Sleep disturbances in patients with chronic pain: effectively managing opioid analgesia to improve outcomes

Brennan, Michael J.; Lieberman, Joseph A.

doi:10.1185/03007990902797790

Cited by 52 publications

(27 citation statements)

References 55 publications

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“…These findings are intriguing as they suggest that rather than impairing sleep, low doses of morphine targeted to the underlying condition (in this case breathlessness) may actually improve overall sleep quality and could contribute to improvements in symptom perception relating to the underlying condition. Although pain perception was not the focus of the current investigation, the proposed scenario for sleep and breathlessness is consistent with the purported bidirectional relationship in patients suffering from pain in whom strategies to improve pain symptoms (including morphine) can improve sleep, and improved sleep may facilitate further reductions in perceived pain and vice versa …”

Section: Discussionsupporting

confidence: 62%

“…For example, sleep disruption is common in chronic pain and poor sleep worsens pain perception . When administered at doses that do not cause respiratory depression, morphine can improve sleep and pain in people experiencing chronic pain . Recent advances in the understanding of sleep‐disordered breathing clearly identify marked heterogeneity in the underlying pathophysiology and the response to opioids …”

Section: Introductionmentioning

confidence: 99%

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Effects of low‐dose morphine on perceived sleep quality in patients with refractory breathlessness: A hypothesis generating study

et al. 2015

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Background and objective: The management of chronic refractory breathlessness is one of the indications for regular low-dose (≤30 mg/24 h) oral sustained release morphine. Morphine may disrupt sleep in some conditions and improve sleep quality in others. This study aimed to determine any signal of regular, lowdose morphine on perceived sleep disruption due to breathlessness and perceived sleep quality. Methods: This is a secondary analysis of data from 38 participants with refractory breathlessness (30 male; 33 with COPD) aged 76 ± 0.9 years who completed a double-blind, randomized, placebo-controlled, crossover study in which they received 20 mg oral sustained release morphine daily and placebo for 4 days each. Participant ratings of sleep disruption due to breathlessness and perceived sleep quality were obtained daily throughout the 8-day trial. Results: Perceived sleep disruption due to breathlessness over the 4-day period ranged between 13% and 32% of participants for placebo and 13% and 26% for morphine, decreasing by each day of the study during

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Effects of low‐dose morphine on perceived sleep quality in patients with refractory breathlessness: A hypothesis generating study

et al. 2015

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“…Sleep and mood disturbances are frequently experienced as a consequence of pain in chronic pain patients (Brennan and Lieberman, 2009), and often interact to worsen pain (Chiu et al, 2005; Zautra et al, 2005; Vitiello et al, 2009; Ong et al, 2010; Theadom and Cropley, 2010; Sivertsen et al, 2015). Conversely, there is also recent research highlighting the amplifying effect of improvements of sleep and mood involved in the recovery from chronic pain (Zautra et al, 2005; Davies et al, 2008; Ashworth et al, 2010; Ong et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

How Perceived Pain Influence Sleep and Mood More Than The Reverse: A Novel, Exploratory Study with Patients Awaiting Total Hip Arthroplasty

Blågestad¹,

Pallesen²,

Grønli³

et al. 2016

Front. Psychol.

