Disrupted Sleep Is Associated With Altered Pain Processing by Sex and Ethnicity in Knee Osteoarthritis

Abstract

Studies indicate that improving sleep decreases reported pain in patients with knee osteoarthritis (OA), but it is unclear if this association extends to experimentally-induced pain responses. A community-based sample of 88 African-American and 52 non-Hispanic white adults (45-76y) with knee OA completed the Insomnia Severity Index and the arousal subscale of the Sleep Hygiene and Practices Scale. Participants underwent quantitative sensory testing including measures of pain sensitivity and facilitation at the knee, and pain inhibition. Outcomes were analyzed with multiple Tobit, hierarchical regression models, with adjustment for relevant covariates. Ethnicity and sex by sleep interactions were also entered into the models. After covariate adjustment, main associations were not observed. However, sex interacted with insomnia severity to predict greater temporal summation of heat and punctate pressure pain among women and lower heat temporal summation among men. Men and women who engaged in frequent arousal-associated sleep behaviors demonstrated higher and lower heat temporal summation, respectively. Non-Hispanic whites with greater insomnia severity displayed lower pressure pain thresholds and pain inhibition. Our findings are the first to demonstrate that disrupted sleep is associated with altered pain processing differentially by sex and ethnicity/race among people with knee OA.

A Mechanism-Based Approach to the Management of Osteoarthritis Pain

“…Vitiello et al showed that in older adults with OA and insomnia, short-term improvements in sleep predicted long-term improvements in pain, fatigue, and sleep [28]. Another study by Petrov et al found an association between insomnia severity and experimental pain responses [29]. Disruption of sleep continuity was associated with impaired conditioned pain modulation, whereas sleep restriction was associated with increased circulating levels of CRP, TNF-α, and IL-6, acute phase reactants, and inflammatory cytokines which may play a role in central sensitization [30, 31].…”

Psychological interventions that target sleep reduce pain catastrophizing in knee osteoarthritis

“…Poor sleep, especially short duration and/or fragmented sleep, are thought to enhance pain sensitivity in KOA [35; 38; 42] and may be heightened by pain-catastrophizing [4]. Pain-catastrophizing has been conceptualized as a form of repetitive negative thinking closely related to worry [12].…”

Depressive Symptoms and Sleep Efficiency Sequentially Mediate Racial Differences in Temporal Summation of Mechanical Pain

“…Characterization of temporal summation responses provides information about endogenous pain facilitatory mechanisms underlying nociceptive processing in healthy individuals and those with chronic pain (2–4). Tests of experimental pain sensitivity like temporal summation responses are widely incorporated in psychophysical studies to invoke neural mechanisms related to central sensitization (5).…”

“…A recent comprehensive review of the literature indicated that in (micro)longitudinal studies, poor sleep was generally a stronger, more reliable predictor of pain than pain was of poor sleep (17). Further, poor sleep also predicted experimental pain outcomes such as endogenous pain modulatory processes (29). This conclusion identifies a directional relationship between sleep and pain, rather than an equally bi-directional relationship as commonly thought.…”