravanakumar Kanakarajan ◽  
Uzunma Onyeakazi ◽  
Malachy Columb ◽  
Helen Galley
Keyword(s):  
Chronic Pain ◽  
Reaction Time ◽  
Sleep Disturbance ◽  
Pain Intensity ◽  
Treatment Period ◽  
Controlled Trial ◽  
Pain Clinic ◽  
Endogenous Opioid ◽  
Double Blind ◽  
Endogenous Opioid Peptide

IntroductionChronic pain is prevalent, and approximately half of patients with chronic pain experience sleep disturbance. Exogenous melatonin is licensed to treat primary insomnia and there is some evidence for analgesic effects of melatonin.The aim of this study is to investigate the effects of oral melatonin (as Circadin) 2 mg at night in adults with severe non-malignant pain of at least 3 months’ duration.Methods and analysisWe will conduct a randomised double-blind placebo-controlled cross-over study. The primary outcome is sleep disturbance. Secondary outcomes are pain intensity, actigraphy, fatigue, reaction time testing, serum melatonin and endogenous opioid peptide levels along with patient views about study participation.We aim to recruit 60 patients with severe chronic pain (average pain intensity ≥7 on the Brief Pain Inventory (BPI)) from a tertiary referral pain clinic in Northeast Scotland. Participants will be randomised to receive melatonin (as modified release Circadin) 2 mg daily for 6 weeks or placebo, followed by a 4-week washout period, then 6 weeks treatment with the treatment they did not receive. Participants will complete the Verran Snyder-Halpern Sleep Scale, Pittsburgh Sleep Quality Index, Pain and Sleep Questionnaire 3-item index, BPI and psychomotor vigilance reaction time testing at 6 points over 20 weeks. Actigraphy watches will be used to provide objective measures of sleep duration and latency and other sleep measures and will prompt patients to report contemporaneous pain and fatigue scores daily.Cross-over analyses will include tests for effects of treatment, period, treatment–period interaction (carryover effect) and sequence. Within-patient effects and longitudinal data will be analysed using mixed linear models, accounting for potential confounders.Ethics and disseminationApproved by Office for Research Ethics Committees Northern Ireland, reference 19/NI/0007. Results will be published in peer-reviewed journals and will be presented at national and international conferences.Trial registration numberISRCTN12861060

scholarly journals Chronic Pain and Sleep Disorders in Primary Care

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Robert Jank ◽  
Alexander Gallee ◽  
Markus Boeckle ◽  
Sabine Fiegl ◽  
Christoph Pieh
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Sleep Disorders ◽  
Medical Information ◽  
Severity Index ◽  
Total Sample ◽  
Self Report ◽  
Pain Experience ◽  
Assessment And Treatment ◽  
Insomnia Severity

Background. Chronic pain (CP) and sleep disorders (SD) are highly prevalent in the general population. However, comprehensive data regarding the prevalence and characteristics of pain and SD in primary care are rare. Methods. From N=578 patients N=570 were included within 8 weeks (mean age: 50.8±18.7 years, females: 289). Sociodemographic data, Insomnia Severity Index (ISI), and parts of a self-report questionnaire for pain (Multidimensional German Pain Questionnaire) were recorded and additional medical information (pain medication, sleep medication) was gathered from the patient charts. Results. Of the total sample, 33.2% (n=189) suffer from CP (pain ≥ 6 months) and 29.1% (n=166) from SD. 45.5% of the CP patients suffer from SD and 26.5% from clinical insomnia (ISI ≥ 15). SD (β = 0.872, SE = 0.191,  t = 4,572, p<0.001, CI [0.497; 1.246]) and older age (β = 0.025, SE = 0.005, t = 5.135, p<0.001, CI [0.015; 0.035]) were significantly associated with pain experience. Conclusion. About a quarter of CP patients suffer from clinical insomnia. The suggested bidirectional relation should be considered during comprehensive assessment and treatment of patients.

scholarly journals The Pain Frequency-Severity-Duration Scale as a Measure of Pain: Preliminary Validation in a Pediatric Chronic Pain Sample

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Katherine S. Salamon ◽  
W. Hobart Davies ◽  
Melissa R. Fuentes ◽  
Steven J. Weisman ◽  
Keri R. Hainsworth
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Pain Intensity ◽  
Functional Limitations ◽  
Pain Clinic ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Pain Frequency

Typically, pain is measured by intensity and sensory characteristics. Although intensity is one of the most common dimensions of pain assessment, it has been suggested that measuring pain intensity in isolation is only capturing part of the pain experience and may not lead to an accurate measurement of how pain impacts a child’s daily functioning. The current study aimed to develop a measure that would capture pain intensity along with frequency and duration in a clinical sample of youth diagnosed with chronic pain. The pain-frequency-severity-duration (PFSD) scale was developed and data were collected from a multidisciplinary pain clinic at a large, midwestern children’s hospital. Validated measures of functional limitations and health related quality of life were also collected. Significant correlations were found between the PFSD composite score, functional limitations, and health related quality of life. Future research should continue to evaluate this questionnaire utilizing other validated pain measures and other areas potentially impacted by chronic pain and with more diverse samples. This initial finding suggests that the PFSD is a convenient self-reported measure and is strongly related to health related quality of life and functional disability.

scholarly journals Associations Between Sleep Disturbance and Chronic Pain Intensity and Function

2019 ◽  
Vol 35 (7) ◽  
pp. 569-576 ◽  
Author(s):  
Helen J. Burgess ◽  
John W. Burns ◽  
Asokumar Buvanendran ◽  
Rajnish Gupta ◽  
Melissa Chont ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Sleep Disturbance ◽  
Pain Intensity ◽  
And Function

scholarly journals Disrupted Sleep Patterns and Daily Functioning in Patients with Chronic Pain

