An update of management of insomnia in patients with chronic orofacial pain

Almoznino, Galit; Haviv, Yaron; Sharav, Yair; Benoliel, Rafael

doi:10.1111/odi.12637

Cited by 11 publications

(8 citation statements)

References 57 publications

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“…Such was reflected in our participants’ considerations for improvements and ideal treatment scenarios. Since research has demonstrated the existence of a complex, bi-directional relationship which informs pain-related insomnia [ 17 , 18 , 20 , 21 , 25 , 66 , 82 – 84 ] further education and information exposure should focus on its clinical application and treatment in line with recommendations of integrated, multidisciplinary service provisions [ 85 ].…”

Section: Discussionmentioning

confidence: 99%

Challenges and visions for managing pain-related insomnia in primary care using the hybrid CBT approach: a small-scale qualitative interview study with GPs, nurses, and practice managers

et al. 2021

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Background Chronic pain and insomnia have a complex, bidirectional relationship – addressing sleep complaints alongside pain may be key to alleviating patient-reported distress and disability. Healthcare professionals have consistently reported wanting to offer psychologically informed chronic pain management at the primary care level. Research in secondary care has demonstrated good treatment efficacy of hybrid CBT for chronic pain and insomnia. However, primary care is typically the main point of treatment entry, hence may be better situated to offer treatments using a multidisciplinary approach. In this study, primary care service providers’ perception of feasibility for tackling pain-related insomnia in primary care was explored. Methods The data corpus originates from a feasibility trial exploring hybrid CBT for chronic pain and insomnia delivered in primary care. This formed three in-depth group interviews with primary care staff (n = 9) from different primary care centres from the same NHS locale. All interviews were conducted on-site using a semi-structured approach. Verbal data was recorded, transcribed verbatim and analysed using the thematic analysis process. Results Eight themes were identified – 1) Discrepant conceptualisations of the chronic pain-insomnia relationship and clinical application, 2) Mismatch between patients’ needs and available treatment offerings, 3) Awareness of psychological complexities, 4) Identified treatment gap for pain-related insomnia, 5) Lack of funding and existing infrastructure for new service development, 6) General shortage of psychological services for complex health conditions, 7) Multidisciplinary team provision with pain specialist input, and 8) Accessibility through primary care. These mapped onto four domains - Current understanding and practice, Perceived facilitators, Perceived barriers, Ideal scenarios for a new treatment service – which reflected the focus of our investigation. Taken together these provide key context for understanding challenges faced by health care professionals in considering and developing a new clinical service. Conclusions Primary care service providers from one locale advocate better, multidisciplinary treatment provision for chronic pain and insomnia. Findings suggest that situating this in primary care could be a feasible option, but this requires systemic support and specialist input as well as definitive trials for success.

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Section: Discussionmentioning

confidence: 99%

Challenges and visions for managing pain-related insomnia in primary care using the hybrid CBT approach: a small-scale qualitative interview study with GPs, nurses, and practice managers

et al. 2021

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“…Behavioral manifestations such as irritability, impatience, yawning, falling asleep during the appointment, slow body movements, and lack of interest or focus in conversation may all be indicators a patient might be experiencing chronic sleep quality issues. 3,4,24 Chronic poor sleep quality and/or quantity situations can affect facial feature appearance, the formation of oral structures, and the development of oral disease. 8,24,25,[38][39][40] Health History Assessment of a patient's health history includes information such as demographics, social history, medical history, and dental history.…”

Section: Oral Health Assessments That Identify Poor Sleep Qualitymentioning

confidence: 99%

“…3,4,24 Chronic poor sleep quality and/or quantity situations can affect facial feature appearance, the formation of oral structures, and the development of oral disease. 8,24,25,[38][39][40] Health History Assessment of a patient's health history includes information such as demographics, social history, medical history, and dental history. 19 Each piece of information regarding a patient's health, lifestyle, and cultural beliefs can help a health care provider determine the best avenues for ideal health outcomes.…”

