Quality of sleep and its daily relationship to pain intensity in hospitalized adult burn patients

Raymond, Isabelle; Nielsen, Toré; Lavigne, Gilles; Manzini, Christiane; Choinière, Manon

doi:10.1016/s0304-3959(01)00282-2

Cited by 231 publications

(141 citation statements)

References 46 publications

Supporting

Mentioning

122

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, while we were able to control for premorbid pain, health and mental health status, premorbid insomnia symptoms were not measured and so it remains possible that premorbid insomnia is also an important risk factor for developing chronic pain after acute injury. In support of this possibility, Raymond and colleagues have reported that retrospective ratings of pre-burn sleep problems predicted more intense pain during burn care procedures, more pain during the night, and more pain upon awakenings in hospitalized burn patients (41).…”

Section: Discussionmentioning

confidence: 98%

Sleep onset insomnia symptoms during hospitalization for major burn injury predict chronic pain

Smith

Klick

Kozachik

et al. 2008

Pain

View full text Add to dashboard Cite

Both cross-sectional studies of chronic pain and sleep deprivation experiments suggest a bidirectional relationship between sleep and pain. Few longitudinal studies, however, have assessed whether acute-insomnia following traumatic injury predicts the development of persistent pain. We sought to evaluate: 1) whether in-hospital insomnia independently predicts long-term pain after burn injury and 2) whether in-hospital pain predicts future insomnia symptoms. We analyzed data on 333 subjects hospitalized for major burn injury (72.7% male; mean age = 41.1 years ±14.5) who were participating in the multi-site, Burn Model System project. Subjects completed measures of health, function (SF-36), and psychological distress (Brief Symptom Inventory) while in-hospital, at 6, 12, and 24 months after discharge. Participants were categorized as either having or not having sleep onset insomnia at discharge. Linear mixed effects analyses revealed that persons reporting insomnia at discharge (40.5%) had significantly decreased improvement in pain and increased pain severity during long-term follow up (p<.001). More severe pain during the week preceding hospital discharge, time from injury, lack of college education and older age also contributed independent effects on chronic pain (p<.05). In a reciprocal model (N = 299), more severe pain during the week preceding discharge predicted increased rates of long-term sleep onset insomnia. In-hospital insomnia and preburn mental health symptoms were also highly significant predictors of insomnia. This study provides support for a long-term, prospective and reciprocal interaction between insomnia and pain. Future work should ascertain whether treatment of insomnia and pain during acute injury can prevent or minimize chronic pain.

show abstract

Section: Discussionmentioning

confidence: 98%

Sleep onset insomnia symptoms during hospitalization for major burn injury predict chronic pain

Smith

Klick

Kozachik

et al. 2008

Pain

View full text Add to dashboard Cite

show abstract

“…18 In clinical practice, patients frequently attribute their sleep disturbance to pain and pain intensity scores have been found to predict sleep disturbances. 19,20 Two long-term prospective studies have suggested that prolonged nighttime awakenings in patients with rheumatoid arthritis are associated with increased joint pain severity, and that subjective sleep problems increased risk for development of widespread pain within 15 mo in the general population. 21,22 Different theories have been advanced to explain the mechanisms underlying sleep and pain, including repeated mircroarousals and disruption of restorative slow-wave sleep.…”

Section: Discussionmentioning

confidence: 99%

Pain Intensity and Opioid Utilization in Response to CPAP Therapy in Veterans with Obstructive Sleep Apnea on Chronic Opioid Treatment

