Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20230077-en
Brazilian Journal of Pain
Original Article

Sleep disorders in patients with chronic pain: cross-sectional study

Distúrbios do sono em pacientes com dor crônica: estudo transversal

Michelle dos Santos Severino Costa; Caroline Carvalho Mageste; Dierisson Souza Simão; Renato Santiago Gomez

Downloads: 1
Views: 365

Abstract

BACKGROUND AND OBJECTIVES: Chronic pain and its relationship with sleep disturbance are common conditions with great influence on the individual’s quality of life. The simultaneous occurrence of these two entities results in greater suffering, reduced functionality and well-being. The objective of this research was to evaluate the influence of chronic pain on sleep and its impact on quality of life.
METHODS: This is an observational, cross-sectional, individual, uncontrolled study carried out at the Multidisciplinary Pain Center of the Clinical Hospital of the Federal University of Minas Gerais (Hospital das Clínicas da Universidade Federal de Minas Gerais - HC-UFMG). The patients answered a semi-structured, face-to-face interview via the pain center’s own computer system (avaliaDor®), using internet-connected mobile devices. Socioeconomic and pain data was collected, and then instruments were applied to assess pain intensity (Visual Numerical Scale - VNS), quality of life (Medical Outcomes Study 36 - Short Form Health Survey - SF-36), presence of psychiatric disturbances (Hospital Depression Anxiety Scale - HAD) and sleep (Mini Sleep Questionnaire - MSQ).
RESULTS: One hundred and three patients participated in the study. Seventy two percent were women, the median age was 55 years, and the patients were predominantly married, white and with a low level of schooling. Of the entire study population 74.76% presented “severe difficulty” in sleeping, while 22.33% had “good quality” sleep. Regarding pain intensity, patients in the moderate and severe pain groups had a higher percentage of “severe difficulty” in sleeping, when compared to patients with mild pain. About the presence of anxiety and depression, it was observed lower scores on: “restless sleep”, “tiredness for no apparent reason”, “wakes up with a headache”, “wakes up and goes back to sleep”, “wakes up tired in the morning”, and finally “wakes up and does not go back to sleep”. The general data from the SF-36 points to a low quality of life for the patients in the present study and, based on the multivariate analysis, the items “SF-36-Pain and SF-36-Vitalidade” were shown to be protective factors for the presence of sleep disturbances.
CONCLUSION: Sleep disorders in patients with chronic pain are common and show a worsening in quality of life. The frequency of this disturbance was higher in patients with anxiety and depression compared to patients without these psychiatric disorders. The early identification of sleep disturbances in individuals with chronic pain is necessary to improve well-being.

Keywords

Chronic pain, Quality of life, Sleep

Resumo

JUSTIFICATIVA E OBJETIVOS: A dor crônica e os distúrbios do sono são condições comuns. A ocorrência simultânea dessas duas entidades resulta em maior sofrimento pessoal e redução do bem-estar e da funcionalidade. O objetivo desta pesquisa foi avaliar a influência da dor crônica no sono e o seu impacto na qualidade de vida. 
MÉTODOS: Trata-se de um estudo observacional, transversal, individual e não controlado, realizado no Centro Multidisciplinar de Dor do Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG). Os pacientes responderam a uma entrevista semiestruturada, face a face, por meio do sistema de computador do próprio centro de dor (avaliaDor®), utilizando dispositivos móveis conectados à internet. Foram coletados dados socioeconômicos e de dor; em seguida foram aplicados instrumentos para avaliar a intensidade da dor (Escala Visual Numérica - EVN), a qualidade de vida (Medical Outcomes Study 36 - Short Form Health Survey - SF-36), a presença de distúrbios psiquiátricos (Escala Hospitalar de Ansiedade e Depressão - HAD) e o sono (Mini Sleep Questionnaire - MSQ).
RESULTADOS Cento e três pacientes participaram do estudo. Setenta e dois por cento eram do sexo feminino, com mediana de idade de 55 anos, com predominância de brancos com baixo nível de escolaridade. De toda a população estudada, 74,76% dos participantes apresentaram “dificuldade grave” para dormir, enquanto 22,33% tiveram “boa qualidade” de sono. Em relação à intensidade da dor, os pacientes dos grupos de dor moderada e intensa apresentaram maior percentual de “dificuldade grave” para dormir quando comparados aos pacientes com dor leve. Em relação à presença de ansiedade e depressão, observou-se maior pontuação nos itens: “sono agitado”, “cansaço sem motivo aparente”, “acorda com dor de cabeça”, “acorda e volta a dormir”, “acorda cansado pela manhã” e, por fim, “acorda e não volta a dormir”. Os dados gerais do 
SF-36 apontam para uma baixa qualidade de vida dos doentes do presente estudo e, com base na análise multivariada, os itens 
“SF-36-Dor e SF-36-Vitalidade” revelaram-se fatores protetores da presença de perturbações do sono.
CONCLUSÃO: Os distúrbios de sono em pacientes com dor crônica são comuns e determinam piora na qualidade de vida. A frequência desse distúrbio foi maior nos pacientes com ansiedade e depressão, em comparação com os pacientes que não apresentaram essas desordens psiquiátricas. A identificação precoce dos distúrbios do sono, em indivíduos com dor crônica, é fundamental para alcançar maior bem-estar.

