ARE THERE DIFFERENCES IN THE QUALITY OF SLEEP AMONG PATIENTS WITH CHRONIC PAIN? RESULTS IN PATIENTS WITH FIBROMYALGIA, MUSCULOSKELE TAL PAIN AND NEUROPATHIC PAIN.RESULTS IN PATIENTS WITH FIBROMYALGIA, MUSCULOSKELE TAL PAIN AND NEUROPATHIC PAIN.

Ojeda B 1, Dueñas M 1, Salazar A 1, Torres LM 2, Micó JA 3, Failde I 1.1Preventive Medicine and Public Health Department, U niversity of Cádiz, 2Anesthesiology -Critical Care and Pain Management,

External Chair of Pain GrünenthalFoundation-University of Cádiz. @observadolor

1Preventive Medicine and Public Health Department, U niversity of Cádiz, 2Anesthesiology -Critical Care and Pain Management, University Hospital, Cádiz, 3NeuroScience Department, University of Cádiz, Spain

RESULTS CONCLUSIONWHAT IS ALREADY KNOWN? RESULTS CONCLUSION

� Sleep disorders are among the most commoncomplaints reported by chronic pain (CP) patients.

WHAT IS ALREADY KNOWN?

Treatment % CP NP MP FM

Antidepressant 33.5 31.7 24.2 54.9Fibromyalgia

� The current study confirmsthat chronic pain affects

Hours of sleep (MOS-Sleep scale)

Optimal sleep (7-8 hours)

� The relationship between chronic pain andsleepdisorders is reciprocal; both conditions maypredispose, maintain and exacerbate the other.

36,2%63,8%

AntidepressantBZDAnticonvulsivantOpioidNSAID

33.535

45.746.18.3

31.731.752.951.97.7

24.229.344.449.510.1

54.952.933.327.55.9

Musculoskeletal pain

Fibromyalgia(FM) n=51 Clinical Information %

Comorbidity

HAD-D≥10

74,7

29,1

that chronic pain affectssleep quality substantiallyin patients who sufferingfrom it, and that the impactvaries depending on thetype of pain .

anal

yses

Optimal sleep (7-8 hours)No optimal sleep (<7&>8 Hours)

� Sleep disorders may vary depending on thecause that produces pain.

Musculoskeletal pain(MSK) n=99

HAD-D≥10

HAD-A≥10

29,1

43,3

10

type of pain .

� Besides the management ofpain intensity, assessmentof anxiety and depression

24%

MP

Des

crip

tive

anal

yses

WHAT WE ARE INTERESTED IN?Pain intensity VAS mean(SD)

6,6 (1,9) Neuropatic pain(NP) n=104

Pain duration

10

5

of anxiety and depressionare variables to consider inorder to improve the qualityof sleep in patients withchronic pain.

76%

MP

14%

Thus weprososed… Des

crip

tive

Pain duration (months)

mean(SD) 108,5 (97,6)0

86%FM

Thus weprososed…

TO EVALUATE AND ANALYZE THE IMPACTOF THREE DIFFERENT CAUSES OF CP ONTHE STRUCTURE AND QUALITY OF SLEEP.

Des

crip

tive

Higher scores=More sleep problems Lower scores=More sleep problemsReferences

Alsaadi SM, McAuley JH, Hush JM, et al. The bidirectionalrelationship between pain intensity and sleepdisturbance/quality in patients with low back pain . Clin J

MATERIALS & METHODS

Neuropathic pain (n=51) Musculoskeletal pain (n=99) Fibromyalgia (n=51)THE STRUCTURE AND QUALITY OF SLEEP.

anal

yses

disturbance/quality in patients with low back pain . Clin JPain. 2014;30(9):755-765.

O'Brien EM, Waxenberg LB, Atchison JW, et al. Negativemood mediates the effect of poor sleep on pain amongchronic pain patients. Clin J Pain. 2010;26(4):310-319.

Finan PH, Goodin BR, Smith MT. The association of sleepand pain: An update and a path forward. J Pain.2013;14(12):1539-1552.

MATERIALS & METHODS

Subjets.Chronic pain patients (>3 months) from different

Mul

tivar

iate

anal

yses

2013;14(12):1539-1552.

Chronic pain patients (>3 months) from differentcauses: Neuropathic pain (NP), Musculoskeletal pain(MP) and Fibromyalgia (FM).Instruments.

Mul

tivar

iate

Anxiety (HASD-A)

I-9 MOSPain

duration

Depression (HAD-D)

Depression B: 2,3; IC95%:(1,5;3);

B: 0,4; IC95%:(0;0,7);P=0.05

Model 1Model 2

Model 3

Instruments.Sleep: MOS Sleep scale. Psychiatric disorders:Hospital Anxiety and Depression scale (HADs).Clinical and demographic questionnaire.Analyses

Biv

aria

te&

Mul

tivar

iate

Age Pain duration

Salvador Dalí, 1944.Salvador Dalí, 1944.Salvador Dalí, 1944.Salvador Dalí, 1944.

SueñoSueñoSueñoSueño causado por el vuelo de una

abeja alrededor de una granada un

I-9 MOS(Sleep quality)

Antidepresivos

Pain duration

I-9 MOS(Sleep quality)

duration

Pain intensity

Anxiety (HAD-A)

I-9 MOS(Sleep quality)

Depression (HAD-D)

B: 2,3; IC95%:(1,5;3);P<0,001B: 9,6; IC95%:(2;17,2);

P=0.013

B: 0,5; IC95%:(0,1;0,9);P=0.01

B: 1,7; IC95%:(-0,1;3,6);P=0.066

B: 1,1; IC95%:(0,4;2,2);P=0.042

B: 1,3; IC95%:(0,2;2,4);P=0.026

B: 1,3; IC95%:(0,2;2,4);P=0.02

Model 3AnalysesDescriptive, bivariate and multivariate (linearregresion: Model 1, 2 & 3) analyses. B

ivar

iate

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abeja alrededor de una granada un

segundo antes del despertar.P=0.02