2002 ◽  
Vol 7 (2) ◽  
pp. 75-79 ◽  
Author(s):  
Lance M McCracken ◽  
Grant L Iverson
Keyword(s):  
Chronic Pain ◽  
Sleep Disturbance ◽  
Physical Symptoms ◽  
Pain Clinic ◽  
Daily Functioning ◽  
Hierarchical Regression ◽  
Pain Experience ◽  
Pain Disability ◽  
Disturbed Sleep

OBJECTIVE:To investigate the role of disturbed sleep in the daily functioning of persons with chronic pain.SUBJECTS AND METHODS:Participants comprised 287 patients seeking treatment for chronic pain at a university pain clinic. All patients completed the measures employed in the present study as part of a comprehensive initial evaluation.RESULTS:Descriptive analyses showed that 88.9% of patients reported as least one problem with disturbed sleep. Correlation analyses showed that greater sleep disturbance was associated with greater pain, disability, depression and physical symptoms, and less daily uptime. Hierarchical regression analyses showed that sleep disturbance predicted disability, daily uptime and physical symptoms independent of pain or depression.CONCLUSIONS:Sleep disruption is usually considered to be a consequence of the pain experience. However, the results of the present study reinforce the view that sleep disturbance may have a bidirectional relation with other features of chronic pain. Future studies should confirm that repairing disrupted sleep leads to an improvement in patients' daily activity and a reduction in their suffering.

scholarly journals Effects of Linear-Polarized Near-Infrared Light Irradiation on Chronic Pain

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Dong Huang ◽  
Yong-Hong Gu ◽  
Qin Liao ◽  
Xue-Bin Yan ◽  
Shai-Hong Zhu ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Near Infrared ◽  
Light Irradiation ◽  
Pain Clinic ◽  
Infrared Light ◽  
Controlled Study ◽  
Near Infrared Light ◽  
Group I ◽  
Significant Difference

In order to study the efficacy of linear-polarized near-infrared light irradiation (LPNIR) on relieving chronic pain in conjunction with nerve block (NB) or local block (LB), a 3-week prospective, randomized, double-blind, controlled study was conducted to evaluate the pre- and post-therapy pain intensity. Visual analogue scales (VASs) were measured in all patients before and 6 months after therapy visiting the pain clinic during the period of August 2007 to January 2008. A total of 52 patients with either shoulder periarthritis or myofascial pain syndrome or lateral epicondylitis were randomly assigned into two groups by drawing lots. Patients in Group I were treated with NB or LB plus LPNIR; Group II patients, for their part, were treated with the same procedures as in Group I, but not using LPNIR. In both groups, the pain intensity (VAS score) decreased significantly immediately after therapy as compared to therapy. There was a significant difference between the test and control groups immediately after therapy (P<0.05), while no effect 6 months later. No side effects were observed. It is concluded that LPNIR is an effective and safe modality to treat various chronic pains, which has synergic effects with NB or LB.

scholarly journals Acupuncture for Chronic Pain in the Vermont Medicaid Population: A Prospective, Pragmatic Intervention Trial

2018 ◽  
Vol 7 ◽  
pp. 216495611876955 ◽  
Author(s):  
Robert T Davis ◽  
Gary Badger ◽  
Kristina Valentine ◽  
Alexander Cavert ◽  
Remy R Coeytaux
Keyword(s):  
Chronic Pain ◽  
Sleep Disturbance ◽  
Pain Intensity ◽  
Physical Function ◽  
Treatment Period ◽  
Social Isolation ◽  
Pain Interference ◽  
Opioid Medication ◽  
Medicaid Population ◽  
Anxiety Depression

Introduction In response to the opioid crisis, the 2016 Vermont legislature commissioned a study to assess acupuncture for patients with chronic pain in the Vermont Medicaid population. Objective To assess the feasibility, acceptability, and effectiveness of acupuncture provided by licensed acupuncturists for Vermont Medicaid patients with chronic pain. Methods A total of 156 Medicaid patients with chronic pain were offered up to 12 acupuncture treatments within a 60-day period at the offices of 28 Vermont licensed acupuncturists. PROMIS® questionnaires were administered prior to and at the end of the treatment period to assess changes in pain intensity, pain interference, physical function, fatigue, anxiety, depression, sleep disturbance, and social isolation. Questionnaires also captured patients’ overall impressions of treatments as well as self-reported changes in medication use and work function. Results One hundred eleven women (71%) and 45 men (29%) with a wide range of pain complaints received a mean of 8.2 treatments during the intervention period. Measurements captured prior to and at the end of the treatment period showed significant improvements in group mean pain intensity, pain interference, physical function, fatigue, anxiety, depression, sleep disturbance, and social isolation as assessed by Patient-Reported Outcomes Measurement Information System (PROMIS) measures (paired t tests, P < .01). Fifty-seven percent of patients using analgesic (nonopioid) medication reported reductions in use. Thirty-two percent of patients using opioid medication reported reductions in use of opioid medication following the intervention. Seventy-four percent of employed patients reported improved capacity to work. Ninety-six percent of patients said that they would recommend acupuncture to others with chronic pain, and 91% reported qualitative improvements, including physical (31%), functional/behavioral (29%), and psycho-emotional (24%) improvements. Conclusions Our findings demonstrate that acupuncture treatment for chronic pain is feasible and well received by patients in the Vermont Medicaid population. Receiving care from Licensed Acupuncturists was associated with significant improvements in physical, functional, psycho-emotional, and occupational outcomes compared with before receiving acupuncture treatments.

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