Highlights
- •We studied the link between sleep and experimental pain in knee osteoarthritis.
- •Sleep disruption was related to altered pain processing by sex and ethnicity/race.
- •Disrupted sleep was related to greater heat and pressure pain facilitation in women.
- •Compared to African Americans, whites with poor sleep had less pain inhibition.
- •Whites with poor sleep had lower pressure pain thresholds than African Americans.
Abstract
Studies indicate that improving sleep decreases reported pain in patients with knee
osteoarthritis, but it is unclear if this association extends to experimentally induced
pain responses. A community-based sample of 88 African American and 52 non-Hispanic
white adults (45–76 years) with knee osteoarthritis completed the Insomnia Severity
Index and the arousal subscale of the Sleep Hygiene and Practices Scale. Participants
underwent quantitative sensory testing, including measures of pain sensitivity and
facilitation at the knee, and pain inhibition. Outcomes were analyzed with multiple
Tobit hierarchical regression models, with adjustment for relevant covariates. Ethnicity
and sex by sleep interactions were also entered into the models. After covariate adjustment,
main associations were not observed. However, sex interacted with insomnia severity
to predict greater temporal summation of heat and punctate pressure pain among women
and lower heat temporal summation among men. Men and women who engaged in frequent
arousal-associated sleep behaviors demonstrated higher and lower heat temporal summation,
respectively. Non-Hispanic whites with greater insomnia severity displayed lower pressure
pain thresholds and pain inhibition. Our findings are the first to demonstrate that
disrupted sleep is associated with altered pain processing differentially by sex and
ethnicity/race among people with knee osteoarthritis.
Perspective
This article presents the association between insomnia severity, maladaptive sleep
behaviors, and experimentally induced pain responses among people with knee osteoarthritis.
Disrupted sleep was associated with altered pain processing by sex and ethnicity/race.
Offering sleep interventions may help ameliorate pain, but treatment may need to be
tailored by sex and ethnicity/race.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of PainAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Racial differences in self-reported pain and function among individuals with radiographic hip and knee osteoarthritis: The Johnson County Osteoarthritis Project.Osteoarthritis Cartilage. 2009; 17: 1132-1136
- Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.Arthritis Rheum. 1986; 29: 1039-1049
- Normalization of widespread pressure pain hypersensitivity after total hip replacement in patients with hip osteoarthritis is associated with clinical and functional improvements.Arthritis Rheum. 2013; 65: 1262-1270
- Sensitization in patients with painful knee osteoarthritis.Pain. 2010; 149: 573-581
- Validation of the Insomnia Severity Index as an outcome measure for insomnia research.Sleep Med. 2001; 2: 297-307
- Pain assessment in osteoarthritis: Experience with the WOMAC osteoarthritis index.Semin Arthritis Rheum. 1989; 18: 14-17
- Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee.J Rheumatol. 1988; 15: 1833-1840
- Ethnic differences in responses to multiple experimental pain stimuli.Pain. 2005; 113: 20-26
- Ethnic differences in diffuse noxious inhibitory controls (DNIC).J Pain. 2008; 9: 759-766
- Racial/ethnic differences in the prevalence and impact of doctor-diagnosed arthritis—United States, 2002.MMWR Morb Mortal Wkly Rep. 2005; 54: 119-123
- Can quantitative sensory testing move us closer to mechanism-based pain management?.Pain Med. 2014; 15: 61-72
- Racial and ethnic differences in older adults with knee osteoarthritis.Arthritis Rheumatol. 2014; 66: 1800-1810
- Emotional modulation of pain and spinal nociception in persons with severe insomnia symptoms.Ann Behav Med. 2014; 47: 303-315
- Ethnic differences in pain tolerance: Clinical implications in a chronic pain population.Psychosom Med. 2001; 63: 316-323
