Sleep, Pain Catastrophizing, and Central Sensitization in Knee Osteoarthritis Patients With and Without Insomnia

Abstract

Objectives: Osteoarthritis, a chronic degenerative joint disorder, is characterized by joint pain. Emerging research demonstrates that a significant number of patients evidence central sensitization (CS), a hyper-excitability in nociceptive pathways, which is known to amplify and maintain clinical pain. The clinical correlates of CS in OA, however, are poorly understood. Insomnia is prevalent in older adults with OA and recent experiments suggest associations between poor sleep and measures of CS. Catastrophizing, a potent predictor of pain outcomes has also been associated with CS, but few studies have investigated possible interactions between catastrophizing, sleep and CS. Methods: We conducted a case controlled study of 4 well characterized groups of adults with insomnia and/or knee osteoarthritis. A total of 208 participants completed multimodal sleep assessments (questionnaire, diary, actigraphy, polysmnography) and extensive evaluation of pain using clinical measures and quantitative sensory testing to evaluate associations between CS, catastrophizing and insomnia. Descriptive characterization of each measure is presented, with specific focus on sleep efficiency and CS. Results: The KOA-Insomnia group demonstrated the greatest degree of CS compared to controls. In the overall sample, we found that catastrophizing moderated the relationship between sleep efficiency and CS. Specifically those with low sleep efficiency and high catastrophizing scores reported increased levels of CS. In addition, CS was significantly associated with increased clinical pain. Conclusions: These findings highlight the importance of assessing sleep efficiency, CS and catastrophizing in chronic pain patients and have important clinical implications for treatment planning.

An Evaluation of Central Sensitization in Patients With Sickle Cell Disease

“…Patients in the high CS group reported overwhelmingly poorer sleep than those in the low CS group and these differences appear stable over time. These findings are consistent with a growing literature documenting a specific relationship between sleep disturbance and CS indices in clinical pain samples [10;18;42]. It is important to note, however, that our analyses are unable to speak to the temporal relationship between these constructs.…”

A Mechanism-Based Approach to the Management of Osteoarthritis Pain

“…In a cluster analysis of 216 individuals with knee OA, individuals with high pain catastrophizing were noted to have lower pain thresholds in a widespread distribution, higher measures of temporal summation, and lower levels of conditioned pain modulation, suggesting abnormalities in CNS pain regulation [32•]. Consistent with these results, a recent study of 208 individuals with knee OA and/or insomnia showed that pain catastrophizing was significantly associated with higher scores on a composite measure of abnormalities in CNS pain regulation [33]. In the same study, pain catastrophizing was also noted to be an effect modifier of the relationship between sleep efficiency and CNS pain regulation.…”

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].…”