Deeper Causes of Pain and Inflammation - by Dr. Eric Berg DC
Pain Sensitivity Spikes in OA Patients With Sleep Problems
Knee OA was also linked to depression, researchers said.
By Frieda Wiley, PharmD, CGP, RPh
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Inadequate and/or disrupted sleep increases sensitivity to pain in patients who have knee osteoarthritis (OA) when compared with healthy controls suggested a recent study.
A statistically significant association existed between a report of clinical pain and each sleep questionnaire , catastrophizing, depression, diary sleep efficiency, and a central sensitization (CS) measure -- which refers to a hyper-excitability in nociceptive pathways -- according to Claudia Campbell, PhD, from the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine, and colleagues.
"Our study is the largest and most comprehensive examination of the relationship between sleep disturbance, catastrophizing, and central sensitization (CS) in knee OA," stated Campbell in a recent press release. The researchers defined catastrophizing as "a persistently negative cognitive affective style characterized by helplessness, magnification and ruminative thoughts regarding one's pain."
Campbell and associates evaluated 208 patients in a case control study in the first phase of a project ultimately intended to be a randomized, controlled trial by separating subjects into four separate groups: OA patients presenting with insomnia, OA patients who had normal sleep habits, and two healthy control groups -- one with insomnia and the group without pain or sleep problems.
Published in the American College of Rheumatology journal Arthritis Care and Research, Quantitative Sensory Testing (QST) showed that patients who had both knee osteoarthritis and insomnia (KOA-I) were not only the most sensitive to pain, they were also much more sensitive when compared to healthy control subjects.
Additionally, data collected from subjects' sleep diaries indicated that both groups with insomnia had significantly less efficient sleep in comparison with both of the healthy control groups.
Catastrophizing was associated with statistically significant increases in CS levels, as was sleep efficiency.
Inclusion criteria for subjects enrolling in the KOA arms of the trial were as follows: All subjects met criteria defined by the American College of Rheumatology (ACR), as determined per medical history, physician examination, bilateral standing, and semi-flexion view radiographs. Additionally, participants were subjected to diagnosis by a board-certified rheumatologist and must have met the following remaining requirements: have had at least one knee with a rating of 1 on the Kellgren-Lawrence scale (which radiographically assesses joint damage); have knee pain greater than 2/10 for more than 4 days a week for at least 6 months prior to study enrollment; have no pending arthroplasty scheduled during the study period; and maintain consistent dosing for at least 1 month before participating in the study.
Additional examination was required of subjects for inclusion into the insomnia groups, as outlined per the Structured Interview for Sleep Disorders (SIS-D (26). Campbell and colleagues used SIS-D as a tool to help determine whether participants met the criteria established by both the American Academy of Sleep Medicine and the Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria for additional insomnia disorders.
Exclusion criteria included current history of a serious medical illness, like congestive heart disease, history of cerebral vascular accidents, impaired cognition or dementia, substance abuse disorder within the last 6 months, cancer, chronic pain, and other rheumatic disorders along with other major medical illnesses.
RELATED: 9 Ways to Rise and Shine With Osteoarthritis
Aside from age, demographic characteristics generally varied little between groups, with the KOA group containing subjects who were significantly older than other members of the groups followed. However, employing a control for age bore no effect on statistical significance.
Total sleep time (TSTS), sleep latency, and wake after sleep onset (WASO) in the insomnia groups were all worse than the sleep quality evaluated in both control groups.
Using SPSS, Campbell and colleagues employed Chi-Square tests to distinguish between participant groups and conducted several analyses of variance (ANOVA) to evaluate sleep efficiency and questions of interest.
Campbell and colleagues sought to ameliorate potential family-wise error by conducting statistical measures of interest, defined as sleep efficiency, CS, and questionnaires, along with disclosing information describing all variables for the study. "Out of all the sleep and pain variables ... measured, sleep efficiency and CS were chosen as they are the strongest summary measures representing the overall quality of sleep continuity and CS hypersensitivity to pain," Campbell and colleagues explained in the article.
In the article, the researchers point out that "A limitation of the study is that the study was underpowered, preventing a thorough examination of all potential data." Additionally, there was a significant age difference between groups despite the authors' attempts to organize groups based on demographics. The authors also point out that the KOA good sleep group -- which also happened to be the oldest group -- had the greatest thermal temporal summation; however, these subjects had the lowest after sensations ratings.
Not only did insomniac KOA patients present with greater pain, but they also experienced greater depression and pain-related catastrophizing.
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