Palavras-chave

Dor crônica, Qualidade de vida, Sono

References

1 Ong KS, Keng SB. The biological, social, and psychological relationship between depression and chronic pain. Cranio. 2003;21(4):286-94.

2 Cáceres-Matos R, Gil-García E, Barrientos-Trigo S, Porcel-Gálvez AM, Cabrera-León A. Consequences of chronic non-cancer pain in adulthood. Scoping review. Rev Saude Publica. 2020;54:39.

3 Zanuto EAC, Lima MCS, Araújo RG, Silva E P, Anzolin CC, Araujo MYC, Codongnol JS, Christofaro DGD, Fernandes RA. Distúrbios do sono em adultos de uma cidade do estado de São Paulo. Rev Bras Epidemiol. 2015;18(1):42-53.

4 Smith BH, Elliott AM, Chambers WA, Smith WC, Hannaford PC, Penny K. The impact of chronic pain in the community. Fam Pract. 2001;18(3):292-9.

5 Andersen ML, Araujo P, Frange C, Tufik S. Sleep disturbance and pain. Chest. 2018;154(5):1249-59.

6 Smith M T, Haythornthwaite JA. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev. 2004;8(2):119-32.

7 Boakye PA, Olechowski C, Rashiq S, Verrier MJ, Kerr B, Witmans M, Baker G, Joyce A, Dick BD. A Critical Review of Neurobiological Factors Involved in the Interactions Between Chronic Pain, Depression, and Sleep Disruption. Clin J Pain. 2016;32(4):327-36.

8 Smith M T, Edwards RR, McCann UD, Haythornthwaite JA. The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep. 2007;30(4):494-505.

9 Martins MRI, Polvero LO, Rocha CE, Foss MH, Santos Junior R. Uso de questionários para avaliar a multidimensionalidade e a qualidade de vida do fibromiálgico. Rev Bras Reumatol. 2012;52(1):21-6.

10 Zhai L, Zhang H, Zhang D. Sleep duration and depression among adults: a meta-analysis of prospective studies. Depress Anxiety. 2015;32(9):664-70.

11 Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539-52.

12 Mathias JL, Cant ML, Burke ALJ. Sleep disturbances and sleep disorders in adults living with chronic pain: a meta-analysis. Sleep Med. 2018;52:198-210.

13 Call-Schmidt TA, Richardson SJ. Prevalence of sleep disturbance and its relationship to pain in adults with chronic pain. Pain Manag Nurs. 2003;4(3):124-33.

14 Zambelli Z, Halstead EJ, Fidalgo AR, Dimitriou D. Good sleep quality improves the relationship between pain and depression among individuals with chronic pain. Front Psychol. 2021;12:668930.

15 Generaal E, Vogelzangs N, Penninx BW, Dekker J. Insomnia, sleep duration, depressive symptoms, and the onset of chronic multisite musculoskeletal pain. Sleep. 2017;40(1).

16 Dunietz GL, Swanson LM, Jansen EC, Chervin RD, O’Brien LM, Lisabeth LD, Braley TJ. Key insomnia symptoms and incident pain in older adults: direct and mediated pathways through depression and anxiety. Sleep. 2018;41(9):zsy125.

17 Lo CM, Lee PH. Prevalence and impacts of poor sleep on quality of life and associated factors of good sleepers in a sample of older Chinese adults. Health Qual Life Outcomes. 2012;10:72.

