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