- Ethnic differences in thermal pain responses.Psychosom Med. 1999; 61: 346-354
- Race, ethnicity and pain: A review.Pain. 2001; 94: 133-137
- Sleep continuity and architecture: Associations with pain—inhibitory processes in patients with temporomandibular joint disorder.Eur J Pain. 2009; 13: 1043-1047
- Quantitative assessment of experimental pain perception: Multiple domains of clinical relevance.Pain. 2005; 114: 315-319
- Sex differences in temporal summation but not sensory-discriminative processing of thermal pain.Pain. 1998; 75: 121-127
- Discordance between pain and radiographic severity in knee osteoarthritis. Findings from quantitative sensory testing of central sensitization.Arthritis Rheum. 2013; 65: 363-372
- Sleep disturbances and chronic disease in older adults: Results of the 2003 National Sleep Foundation Sleep in America survey.J Psychosom Res. 2004; 56: 497-502
- Vitamin D, race, and experimental pain sensitivity in older adults with knee osteoarthritis.Arthritis Rheum. 2012; 64: 3926-3935
- Temporal summation of pain as a prospective predictor of clinical pain severity in adults aged 45 years and older with knee osteoarthritis: Ethnic differences.Psychosom Med. 2014; 76: 302-310
- Elevated inflammatory markers in response to prolonged sleep restriction are associated with increased pain experience in healthy volunteers.Sleep. 2007; 30: 1145-1152
- Pain sensitivity and modulation in primary insomnia.Eur J Pain. 2012; 16: 522-533
- The multidimensionality of sleep quality and its relationship to fatigue in older adults with painful arthritis.Osteoarthritis Cartilage. 2010; 18: 1365-1371
- Experimental pain sensitivity differs as a function of clinical pain severity in symptomatic knee osteoarthritis.Osteoarthritis Cartilage. 2013; 21: 1243-1252
- Arthritic pain is processed in brain areas concerned with emotion and fear.Arthritis Rheum. 2007; 56: 1345-1354
- Chronic pain linked with poor sleep: Exploration of causes and treatment.JAMA. 1999; 281: 691-692
- The role of sleep problems in central pain processing in rheumatoid arthritis.Arthritis Rheum. 2013; 65: 59-68
- Comparison of sleep in osteoarthritic patients and age and sex matched healthy controls.Ann Rheum Dis. 1988; 47: 40-42
- Prediction of persistent pain after total knee replacement for osteoarthritis.J Bone Joint Surg Br. 2008; 90-B: 166-171
- Avoidant safety-behaviors and catastrophizing: Shared cognitive-behavioral processes and consequences in co-morbid pain and sleep disorders.Int J Behav Med. 2008; 12: 201-210
- The evolution of primary hyperalgesia in orthopedic surgery: Quantitative sensory testing and clinical evaluation before and after total knee arthroplasty.Anesth Analg. 2007; 105: 815-821
- Frequency of comorbid insomnia, pain, and depression in older adults with osteoarthritis: Predictors of enrollment in a randomized treatment trial.J Psychosom Res. 2011; 71: 296-299
- Sleep deprivation as a neurobiologic and physiologic stressor: Allostasis and allostatic load.Metab Clin Exp. 2006; 55: S20-S23
- Insomnia: Psychological Assessment and Management.Guilford Press, New York1993
- The Insomnia Severity Index: Psychometric indicators to detect insomnia and evaluate treatment response.Sleep. 2011; 34: 601-608
- Self-reported sleep and mood disturbance in chronic pain patients.Clin J Pain. 1998; 14: 311-314
- Is the deficit in pain inhibition in fibromyalgia influenced by sleep impairments?.Open Rheumatol J. 2012; 6: 296-302
- Rank analysis of covariance.J Am Stat Assoc. 1967; 62: 1187-1200
Quartana PJ, Finan PH, Page GG, Smith MT. Effects of insomnia disorder and knee osteoarthritis on resting and pain-evoked inflammatory markers. Brain Behav Immun [Epub ahead of print]. http://dx.doi.org/10.1016/j.bbi.2014.12.010
- The CES-D scale: A self-report depression scale for research in the general population.Appl Psychol Meas. 1977; 1: 384-401
- Lack of endogenous modulation and reduced decay of prolonged heat pain in older adults.Pain. 2010; 150: 153-160
- Sex differences in the perception of noxious experimental stimuli: A meta-analysis.Pain. 1998; 74: 181-187