18 Karaman S, Karaman T, Dogru S, Onder Y, Citil R, Bulut YE, Tapar H, Sahin A, Arici S, Kaya Z, Suren M. Prevalence of sleep disturbance in chronic pain. Eur Rev Med Pharmacol Sci. 2018;18(17):2475-81.

19 Smith M T, Haythornthwaite JA. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev. 2004;8(2):119-32.

20 Wilson KG, Eriksson MY, D’Eon JL, Mikail F, Emery C. Major depression, and insomnia in chronic pain. Clin J Pain. 2002;18(2):77-83.

21 Castro A, Gili M, Aguilar JL, Pélaez R, Roca M. Sueño y depresión en una muestra de pacientes con dolor crónico. Rev Soc Esp Dolor. 2014;21(6):299-306.

22 Ciena A P, Gatto R, Paccini VC, Picanço VV. Influence of pain intensity on the unidimensional scales responses of pain measurement in an elderly and young adults population. Semina Ciências Biológicas e da Saúde. 2009;29(2).

23 Bertolazi AN. Universidade Federal do Rio Grande do Sul Faculdade de Medicina Programa de pós-graduação em Medicina: ciências médicas - Tradução, adaptação cultural e validação de dois instrumentos de avaliação do sono: escala de sonolência de Epworth e Índice de qualidade de sono de Pittsburgh. 2008.

24 Zomer J. Mini Sleep Questionnaire (MSQ) for screening large populations for EDS complaints. Sleep. 1985.

25 Cicconelli RM, Ferraz MB, Santos W, Meinão I, Rodrigues IQM. Tradução para a Língua Portuguesa e avaliação do questionário genérico de avaliação de qualidade de vida SF-36 (Brasil SF-36). Rev Bras Reumatol. 1999;39(3):143-50.

26 Hosmer D W, Lemeshow S, Sturdivant RX. Applied Logistic Regression [Internet]. Wiley; 2013. (Wiley Series in Probability and Statistics). Available from: https://onlinelibrary.wiley.com/doi/book/10.1002/9781118548387.

27 Amtmann D, Bamer AM, Askew R, Jensen M P. Cross-lagged longitudinal analysis of pain intensity and sleep disturbance. Disabil Health J. 2020;13(3):100908.

28 Affleck G, Urrows S, Tennen H, Higgins P, Abeles M. Sequential daily relations of sleep, pain intensity, and attention to pain among women with fibromyalgia. Pain. 1996;68(2-3):363-8.

29 Sun Y, Laksono I, Selvanathan J, Saripella A, Nagappa M, Pham C, Englesakis M, Peng P, Morin CM, Chung F. Prevalence of sleep disturbances in patients with chronic non-cancer pain: a systematic review and meta-analysis. Sleep Med Rev. 2021;57:101467.

30 Keilani M, Crevenna R, Dorner TE. Sleep quality in subjects suffering from chronic pain. Wien Klin Wochenschr. 2018;130(1-2):31-6.

31 Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539-52.

32 Zhang J, Lam S P, Li SX, Tang NL, Yu MWM, Li AM, Wing YK. Insomnia, sleep quality, pain, and somatic symptoms: sex differences and shared genetic components. Pain. 2012;153(3):666-73

33 Foo H, Mason P. Brainstem modulation of pain during sleep and waking. Sleep Med Rev. 2003;7(2):145-54.

34 Coutinho VS, Urban OM, Gebhart FG. Role of glutamate receptors and nitric oxide in the rostral ventromedial medulla in visceral hyperalgesia. Pain. 1998;78(1):59-69.

35 Paulson PE, Casey KL, Morrow TJ. Long-term changes in behavior and regional cerebral blood flow associated with painful peripheral mononeuropathy in the rat. Pain. 2002;95(1):31-40.

36 Tenti M, Raffaeli W, Gremigni P. A narrative review of the assessment of depression in chronic pain. Pain Manag Nurs. 2022;23(2):158-67.

37 Dansie EJ, Turk DC. Assessment of patients with chronic pain. Br J Anaesth. 2013;111(1):19-25.

38 van Hecke O, Torrance N, Smith BH. Chronic pain epidemiology and its clinical relevance. Br J Anaesth. 2013;111(1):13-8.

39 Lee S, Kin JH, Chung JH. The association between sleep quality and quality of life: a population-based study. Sleep Med. 2021;84:121-6.
 


Submitted date:
05/22/2023

Accepted date:
09/16/2023

65a6e2b3a95395798e360ee4 brjp Articles

BrJP

Share this page
Page Sections