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Good sleep optimizes pain outcomes in patients taking analgesics

09 Oct 2019

Sleep disturbance appears to limit improvements in pain-related function and pain severity overall, regardless of analgesic regimen, according to a secondary analysis of the SPACE* trial.

The current analysis included 238 participants with chronic back pain or hip or knee osteoarthritis pain who received treatment with either opioid (n=120) or nonopioid medication therapy (n=120). In the entire cohort, 80 participants (34 percent) reported severe sleep disturbance.

Patients with vs without severe sleep disturbance had poorer baseline pain-related function (Brief Pain Inventory [BPI] interference score, 6.5 vs 5.0; p<0.0001) and pain severity (BPI severity score, 5.9 vs 5.2; p<0.0002). They also had higher depression (9.4 vs 4.4; p<0.0001), anxiety (5.8 vs 2.7; p<0.0001) and fatigue scores.

Worse sleep disturbance did not modify the relative effects of opioid vs nonopioid treatment on pain outcomes, but was significantly associated with reduced improvement in BPI interference (β, 0.058; p=0.0002) and BPI severity (β, 0.026; p=0.0164).

Specifically, each 10-point increase in baseline sleep disturbance score predicted 0.58- and 0.26-points less improvement in BPI interference and severity, respectively.

In light of the findings, improving sleep before or during pain treatment may be essential if outcomes for patients with chronic pain are to be optimized, researchers said. Clinicians should proactively assess and treat sleep disturbance in patients with chronic pain using evidence-based behavioural sleep interventions.

*Strategies for Prescribing Analgesics Comparative Effectiveness

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Most Read Articles
29 Jul 2020
Adjunctive perampanel appears to be safe and effective for long-term treatment of patients with tonic‐clonic seizures, according to a posthoc analysis.
27 Apr 2020
Long-term use of brivaracetam as an adjunctive treatment is well tolerated and effective in patients with focal seizures or primary generalized seizures, as shown in a study.
01 Apr 2019
Perampanel is safe and effective for treating refractory focal seizures in both Asian and non‐Asian populations, a study has found.
Elvira Manzano, 20 Jun 2018
A higher proportion of patients with systemic lupus erythematosus (SLE) experienced improvements in joint and skin symptoms with baricitinib 4 mg once daily vs placebo in a phase II randomized, double-blind, global study.