Sleep, Pain Catastrophizing, and Central Sensitization in Knee Osteoarthritis Patients With and Without Insomnia.
Sleep, Pain Catastrophizing, and Central Sensitization in Knee Osteoarthritis Patients With and Without Insomnia.
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DOI：
10.1002/acr.22609
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发表时间：
2015-10
影响因子：
4.7
通讯作者：
Smith MT
中科院分区：
文献类型：
--
作者：
Campbell CM;Buenaver LF;Finan P;Bounds SC;Redding M;McCauley L;Robinson M;Edwards RR;Smith MT
目的：骨关节炎是一种慢性退行性关节疾病，以关节疼痛为特征。新兴研究表明，大量患者表现出中枢致敏（CS），这是一种伤害性通路的高度兴奋性，已知会放大和维持临床疼痛。然而，骨性关节炎中CS的临床相关性尚不清楚。失眠在老年OA患者中普遍存在，最近的实验表明睡眠质量差与CS之间存在关联。灾难化，一个有效的预测疼痛结果的因素也与CS有关，但很少有研究调查灾难化，睡眠和CS之间可能的相互作用。方法：我们对4组有失眠和/或膝关节骨关节炎的成年人进行了病例对照研究。共有208名参与者完成了多模态睡眠评估（问卷、日记、活动记录仪、多导睡眠记录仪），并使用临床测量和定量感觉测试对疼痛进行了广泛评估，以评估CS、灾难化和失眠之间的关系。提出了每个测量的描述性特征，特别关注睡眠效率和CS。结果：与对照组相比，koa -失眠组表现出最大程度的CS。在整个样本中，我们发现灾难化调节了睡眠效率和CS之间的关系。特别是那些睡眠效率低、灾难化得分高的人，CS水平有所上升。此外，CS与临床疼痛增加显著相关。结论：这些发现强调了评估慢性疼痛患者的睡眠效率、CS和灾难化的重要性，并对治疗计划具有重要的临床意义。
Objectives: Osteoarthritis, a chronic degenerative joint disorder, is characterized by joint pain. Emerging research demonstrates that a significant number of patients evidence central sensitization (CS), a hyper-excitability in nociceptive pathways, which is known to amplify and maintain clinical pain. The clinical correlates of CS in OA, however, are poorly understood. Insomnia is prevalent in older adults with OA and recent experiments suggest associations between poor sleep and measures of CS. Catastrophizing, a potent predictor of pain outcomes has also been associated with CS, but few studies have investigated possible interactions between catastrophizing, sleep and CS. Methods: We conducted a case controlled study of 4 well characterized groups of adults with insomnia and/or knee osteoarthritis. A total of 208 participants completed multimodal sleep assessments (questionnaire, diary, actigraphy, polysmnography) and extensive evaluation of pain using clinical measures and quantitative sensory testing to evaluate associations between CS, catastrophizing and insomnia. Descriptive characterization of each measure is presented, with specific focus on sleep efficiency and CS. Results: The KOA-Insomnia group demonstrated the greatest degree of CS compared to controls. In the overall sample, we found that catastrophizing moderated the relationship between sleep efficiency and CS. Specifically those with low sleep efficiency and high catastrophizing scores reported increased levels of CS. In addition, CS was significantly associated with increased clinical pain. Conclusions: These findings highlight the importance of assessing sleep efficiency, CS and catastrophizing in chronic pain patients and have important clinical implications for treatment planning.