Section: Oral Health Assessments That Identify Poor Sleep Qualitymentioning

confidence: 99%

“…5,6 Poor sleep quality can be a multifactorial situation and/or condition(s) that can be affected by a person's sleep environment, physiological features related to systemic health, oral myofunctional disorders, restricted airway, and/ or chemical and electrical imbalances related to melatonin or circadian rhythm. 1,3,7,8,11,16,24,25 Sleep deprivation, including OSA, does not discriminate according to age, gender, or body composition. OSA is not often identified in childhood, because the severity of signs and symptoms tend to increase through developmental growth into adulthood.…”

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confidence: 99%

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Recognizing Poor Sleep Quality Factors During Oral Health Evaluations

Schroeder

Gurenlian

2019

Clin Med Res

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Oral health practitioners routinely perform oral health assessments for the dental patient to determine if oral disease is present. Systemic health is often a contributor to oral health concerns. One area in particular that has a direct effect on oral structures and oral health is poor sleep quality and open mouth breathing. Sleep is a fundamental process of the human body, which regulates core biological functions. Sleep quality reflects a person's ability to fall asleep, stay asleep, and enter into the various rejuvenating sleep cycles for the full duration. A person who does not obtain quality sleep can exhibit a wide range of oral, systemic, and cognitive health problems. Obstructive sleep apnea, which historically has been considered an adult male disease, is being recognized more often in women children. Research suggests various oral malformations found in newborns and young children can manifest as obstructive sleep apnea in adults. Oral health professionals are in a position to recognize the relationship between sleep and health, identify sleep quality concerns in relation to oral health assessments, administer sleep quality assessments, and determine appropriate referrals for further sleep quality evaluation.

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“…Different general medical comorbidities have insomnia as one of their symptoms; a condition referred to as secondary insomnia (Figure 1). Examples of these conditions are those suffering from chronic pain, such as migraine (57,58), orofacial pain (59), and musculoskeletal pain (60,61). Overall, the data from studies using different designs suggest a bidirectional and proportional association between sleep duration and pain intensity.…”

Section: Insomnia As a Manifestation Of General Medical Comorbiditymentioning

confidence: 99%

Pharmacological treatment for insomnia in patients with major depressive disorder

Brietzke

Vázquez

Kang

et al. 2019

Expert Opinion on Pharmacotherapy

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Introduction: Insomnia in Major Depressive Disorder (MDD) is highly prevalent and associated with increased suffering and functional impairment. Effective, evidence-based treatments for insomnia in MDD are an unmet need in clinical practice. Areas covered: Herein, the authors provide a review of the clinical correlates, putative neurobiological mechanisms and treatment options for the management of insomnia in individuals with MDD.Expert opinion: Sleep disturbances in MDD should be recognized as at least one of the following: 1) a domain of depressive psychopathology; 2) a consequence of rhythm disruptions; 3) a manifestation of comorbidities of sleep disturbances; 4) a manifestation of the influence of sex hormones in the brain in MDD; 5) a general medical comorbidity; and 6) a side effect of antidepressant medications. Assessment of insomnia in clinical practices is routinely performed with the use of non-structured interviews. Other methods, such as standardized questionnaires and sleep diaries, along with complementary methods such as actigraphy, and polysomnography are more scarcely applied. Smartphones and personal devices offer a promising strategy with the use of passive, long-lasting, and ecologically valid assessments despite the lack of studies specifically targeting insomnia in individuals with MDD. New therapeutic approaches are essential, including novel targets such as orexins/hypocretin and the endocannabinoid system.

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An update of management of insomnia in patients with chronic orofacial pain

Cited by 11 publications

References 57 publications

Challenges and visions for managing pain-related insomnia in primary care using the hybrid CBT approach: a small-scale qualitative interview study with GPs, nurses, and practice managers

Challenges and visions for managing pain-related insomnia in primary care using the hybrid CBT approach: a small-scale qualitative interview study with GPs, nurses, and practice managers

Recognizing Poor Sleep Quality Factors During Oral Health Evaluations

Pharmacological treatment for insomnia in patients with major depressive disorder

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