Associations Between Sleep Disturbance and Chronic Pain Intensity and Function

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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Associations Among Sleep Disturbance, Pain Catastrophizing, and Pain Intensity for Methadone-maintained Patients With Opioid Use Disorder and Chronic Pain

Clinical Journal of Pain ◽

10.1097/ajp.0000000000000848 ◽

2020 ◽

Vol 36 (9) ◽

pp. 641-647

Author(s):

Caridad Ponce Martinez ◽

Karlyn A. Edwards ◽

Corey R. Roos ◽

Mark Beitel ◽

Anthony Eller ◽

...

Keyword(s):

Chronic Pain ◽

Sleep Disturbance ◽

Pain Intensity ◽

Pain Catastrophizing ◽

Opioid Use Disorder ◽

Opioid Use

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There Are Not Enough Sheep

Psychological and Psychiatric Issues in Patients with Chronic Pain ◽

10.1093/med/9780197544631.003.0014 ◽

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.

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

BMJ Open ◽

10.1136/bmjopen-2019-034443 ◽

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

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Pre-sleep cognitive arousal exacerbates sleep disturbance in chronic pain: an exploratory daily diary and actigraphy study

Scandinavian Journal of Pain ◽

10.1515/sjpain-2020-0185 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Debbie J. Bean ◽

Juliette Horne ◽

Arier C. Lee ◽

Malcolm H. Johnson

Keyword(s):

Chronic Pain ◽

Sleep Quality ◽

Sleep Disturbance ◽

Pain Intensity ◽

Sleep Onset ◽

Daily Diary ◽

Low Mood ◽

Cognitive Arousal ◽

Pain Outcomes ◽

Time Awake

Abstract Objectives Insomnia is commonly comorbid with chronic pain, and typically leads to worse outcomes. Two factors that could contribute to a cycle of pain and sleeplessness are pre-sleep cognitive arousal (repetitive thought processes) and low mood. This study aimed to examine how pain, sleep disturbance, mood, and pre-sleep cognitive arousal inter-relate, to determine whether low mood or pre-sleep cognitive arousal contribute to a vicious cycle of pain and insomnia. Methods Forty seven chronic pain patients completed twice daily diary measures and actigraphy for one week. Analyses investigated the temporal and directional relationships between pain intensity, sleep quality, time awake after sleep onset, anhedonic and dysphoric mood, and pre-sleep cognitive arousal. Fluctuations in predictor variables were used to predict outcome variables the following morning using mixed-effects modelling. Results For people with chronic pain, an evening with greater pre-sleep cognitive arousal (relative to normal) led to a night of poorer sleep (measured objectively and subjectively), lower mood in the morning, and a greater misperception of sleep (underestimating sleep). A night of poorer sleep quality led to greater pain the following morning. Fluctuations in pain intensity and depression did not have a significant influence on subsequent sleep. Conclusions For people with chronic pain, cognitive arousal may be a key variable exacerbating insomnia, which in turn heightens pain. Future studies could target cognitive arousal to assess effects on sleep and pain outcomes.

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790 Adaptive Body Awareness Mediates the Relationship between Quality of Sleep and Symptoms of Central Sensitization

SLEEP ◽

10.1093/sleep/zsab072.787 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A308-A308

Author(s):

Dana Dharmakaya Colgan ◽

Miranda Lim ◽

Lynn Marshall ◽

Barry Oken

Keyword(s):