- Sleep loss and REM sleep loss are hyperalgesic.Sleep. 2006; 29: 145-151
- Sleep disorders in African Americans and Caucasian Americans: A meta-analysis.Behav Sleep Med. 2010; 8: 246-259
- Likelihood estimation for censored random vectors.Econ Rev. 2005; 24: 195-217
- One night of total sleep deprivation promotes a state of generalized hyperalgesia: A surrogate pain model to study the relationship of insomnia and pain.Pain. 2013; 154: 1613-1621
- Measurement reliability and agreement in psychiatry.Stat Methods Med Res. 1998; 7: 301-317
- The effects of sleep deprivation on pain inhibition and spontaneous pain in women.Sleep. 2007; 30: 494-505
- How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature.Sleep Med Rev. 2004; 8: 119-132
- Sleep quality and presleep arousal in chronic pain.J Behav Med. 2000; 23: 1-13
- Mechanisms by which sleep disturbance contributes to osteoarthritis pain: A conceptual model.Curr Pain Headache Rep. 2009; 13: 447-454
- Estimation of relationships for limited dependent variables.Econometrica. 1958; 26: 24-36
- Insomnia with objective short sleep duration: The most biologically severe phenotype of the disorder.Sleep Med Rev. 2013; 17: 241-254
- The effect of maximal exercise on temporal summation of second pain (windup) in patients with fibromyalgia syndrome.J Pain. 2001; 2: 334-344
- A comparison of self-estimated symptoms and impact of disease in fibromyalgia and rheumatoid arthritis.J Musculoskelet Pain. 2000; 8: 21-33
- Short-term improvement in insomnia symptoms predicts long-term improvements in sleep, pain, and fatigue in older adults with comorbid osteoarthritis and insomnia.Pain. 2014; 155: 1547-1554
- Cognitive behavioral therapy for insomnia improves sleep and decreases pain in older adults with co-morbid insomnia and osteoarthritis.J Clin Sleep Med. 2009; 5: 355-362
- Factors related to sleep disturbance in older adults experiencing knee pain or knee pain with radiographic evidence of knee osteoarthritis.J Am Geriatr Soc. 2000; 48: 1241-1251
- Sleep disturbance in patients with rheumatoid arthritis: Evaluation by medical outcomes study and visual analog sleep scales.J Rheumatol. 2006; 33: 1942-1951
- Psychological and behavioral factors in patients with comorbid obstructive sleep apnea and insomnia.J Psychosom Res. 2011; 70: 355-361
- Maladaptive sleep hygiene practices in good sleepers and patients with insomnia.J Health Psychol. 2010; 15: 147-155
- Insomnia, sleep quality, pain and somatic symptoms: Sex differences and shared genetic components.Pain. 2012; 153: 666-673
- Sex differences in insomnia: A meta-analysis.Sleep. 2006; 29: 85-93
- Secondary hyperalgesia to punctate mechanical stimuli. Central sensitization to A-fibre nociceptor input.Brain. 1999; 122: 2245-2257
Article info
Publication history
Published online: February 25, 2015
Accepted:
February 8,
2015
Received in revised form:
January 21,
2015
Received:
September 15,
2014
Footnotes
Support provided by the National Institutes of Health/National Institute on Aging (grant number R01AG033906) and the University of Florida Clinical and Translational Science Institute (grant number UL1TR000064, R.B.F., primary investigator), and the University of Alabama at Birmingham Clinical and Translational Science Institute (grant number UL1TR000165).
M.E.P. received support from the Agency for Healthcare Research and Quality (5 T32 HS013852-09) and the National Institute on Minority Health and Health Disparities (3 P60 MD000502-08S1). T.L.G. received support from the John A. Hartford Foundation (2011-2013) as a Building Academic Geriatric Nursing Capacity Scholar and a Mayday Fund grantee (grant number AAN 11-116). K.T.S. received support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23AR062099). E.J.B. is supported by a National Institute of Neurological Disorders and Stroke training grant T32NS045551 to the University of Florida Pain Research and Intervention Center of Excellence.
The authors have no conflicts of interest to declare.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
Identification
Copyright
© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