Jaoude

Lal

Vermont

et al. 2016

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Study Objectives: Sleep fragmentation has been linked to poor pain tolerance and lowered pain threshold. Little evidence exists on whether continuous positive airway pressure (CPAP) adherence in veterans with obstructive sleep apnea (OSA) who are taking opioids for non-malignant pain would ameliorate pain and reduce consumption of opioids. Methods: A retrospective case-control study was performed at a VA sleep center. Pain intensity was assessed using the Numerical Categorical Scale prior to CPAP treatment and 12-mo follow-up. Opioids intake was assessed using the morphine equivalent daily dose (MEDD). Adherence to CPAP was evaluated with the built-in meter. Results: We reviewed 113 patients with OSA (apnea-hypopnea index [AHI] 35.9 ± 29.5) using a MEDD of 61.6 mg (range 5-980 mg) and a control group of 113 veterans with OSA (AHI 33.4 ± 27.3) on no opioids treatment. CPAP adherence was significantly lower at 12 mo in opioid-treated patients compared to controls (37% versus 55%; p = 0.01). Greater pain intensity was the only independent variable associated with CPAP non-adherence at 12-mo follow-up (p = 0.03). Compared to baseline, no significant difference was observed in pain intensity or consumption of opioids in CPAP adherent patients. I NTRO DUCTI O NChronic pain is a serious and highly prevalent condition among service members. Although the prevalence of chronic pain and opioid use associated with deployment is not well known, a recent report indicated that nearly half of a group of infantry soldiers who had seen combat in Afghanistan have reported experiencing chronic pain.1 The better body armor combined with advanced medical care on the battlefield had led to improved survival rates following serious residual injuries (such as limb amputations and severe nerve and musculoskeletal damage) caused by blasts or projectiles. The multiplicity of these wounds in soldiers, coupled with cognitive impairments associated with traumatic brain injury and mental health morbidity has caused an increase in dependency on opioids to suppress these ailments.The use of opioids has been associated with development of sleep-disordered breathing, including central apneas, ataxic breathing, and nocturnal hypoxemia.2-4 However, obstructive sleep apnea (OSA) is considered the predominant form of sleep-disordered breathing among veterans receiving chronic opioid therapy.5 However, this reduced pain sensitivity has been reported in healthy volunteers with induced rather than preexisting pain. It is speculated that the sleep disruption resulting from repeated arousals alters the nociceptive system, rendering it more susceptible to maladaptive plasticity. Preliminary investigations in healthy volunteers have suggested that although pain sensitivity is increased following sleep restriction, restoring sleep architecture ameliorates pain thresholds. 6,7 Further, treatment of underlying sleep apnea with continuous positive airway pressure (CPAP) has been associated with reduced hyperalgesia in patients with sleep-disordered breathing. ...

show abstract

“…Raymond et al (13) investigated inpatients with burn injuries. The subjective quality of night sleep was a significant predictor for pain intensity on the following day.…”

Section: The Relationship Between Sleep and Pain As Suggested By Corrmentioning

confidence: 99%

The Effects of Sleep Deprivation on Pain

Kundermann

Krieg²,

Schreiber³

et al. 2004

Pain Research and Management

174

View full text Add to dashboard Cite

P atients with chronic pain syndromes often suffer from sleep disturbances (1). However, it is difficult to determine the direction of cause between pain and sleep disturbance. The usual perspective favours an arousal-augmenting function of pain, which prevents the initiation or the continuation of sleep. Alternatively, it is believed that the modulation of pain and sleep-wake regulation share common neurobiological systems, in particular the central serotoninergic one (2). Consequently, the association of pain and disturbed sleep might be a secondary phenomenon due to a common neurobiological dysfunction. Finally, a rather unusual perspective is that poor sleep can interfere with pain processing. With this latter direction of relation in mind, we have addressed the following issues by reviewing the literature with a clear focus on experimental studies. The following perspectives may help to integrate the reviewed findings. The relationship between sleep disturbances and pain assuggested by correlational data. The majority of studies on the relationship between sleep and pain were not based on an experimental design, but relied on correlations only. In this section, a brief summary of the clinical investigations is given, including their first clues concerning the influence of disturbed sleep on pain, and their limitation in deriving causal relations.2. Sleep deprivation as a methodological approach to mimic disturbed sleep and derive experimental evidence for algesic effects. A comprehensive review of animal and human studies, which used sleep deprivation as an independent variable and examined its influence on pain processing, is provided.3. Assumptions on the algesic mechanisms of sleep deprivation.Results from animals studies suggest various neurochemical changes during and after sleep deprivation, which seemed to be involved in the modulation of pain. With a focus on the serotoninergic system, sleep deprivation affects 5-hydroxytryptamine (5-HT) turnover (3), the firing rate of serotoninergic neurons in the dorsal nucleus raphé (4) and 5-HT receptor functions (5). Given the well-known pain inhibitory effects of 5-HT, these changes may be tentatively integrated into a serotoninergic model of hyperalgesic action of sleep deprivation. Chronic pain syndromes are associated with alterations in sleep continuity and sleep architecture. One perspective of this relationship, which has not received much attention to date, is that disturbances of sleep affect pain. To fathom this direction of cause, experimental human and animal studies on the effects of sleep deprivation on pain processing were reviewed. According to the majority of the studies, sleep deprivation produces hyperalgesic changes. Furthermore, sleep deprivation can counteract analgesic effects of pharmacological treatments involving opioidergic and serotoninergic mechanisms of action.The heterogeneity of the human data and the exclusive interest in rapid eye movement sleep deprivation in animals so far do not allow us to draw firm conclusions as to wheth...

show abstract

Quality of sleep and its daily relationship to pain intensity in hospitalized adult burn patients

Cited by 231 publications

References 46 publications

Sleep onset insomnia symptoms during hospitalization for major burn injury predict chronic pain

Sleep onset insomnia symptoms during hospitalization for major burn injury predict chronic pain

Pain Intensity and Opioid Utilization in Response to CPAP Therapy in Veterans with Obstructive Sleep Apnea on Chronic Opioid Treatment

The Effects of Sleep Deprivation on Pain

Contact Info

Product

Resources

About