Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.
Pain. 2022 Jul 1;163(7):e812-e820. doi: 10.1097/j.pain.0000000000002497. Epub 2021 Sep 23.
Chronic pain and sleep problems frequently co-occur. Pain itself disturbs sleep, but other factors may also contribute to sleep problems in pain patients. This cross-sectional study of 473 patients (69.9% female, mean age 47 years) entering tertiary pain management compared normally sleeping pain patients with those having recurring sleep problems to determine the relationship between pain and sleep. Groups were compared for pain and pain aetiology, pain-related anxiety, childhood adversities, use of sleep and pain medications, self-reported diseases, and sleep disorders. Furthermore, the association of pain-related anxiety (cognitive anxiety, escape/avoidance, fear, and physiological anxiety) with more disturbing sleep problems was investigated in the whole cohort. The main results were that those with sleep problems more often reported multiple health conditions than those sleeping normally (depression 31.6% vs 5.0%; angina pectoris 6.5% vs 0.0%; asthma 19.6% vs 1.7%; low back problems 55.1% vs 23.3%; joint disease other than rheumatoid arthritis 32.3% vs 18.3%). Accumulations of 5 or more childhood adversities were more often present in those with sleep problems. Restless legs symptoms were more common in those with sleep problems than those sleeping normally (33.2% vs 11.7%). Patients having sleep problems reported more use of sleep and pain medications than those sleeping normally. Findings about pain-related anxiety suggest physiological reactions as significant factors for increased sleep disturbances. These factors need to be addressed in the management of the comorbidity of pain and sleep problems, and research to understand mechanisms in these is sorely needed.
慢性疼痛和睡眠问题经常同时发生。疼痛本身会干扰睡眠，但其他因素也可能导致疼痛患者出现睡眠问题。本研究对 473 名（69.9%为女性，平均年龄 47 岁）进入三级疼痛管理的患者进行了横断面研究，比较了正常睡眠的疼痛患者和经常出现睡眠问题的疼痛患者，以确定疼痛与睡眠之间的关系。两组在疼痛和疼痛病因、与疼痛相关的焦虑、儿童期逆境、使用睡眠和疼痛药物、自我报告的疾病以及睡眠障碍方面进行了比较。此外，还在整个队列中研究了与疼痛相关的焦虑（认知焦虑、逃避/回避、恐惧和生理焦虑）与更令人困扰的睡眠问题之间的关系。主要结果是，有睡眠问题的患者比正常睡眠的患者更常报告多种健康状况（抑郁 31.6% vs 5.0%；心绞痛 6.5% vs 0.0%；哮喘 19.6% vs 1.7%；下背部问题 55.1% vs 23.3%；除类风湿关节炎外的关节疾病 32.3% vs 18.3%）。有睡眠问题的患者中，5 次或更多次童年逆境的积累更为常见。与正常睡眠的患者相比，有睡眠问题的患者中不安腿症状更为常见（33.2% vs 11.7%）。有睡眠问题的患者比正常睡眠的患者报告使用更多的睡眠和疼痛药物。与疼痛相关的焦虑的发现表明生理反应是睡眠障碍增加的重要因素。在疼痛和睡眠问题的合并症管理中需要解决这些因素，并且迫切需要研究来了解这些机制。