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Objectives: Attributions about how comorbid symptoms worsen or improve each other are central cognitive components of chronic pain that are shown to facilitate or impede the recovery process. Still, these attributions have been poorly illuminated in chronic pain patients. The present study explored perceptions of how sleep, pain, and mood influence each other in patients awaiting total hip arthroplasty (THA).Design and Methods: In this cross-sectional study, 291 patients (mean age 67.8, 65.3% female) rated 12 statements about how much a given symptom (pain, sleep, mood) changed when another symptom (pain, sleep, mood) worsened or improved on a response scale ranging from much worse (-2) via no change (0) to much better (2). Sleep (Bergen Insomnia Scale), pain (McGill Pain Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale) were assessed as background variables.Results: Of the patients in the study, 56% reported symptoms indicating insomnia. Anxiety and depression were indicated in 16 and 10%, respectively. Over 80% rated their pain as horrible/unbearable and reported that pain occurred always/daily. When experiencing increased pain, a majority perceived that sleep (90%) and mood (70%) worsened, whilst experiencing reduced pain improved sleep and mood in 50%. Poor sleep increased pain and worsened mood in 45 and 60% of the patients, respectively. Better sleep was perceived to reduce pain and improve mood in 50%. Worsened mood increased pain (46%) and worsened sleep (52%). Improved mood decreased pain and improved sleep in 25 and 35%, respectively.Discussion: In this study, a novel approach was used to investigate perceptions of reciprocal relationships between symptoms. We found that THA patients perceived interrelationships between pain, sleep and mood. These perceived interrelations were stronger when symptoms worsened than when symptoms improved. They also held stronger beliefs about the effect of pain on sleep and mood, than the effect of sleep and mood on pain. Attributions are central in illness perception and ultimately affect illness behavior. For patients who perceive symptoms to interrelate, the door has already been opened to utilize these attributions in treatments aiming to disrupt vicious cycles, hence supporting the use of multimodal treatments.

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“…There are conflicting reports on the effect of opioids on sleep. Some studies have reported improved sleep quality and efficiency [85], but other studies report that opioids may cause inhibition of the REM and non-REM phases of sleep [86,87], possibly contributing to exacerbation of pain [88,89]. COT can also cause sleep apnea [90,91] and hypoxemia [92].…”

Section: Additional Side Effects/complications Of Opioid Therapymentioning

confidence: 99%

Opioid Therapy in Patients with Chronic Noncancer Pain: Diagnostic and Clinical Challenges

Cheatle¹,

O’Brien²

2011

Chronic Pain and Addiction

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Chronic opioid therapy for patients with chronic noncancer pain has become controversial, given the rising prevalence of opioid abuse. The prevailing literature suggests that the rate of addiction in chronic noncancer pain patients exposed to opioid therapy is relatively low, especially in those patients without significant concomitant psychiatric disorders and personal and family history of addiction. However, the escalating rate of misuse of prescription opioids has resulted in many clinicians caring for these patients to be more judicious in prescribing opioids. Accurately diagnosing addiction in chronic pain patients receiving opioids is complex. Managing the patient with pain and co-occurring opioid abuse is equally challenging. Diagnostic issues, current guidelines for the appropriate use of opioids in the chronic pain population and risk stratification models are examined. Pharmacologic and nonpharmacologic treatment strategies for the patient with pain and opioid addiction are reviewed.Chronic pain has continued to be a major healthcare problem despite noteworthy advancements in diagnostics, pharmacotherapy and invasive and noninvasive interventions. The prevalence of chronic pain is staggering, with studies indicating that more than 25% of the general population experience pain lasting more than 3 months [1, 2], with an annual economic burden of more than USD 100 billion, USD 61.2 billion of which is due to lost productivity of the workforce [3]. The economic cost of opioid misuse/abuse is also noteworthy. The prevailing literature suggests that affected individuals utilize more healthcare resources and incur higher costs [4]. It has been estimated that the cost of prescription opioid abuse in 2001 was USD 8.6 billion including workplace, criminal justice and healthcare expenditures [5].The undertreatment or mismanagement of pain can cause additional suffering to the individual afflicted with chronic pain, but can also lead to other adverse effects including delays in healing, changes in the central nervous system (neuroplasticity),

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Sleep disturbances in patients with chronic pain: effectively managing opioid analgesia to improve outcomes

Cited by 52 publications

References 55 publications

Effects of low‐dose morphine on perceived sleep quality in patients with refractory breathlessness: A hypothesis generating study

Effects of low‐dose morphine on perceived sleep quality in patients with refractory breathlessness: A hypothesis generating study

How Perceived Pain Influence Sleep and Mood More Than The Reverse: A Novel, Exploratory Study with Patients Awaiting Total Hip Arthroplasty

Opioid Therapy in Patients with Chronic Noncancer Pain: Diagnostic and Clinical Challenges

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