Department of Anesthesiology and Pain Medicine, Hyogo Medical University (Formerly Hyogo College of Medicine), School of Medicine, Nishinomiya, Hyogo, Japan.
Department of Pharmacy, Hyogo Medical University Hospital, Hyogo, Japan.
Medicine (Baltimore). 2022 Sep 23;101(38):e30845. doi: 10.1097/MD.0000000000030845.
Several risk factors for insomnia in cancer patients have been recognized, including chronic pain and treatment with opioid. Although associations between insomnia and central sensitization were previously reported in patients with chronic non-cancer pain, those have not been elucidated among cancer survivors undergoing opioid therapy for chronic cancer pain. To investigate the associations between insomnia and central sensitization among cancer survivors undergoing opioid therapy for chronic cancer pain, consecutive patients undergoing chemotherapy with chronic cancer pain under opioid therapy on an outpatient basis were enrolled from September 2019 to August 2020 and answered questions from the Athens Insomnia Scale (AIS) for assessing insomnia. Pain characteristics, including pain intensity, neuropathic pain, central sensitization assessed using the central sensitization inventory (CSI), opioid use disorder, and pain-related psychological symptoms were also examined. Uni- and multivariate regression analyses were performed to elucidate correlations between the AIS score and these pain characteristics. Of 44 enrolled patients, 20 patients completed to answer all questions. Insomnia was identified in 9 patients (45%). Although AIS scores showed no significant associations with pain intensity, neuropathic pain, opioid use disorder, or psychological symptoms, multivariate regression analysis revealed that CSI scores showed a positive relationship with AIS scores (P = .004). Discrimination was assessed using linear regression analysis which confirmed a significant association between the AIS and CSI scores (P = .002). Insomnia appears to be associated with central sensitization in cancer survivors with chronic cancer pain under opioid therapy.
几种癌症患者失眠的风险因素已被认识到，包括慢性疼痛和阿片类药物治疗。尽管先前有报道称慢性非癌痛患者的失眠与中枢敏化有关，但在接受阿片类药物治疗慢性癌痛的癌症幸存者中，这种关系尚未阐明。为了研究接受阿片类药物治疗慢性癌痛的癌症幸存者中失眠与中枢敏化之间的关系，我们于 2019 年 9 月至 2020 年 8 月连续招募了正在接受化疗且伴有慢性癌痛并正在接受阿片类药物治疗的门诊患者，并回答了用于评估失眠的雅典失眠量表 (AIS) 的问题。还检查了疼痛特征，包括疼痛强度、神经性疼痛、使用中枢敏化量表 (CSI) 评估的中枢敏化、阿片类药物使用障碍和与疼痛相关的心理症状。进行了单变量和多变量回归分析，以阐明 AIS 评分与这些疼痛特征之间的相关性。在 44 名入组患者中，有 20 名患者完成了所有问题的回答。9 名患者（45%）被确定为失眠。尽管 AIS 评分与疼痛强度、神经性疼痛、阿片类药物使用障碍或心理症状无显著相关性，但多变量回归分析显示 CSI 评分与 AIS 评分呈正相关（P=0.004）。线性回归分析评估了鉴别能力，该分析证实了 AIS 和 CSI 评分之间存在显著相关性（P=0.002）。在接受阿片类药物治疗慢性癌痛的癌症幸存者中，失眠似乎与中枢敏化有关。
