The role of psychosocial factors in predicting the onset of chronic widespread pain: results from a prospective population-based study

Gupta, Anindya; Silman, A J; Ray, David; Morriss, Richard; Dickens, Chris; Macfarlane, Gary J.; Chiu, Yee; Nicholl, Barbara I; McBeth, John

doi:10.1093/rheumatology/kel363

Cited by 304 publications

(239 citation statements)

References 25 publications

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“…The literature increasingly stresses the importance of paying more attention to the bi-directional relationship between pain and inadequate sleep, from both the diagnostic and the treatment points of view. [20][21][22][23][24] With regard to emotional distress, the results on the BDI-I were consistent with those obtained on the SF-36v2 mental health subscale. Severe or extremely severe BDI scores were observed in a large number of patients.…”

Section: Discussionsupporting

confidence: 74%

The Canadian STOP-PAIN project – Part 1: Who are the patients on the waitlists of multidisciplinary pain treatment facilities?

Choinière

Dion

Peng

et al. 2010

Can J Anesth/J Can Anesth

161

139

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Section: Discussionsupporting

confidence: 74%

The Canadian STOP-PAIN project – Part 1: Who are the patients on the waitlists of multidisciplinary pain treatment facilities?

Choinière

Dion

Peng

et al. 2010

Can J Anesth/J Can Anesth

161

139

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“…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. 23,24 However, not all studies have identified a significant association between pain severity and 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

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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. ...

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“…In FMS, non-restorative sleep and morning fatigue are the most prominent symptoms [20][21][22]. The patients indicated their sleep as unrefreshening when they woke up, which signifies impaired sleep quality even if their sleep duration was normal.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with AHI of ≥5 events/h were diagnosed with OSAS. Based on their AHI scores, the patients were categorized into mild (AHI, 5-15), moderate (AHI, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], and severe OSAS (AHI, >30) groups according to the AASM Task Force criteria [11]. Oxygen desaturation index (ODI) was defined as the total number of measurements of oxyhemoglobin desaturation of ≥4% within ≥10 s-<3 min from the baseline divided by the total sleep time.…”

Section: Psg Evaluationmentioning

confidence: 99%

Is There a Link Between Obstructive Sleep Apnea Syndrome and Fibromyalgia Syndrome?

et al. 2017

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OBJECTIVES:Fibromyalgia syndrome (FMS) is characterized by complaints of chronic musculoskeletal pain, fatigue, and difficulty in falling asleep. Obstructive sleep apnea syndrome (OSAS) is associated with symptoms, such as morning fatigueness and unrefreshing sleep. We aimed to investigate the presence of OSAS and objectively demonstrate changes in sleep pattern in patients with FMS. MATERIAL AND METHODS:Polysomnographic investigations were performed on 24 patients with FMS. Patients were divided into two groups: patients with and without OSAS (Group 1 and Group 2, respectively). A total of 40 patients without FMS who presented to the sleep disorders polyclinic with an initial diagnosis of OSAS were included in Group 3. Based on their apnea hypopnea index (AHI), OSAS in the patients were categorized as mild (AHI,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), moderate (30), or severe (>30). RESULTS:OSAS was detected in 50% of patients with FMS. The most prominent clinical findings were morning fatigue and sleep disorder, which were similar in three groups. In polysomnography (PSG) evaluation, patients with FMS had mild (33%), moderate (25%), and severe (42%) OSAS. In correlation analyses, negative correlations were observed between fibromyalgia impact questionnaire (FIQ) and mean oxygen saturation, visual analogue scale (VAS), and minimum oxygen saturation, whereas a positive correlation was found between FIQ and desaturation times in patients with FMS. CONCLUSION:Detection of OSAS in 50% of the patients with FMS, and similar rates of complaints of sleep disorder and morning fatigue of OSAS and FMS cases are important results. Detection of correlation between the severity of hypoxemia and FIQ and VAS scores are significant because it signifies the contribution of increased tissue hypoxemia to the deterioration of clinical status. Diagnosis and treatment of OSAS associated with FMS are important because of their favorable contributions to the improvement of the clinical picture of FMS. KEYWORDS:Obstructive sleep apnea syndrome, fibromyalgia syndrome, polysomnography, sleep disorders, apnea hypopnea index, hypoxemia INTRODUCTIONFibromyalgia syndrome (FMS) is a chronic health problem that presents with pain all over the body, with other symptoms, such as tenderness of the affected joints, muscles fatigue, sleep problems (waking up unrefreshed and excessive daytime sleepiness), and cognitive impairment [1]. Since its etiology is not fully known, its treatment is symptomatic. Patients with FMS are usually treated with various combinations of physiotherapy, psychotherapy, psychotrophic drugs, and analgesics. Treatment effectiveness in FMS is limited, and these patients frequently lead their lives with symptoms of chronic insomnia, sleep problems, fatigue, and pain [2].Obstructive sleep apnea syndrome (OSAS) is a pathology with systemic effects that are characterized by associated symptoms of recurrent episodes of upper respiratory tract obstruction, hypoxemia, arousals during sleep, morning fatigue because of impaired sleep ...

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The role of psychosocial factors in predicting the onset of chronic widespread pain: results from a prospective population-based study

Abstract: Subjects are at substantial increased odds of developing CWP if they display features of somatization, health-seeking behaviour and poor sleep. Psychosocial distress has a strong aetiological influence on CWP.

Cited by 304 publications

References 25 publications

The Canadian STOP-PAIN project – Part 1: Who are the patients on the waitlists of multidisciplinary pain treatment facilities?

The Canadian STOP-PAIN project – Part 1: Who are the patients on the waitlists of multidisciplinary pain treatment facilities?

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

Is There a Link Between Obstructive Sleep Apnea Syndrome and Fibromyalgia Syndrome?

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