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Bidirectional association between disturbed sleep and neuropathic pain symptoms: a prospective cohort study in post-total joint replacement participants

Authors Stocks J, Tang NKY, Walsh DA, Warner SC, Harvey HL, Jenkins W, Abhishek A, Doherty M, Valdes AM

Received 25 August 2017

Accepted for publication 29 November 2017

Published 6 June 2018 Volume 2018:11 Pages 1087—1093


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor E Alfonso Romero-Sandoval

Video abstract presented by Joanne Stocks.

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Joanne Stocks,1–3 Nicole KY Tang,4 David A Walsh,1–3 Sophie C Warner,1 Hollie L Harvey,1 Wendy Jenkins,1 Abhishek Abhishek,1–3 Michael Doherty,1–3 Ana M Valdes1–3

1Academic Rheumatology, University of Nottingham, Nottingham, UK; 2Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK; 3National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, UK; 4Department of Psychology, University of Warwick, Coventry, UK

Background: Disturbed sleep is strongly correlated with chronic pain. The aim of this study was to examine the association between sleep disturbance and incident joint pain focusing on neuropathic-like pain symptoms.
Methods: A total of 423 individuals who had undergone total joint replacement (TJR) for osteoarthritis were assessed at the mean time of 3.6 years post-surgery and again at 5.9 years post-TJR, using the Medical Outcomes Survey sleep subscale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and painDETECT questionnaire instruments. Cox hazard ratios (HRs) and 95% confidence intervals (CIs) were computed adjusting for age, body mass index, sex, and use of hypnotic and analgesic medication.
Results: The presence of neuropathic pain symptoms predicted incidence of disturbed sleep after adjustment for covariates and pain severity (adjusted HR [aHR] 2.01, 95% CI: 1.00–4.10; p<0.05). There was no association between joint pain and incidence of disturbed sleep when individuals with neuropathic pain symptoms at the baseline visit were excluded (aHR 1.11, 95% CI: 0.47–2.67). Disturbed sleep at baseline predicted incident neuropathic joint pain symptoms (aHR 2.75, 95% CI: 1.21–6.26; p<0.016) but had no effect on incidence of joint pain when all types of pain were considered together (aHR 0.63, 95% CI: 0.30–1.39).
Conclusion: These data suggest a causal bidirectional link between sleep disturbance and joint pain with neuropathic features but not with other types of joint pain.

Keywords: total joint replacement, opioids, osteoarthritis

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