Chronic Pain ◽

Sleep Disturbance ◽

Pain Intensity ◽

Central Sensitization ◽

Body Awareness ◽

Point Estimate ◽

Unit Increase ◽

Quality Sleep ◽

Body Sensations ◽

The Relationship

Abstract Introduction Sleep disturbance is associated with chronic pain. Central sensitization (CS), defined as the amplification of neural signaling within the central nervous system that results in pain hypersensitivity, may be one pathway through which sleep disturbance contributes to chronic pain. Sleep disturbance and CS are both associated with maladaptive body awareness, characterized by increased hypervigilance and catastrophizing in response to body sensations. Impaired sleep, increases maladaptive body awareness, which then contributes to CS. Less is known about the relationship between quality sleep, adaptive body awareness (i.e., increased attention to and awareness of body sensations, devoid of negative evaluations of sensations), and CS. Primary aims were to evaluate mediational pathways through which (1) sleep disturbance might be related to increased pain intensity via CS-related symptoms and (2) quality sleep might be related to lower CS-related symptoms via adaptive body awareness. Methods In a cross-sectional study, online surveys were administrated to 301 individuals with chronic pain. Pearson’s correlations characterized overall relationship between self-reported sleep quality (PROMIS-Sleep), adaptive body awareness (Multidimensional Assessment of Interoceptive Awareness; MAIA-2), and CS-related symptoms (Central Sensitization Inventory; CSI). Two path analyses using PROCESS were conducted. Results Results revealed that a one-unit increase in sleep disturbance was associated with a 1.7 unit increase in pain intensity, which was partially explained by CS-related symptoms [point estimate=.16; 95% bootstrap confident intervals (CI)=0.10 to 0.22]. In a separate path analysis, a one-unit decrease in sleep disturbance was associated with a 3.5 unit decrease in CS-related symptoms, which was partially explained via adaptive body awareness [point estimate=.25; 95% CI=0.03 to 0.52]. Conclusion Novel findings provide greater understanding into pathways through which sleep might contribute to chronic pain. Results support longitudinal studies to explore effects of sleep and adaptive body awareness on self-reported symptoms and biological markers of CS within chronic pain populations. Support (if any):

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Collecting patient reported outcomes to facilitate prescription opioid management: Development and testing of the Opioid Management App (OM-App) (Preprint)

10.2196/preprints.23633 ◽

2020 ◽

Author(s):

Jessica Robinson-Papp ◽

Gabriela Cedillo ◽

Richa Deshpande ◽

Mary Catherine George ◽

Qiuchen Yang ◽

...

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Risk Behaviors ◽

Digital Health ◽

Monitoring Program ◽

Prescription Opioid ◽

Research Database ◽

Cross Sectional ◽

Study Duration ◽

Patient Reported

BACKGROUND Collecting patient-reported data needed by clinicians to adhere to opioid prescribing guidelines represents a significant time burden. OBJECTIVE We developed and tested an opioid management app (OM-App) to collect these data directly from patients. METHODS OM-App used a pre-existing digital health platform to deliver daily questions to patients via text-message and organize responses into a dashboard. We pilot tested OM-App over 9 months in 40 diverse participants with HIV who were prescribed opioids for chronic pain. Feasibility outcomes included: ability to export/integrate OM-App data with other research data; patient-reported barriers and adherence to OM-App use; capture of opioid-related harms, risk behaviors and pain intensity/interference; comparison of OM-App data to urine drug testing, prescription drug monitoring program data, and validated questionnaires. RESULTS OM-App data was exported/integrated into the research database after minor modifications. Thirty-nine of 40 participants were able to use OM-App, and over the study duration 70% of all OM-App questions were answered. Although the cross-sectional prevalence of opioid-related harms and risk behaviors reported via OM-App was low, some of these were not obtained via the other measures, and over the study duration all queried harms/risks were reported at least once via OM-App. Clinically meaningful changes in pain intensity/interference were captured. CONCLUSIONS OM-App was used by our diverse patient population to produce clinically relevant opioid- and pain-related data, which was successfully exported and integrated into a research database. These findings suggest that OM-App may be a useful tool for remote monitoring of patients prescribed opioids for chronic pain. CLINICALTRIAL NCT03669939 INTERNATIONAL REGISTERED REPORT RR2-doi:10.1016/j.conctc.2019.100468

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Sleep disturbance in individuals with physical disabilities and chronic pain: The role of physical, emotional and cognitive factors

Disability and Health Journal ◽

10.1016/j.dhjo.2019.04.001 ◽

2019 ◽

Vol 12 (4) ◽

pp. 588-593 ◽

Cited By ~ 3

Author(s):

Rocío de la Vega ◽

Jordi Miró ◽

Rosa Esteve ◽

Carmen Ramírez-Maestre ◽

Alicia E. López-Martínez ◽

...

Keyword(s):

Chronic Pain ◽

Sleep Disturbance ◽

Physical Disabilities ◽

Cognitive Factors

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Opioid-sparing effects of medical cannabis or cannabinoids for chronic pain: a systematic review and meta-analysis of randomised and observational studies

BMJ Open ◽

10.1136/bmjopen-2020-047717 ◽

2021 ◽

Vol 11 (7) ◽

pp. e047717

Author(s):

Atefeh Noori ◽

Anna Miroshnychenko ◽

Yaadwinder Shergill ◽

Vahid Ashoorion ◽

Yasir Rehman ◽

...

