Sleep problems in pain patients entering tertiary pain care: the role of pain-related anxiety, medication use, self-reported diseases, and sleep disorders  進入三級疼痛護理的疼痛患者的睡眠問題：疼痛相關(guān)焦慮、藥物使用、自我報告的疾病和睡眠障礙的作用

1

Introduction

Chronic pain and sleep problems frequently co-occur. Pain itself disturbs sleep, but other factors may also contribute to sleep problems in pain patients.The first aim of this study was to investigate how patients with sleep problems differ from normally sleeping pain patients regarding a diverse set of factors known or suspected to influence.The second aim is further evaluate the role of painrelated anxiety components in disordered sleeping.

慢性疼痛和睡眠問題經(jīng)常同時發(fā)生。疼痛本身會干擾睡眠，但其他因素也可能導致疼痛患者的睡眠問題。本研究的第一個目的是調(diào)查睡眠問題患者與正常睡眠疼痛患者在已知或懷疑影響的多種因素方面有何不同;第二個目標，為了進一步評估疼痛相關(guān)焦慮成分在睡眠障礙中的作用。

2

Methods

This was a cross-sectional study with a cohort comprising 473 patients entering tertiary pain management and participating in the multicentre (3 multidisciplinary pain clinics and 3 facial pain clinics) KROKIETA study. The cohort comprises chronic pain patients with mixed pain aetiologies, such as low back pain, neuropathic pain, fibromyalgia, or complex regional pain syndrome, who had been referred to tertiary pain care by their physicians after inadequate treatment response in primary care. Patients having active cancer were not recruited to the study. KROKIETA collected a broad range of data, including sociodemographic, health, psychological, lifestyle, and biochemical variables.

這是一項橫斷面研究，隊列包括 473 名進入三級疼痛管理并參與多中心KROKIETA 研究的患者。該隊列包括具有混合疼痛病因的慢性疼痛患者，例如腰痛、神經(jīng)性疼痛、纖維肌痛或復雜的區(qū)域疼痛綜合征,患有活動性癌癥的患者排除在外。KROKIETA 收集了廣泛的數(shù)據(jù)，包括社會人口學、健康、心理、生活方式和生化變量。

3

Results

This cross-sectional study of 473 patients (69.9% female, mean age 47 years) entering tertiary pain management compared normally sleeping pain patients with those having recurring sleep problems to determine the relationship between pain and sleep. Groups were compared for pain and pain aetiology, pain-related anxiety, childhood adversities, use of sleep and pain medications, self-reported diseases, and sleep disorders. Furthermore, the association of pain-related anxiety (cognitive anxiety, escape/avoidance, fear, and physiological anxiety) with more disturbing sleep problems was investigated in the whole cohort.

這項橫斷面研究對 473 名進入三級疼痛管理的患者（69.9% 女性，平均年齡 47 歲）進行了比較，比較了正常睡眠疼痛患者和反復出現(xiàn)睡眠問題的患者，以確定疼痛與睡眠之間的關(guān)系。比較各組的疼痛和疼痛病因、疼痛相關(guān)的焦慮、童年逆境、睡眠和止痛藥的使用、自我報告的疾病和睡眠障礙。此外，在整個隊列中調(diào)查了與疼痛相關(guān)的焦慮（認知焦慮、逃避/回避、恐懼和生理焦慮）與更令人不安的睡眠問題的關(guān)聯(lián)。

3.1 Demographics and pain 基礎(chǔ)信息和疼痛

睡眠正常者和反復出現(xiàn)睡眠問題的人在年齡、性別或受教育年限方面沒有差異。與睡眠正常的患者相比，有睡眠問題的患者工作或?qū)W習的頻率更低（38.1% 對 59.0%，P=0.004），獨居的頻率更高（28.1% 對 14.8%，P=0.04）。有睡眠問題的患者平均疼痛強度高出 2.08 個點（95% CI：1.48-2.67；P，0.001），疼痛部位的中位數(shù)更多（4.0 vs 2.0，P，0.001）和疼痛持續(xù)時間> 2 年（78.1% 對 61.0%；P 5 0.01）比正常睡眠的患者更多。

3.2 Childhood adversities 童年逆境

Those having sleep problems and those sleeping normally did not differ in median numbers of childhood adversities experienced or incidences of individual adversities.In the whole cohort, the most common adversities experienced were parents’ divorce (29.0%), bullying at school (28.8%), and own serious illness (12.7%). 75.3% of all patients in the cohort reported at least one childhood adversity.

