Pain Sensitization as a Potential Mediator of the Relationship Between Sleep Disturbance and Subsequent Pain in Rheumatoid Arthritis

被引:9
|
作者
Song, Jing [1 ]
Muhammad, Lutfiyya N. [1 ]
Neogi, Tuhina [2 ]
Dunlop, Dorothy D. [1 ]
Wohlfahrt, Alyssa [3 ]
Bolster, Marcy B. [4 ]
Bingham, Clifton O., III [5 ]
Clauw, Daniel J. [6 ]
Marder, Wendy [6 ]
Lee, Yvonne C. [1 ]
机构
[1] Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA
[2] Boston Univ, Sch Med, Boston, MA 02118 USA
[3] Tufts Univ, Sch Med, Boston, MA 02111 USA
[4] Massachusetts Gen Hosp, Boston, MA 02114 USA
[5] Johns Hopkins Univ, Baltimore, MD USA
[6] Univ Michigan, Ann Arbor, MI 48109 USA
基金
美国国家卫生研究院;
关键词
NOXIOUS INHIBITORY CONTROLS; ASSOCIATION; POPULATION; DEPRIVATION; MODULATION; MECHANISMS; OUTCOMES; RISK;
D O I
10.1002/acr.24888
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective Many patients with rheumatoid arthritis (RA) experience sleep disturbances, commonly attributed to joint pain. Sleep disturbances could also influence pain. One mechanism may be through dysregulated pain processing, manifested by enhanced pain sensitivity. The present study was undertaken to examine the role of pain sensitization, measured by quantitative sensory testing (QST), as a mediator in the pathway of sleep disturbance leading to subsequent pain. Methods We used longitudinal data from 221 patients with active RA who were followed for 12 weeks after initiating a disease-modifying antirheumatic drug. Baseline QST included pressure pain thresholds at articular (wrists, knees) and nonarticular (trapezius, thumbnails) sites, temporal summation (TS) at the wrist and forearm, and conditioned pain modulation (CPM). Baseline sleep disturbance and subsequent pain intensity were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS). We evaluated correlations between sleep disturbance, QSTs, and subsequent pain intensity. Mediation analyses separately assessed each QST as a mediator, adjusting for baseline confounding factors. Results Sleep disturbance was correlated with all QST measures except wrist TS and CPM. Sleep disturbance significantly predicted subsequent pain (coefficient for a meaningful increase of 5 units in sleep disturbance = 0.32 (95% confidence interval 0.11, 0.50) in multiple regression. QST mediated 10-19% of this effect. Conclusion Pain sensitization may be one mechanism through which sleep disturbance contributes to pain. The small magnitude of association indicates that unmeasured pathways may contribute to this relationship. Intervention studies are needed to establish causality and determine whether improving sleep can improve pain in patients with RA.
引用
收藏
页码:778 / 784
页数:7
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