Keyword(s):

Chronic Pain ◽

Sleep Disturbance ◽

Observational Studies ◽

Prescription Opioids ◽

Randomised Trials ◽

Medical Cannabis ◽

Opioid Use ◽

Opioid Dose ◽

Chronic Cancer Pain ◽

Pain Patients

ObjectiveTo assess the efficacy and harms of adding medical cannabis to prescription opioids among people living with chronic pain.DesignSystematic review.Data sourcesCENTRAL, EMBASE and MEDLINE.Main outcomes and measuresOpioid dose reduction, pain relief, sleep disturbance, physical and emotional functioning and adverse events.Study selection criteria and methodsWe included studies that enrolled patients with chronic pain receiving prescription opioids and explored the impact of adding medical cannabis. We used Grading of Recommendations Assessment, Development and Evaluation to assess the certainty of evidence for each outcome.ResultsEligible studies included five randomised trials (all enrolling chronic cancer-pain patients) and 12 observational studies. All randomised trials instructed participants to maintain their opioid dose, which resulted in a very low certainty evidence that adding cannabis has little or no impact on opioid use (weighted mean difference (WMD) −3.4 milligram morphine equivalent (MME); 95% CI (CI) −12.7 to 5.8). Randomised trials provided high certainty evidence that cannabis addition had little or no effect on pain relief (WMD −0.18 cm; 95% CI −0.38 to 0.02; on a 10 cm Visual Analogue Scale (VAS) for pain) or sleep disturbance (WMD −0.22 cm; 95% CI −0.4 to −0.06; on a 10 cm VAS for sleep disturbance; minimally important difference is 1 cm) among chronic cancer pain patients. Addition of cannabis likely increases nausea (relative risk (RR) 1.43; 95% CI 1.04 to 1.96; risk difference (RD) 4%, 95% CI 0% to 7%) and vomiting (RR 1.5; 95% CI 1.01 to 2.24; RD 3%; 95% CI 0% to 6%) (both moderate certainty) and may have no effect on constipation (RR 0.85; 95% CI 0.54 to 1.35; RD −1%; 95% CI −4% to 2%) (low certainty). Eight observational studies provided very low certainty evidence that adding cannabis reduced opioid use (WMD −22.5 MME; 95% CI −43.06 to −1.97).ConclusionOpioid-sparing effects of medical cannabis for chronic pain remain uncertain due to very low certainty evidence.PROSPERO registration numberCRD42018091098.

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The Pain Situation of Older Home-Care Recipients and Influencing Factors

Innovation in Aging ◽

10.1093/geroni/igaa057.662 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 204-205

Author(s):

Dagmar Dräger ◽

Reinhold Kreutz ◽

Adelheid Kuhlmey ◽

Andrea Budnick ◽

Dagmar Draeger

Keyword(s):

Chronic Pain ◽

Home Care ◽

Older People ◽

Pain Intensity ◽

Prevalence Rate ◽

Severe Pain ◽

Self Report ◽

Primary Data ◽

Common Symptom ◽

Care Recipients

Abstract Chronic pain is a common symptom among older people. The international prevalence rate reaches 50% for older home-care recipients (aged ≥60). The most common causes of pain among older people are degenerative arthropathy and musculoskeletal diseases. Care recipients (81% aged ≥65) constitute a specific sub-group among pain patients, due to the restrictions they experience. In Germany, the prevalence rate in this group is 70%. Currently, no comprehensive information on the pain situation of older home-care recipients exists in Germany. The findings presented are based on a cross-sectional study of older (aged ≥65) home-care recipients (SGB XI) in Berlin, with chronic pain (n=225), capable of self-report (MMST≥18). Structured interviews comprised the primary data source. The pain situation was determined using the German Brief Pain Inventory (BPI-NH). Multiple regression analysis was applied to test how the most severe pain (dependent variable) was influenced by socio-demographic and medical parameters, mental and physical restrictions and pain medication. Analyses of the pain situation show a value of M=4.81 (SD±1.88) on the BPI intensity index, and a BPI pain interference index of M=5.47 (SD±2.15). The most intense pain averaged 6.96 (SD±2.15). On average, respondents reported 16.20 (SD±13.25) pain locations (range: 0-65). The number of pain locations, alongside other factors, had a significant influence, R²=0.038 (corrected R²=0.034), F (1.219) = 8.760, p<0.01), on pain intensity. The findings show severe pain intensity among older home-care recipients not reported in previous findings (e.g. in long-term in-patient care). Action in medical care, nursing care and educational aspects is urgently needed.

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