有睡眠問題的人和正常睡覺的人在經(jīng)歷的童年逆境中位數(shù)或個別逆境的發(fā)生率方面沒有差異.在整個隊列中，最常見的逆境是父母離婚（29.0%）、學校欺凌（28.8%）和自己的重病（12.7%）。隊列中所有患者中有 75.3% 報告了至少一次童年逆境。

3.3 Medication use 藥物使用

27.8% 的有睡眠問題的患者定期使用處方安眠藥（每周 3 晚或更多晚），而只有 3.3% 的正常睡眠患者報告了這一情況（P 0.001）.唑吡坦和褪黑激素是睡眠問題患者中最常用的影響睡眠的藥物（兩者均被 12.6% 的患者使用）。

3.4. Self-reported diseases and sleep disorders 自我報告的疾病和睡眠障礙

有睡眠問題的人心絞痛（6.5% vs 0.0%；P=0.04）、哮喘（19.6% vs 1.7%；P=0.001）、非RA關(guān)節(jié)疾病（32.3% vs 18.3%；P=5）的發(fā)病率更高0.04）、腰背問題（55.1% 對 23.3%；P 0.001）和抑郁癥（31.6% 對 5.0%；P 0.001）比睡眠正常的人（表 3）

3.5 Regression analyses with pain-related anxiety 疼痛相關(guān)焦慮的回歸分析

該完整的模型，包括疼痛強度、疼痛區(qū)域的數(shù)量、疼痛持續(xù)時間> 2 年，生理焦慮作為預測因子，在統(tǒng)計上顯著預測因變量超過截距模型 x2(4)=111.278, P =< 0.001；Nagelkerke R2 =0.265（表 4）。持續(xù)超過 2 年的疼痛在模型中并不顯著.當疼痛相關(guān)認知焦慮、恐懼或逃避/回避被添加到模型中，生理焦慮仍然顯著，而添加的變量不顯著。

4

Conclusions

*1

A high proportion of pain patients entering tertiary care suffer from recurring sleep problems. The results of this study reinforce the belief that sleep problems in pain patients are likely to be highly multifactorial. Alongside previously established factors, such as pain intensity and depression, this study draws attention to physiological anxiety reactions, co-occurring diseases (such as angina pectoris and asthma), restless legs symptoms, and the use of sleep and pain medications. The careful assessment of all these factors and planning treatment accordingly is the key for addressing sleep problems in pain patients. Acknowledging these factors as early as possible in primary care may even halt the development of sleep problems for some patients.

進入三級醫(yī)療機構(gòu)的大部分疼痛患者都會反復出現(xiàn)睡眠問題。這項研究的結(jié)果強化了這樣一種信念，即疼痛患者的睡眠問題可能是高度多因素的。除了先前確定的因素，如疼痛強度和抑郁癥，本研究還關(guān)注生理性焦慮反應、同時發(fā)生的疾?。ㄈ缧慕g痛和哮喘）、不寧腿癥狀以及睡眠和止痛藥的使用。仔細評估所有這些因素并相應地計劃治療是解決疼痛患者睡眠問題的關(guān)鍵。在初級保健中盡早承認這些因素甚至可以阻止一些患者出現(xiàn)睡眠問題。

進入三級疼痛護理的疼痛患者的睡眠問題：疼痛相關(guān)焦慮、藥物使用、自我報告的疾病和睡眠障礙的作用.pdf

筆記/差勁先森。

排版/叮當丸子麻

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